Medicine Revision

Book

Medicine in medieval England c1250-c1500

Church:People in medieval England were very religious. The vast majority of people in England followed the teachings of the Catholic Church. They attended services regularly and ordinary people received most of their teaching from the Church, as they didn’t receive any formal education. The majority of people at this time could not read or write. Instead, they learned from the stories they heard, or the paintings they saw on the Church walls. The Church taught

that those who committed a sin could be punished by God. They also taught that the devil could send disease to test someone’s faith.

Leprosy was sent by God as a punishment!Leprosy usually began as a particularly painful skin disease, followed by paralysis and eventual death. Fingers and toes would fall off, body hair would drop out and ulcers would develop both inside and outside of the body. There was no cure for leprosy, so lepers were banished from their communities. They usually had to move to leper houses or to isolated island communities. If they were allowed to stay in their home towns, they had to wear a cloak and ring a bell to announce their presence, and they were banned from going down narrow alleys, where it was impossible to avoid them.

Astrology:Along with the role of God, the alignment of the planets and stars was also considered very important when diagnosing illness. A physician would consult star charts, looking at when the patient was born and when they fell ill,

Unit 1: How has what people understood about the causes of disease changed?

to help identify what was wrong. Traditionally, the Church frowned upon the idea of using astrology in diagnosing illness, as it seemed only one step away from predicting the future, or fortune telling. However, after the Black Death arrived, astrology became more popular and the Church became more acceptant of it. Many people believed the Black Death was caused by a bad alignment of the planets.

The Theory of the Four HumoursAccording to the theory, each humour was lined to certain characteristics that physicians would look for when carrying out their diagnosis. For example, a person suffering from a fever had a temperature, causing the skin to go hot and red because, physicians believed, they had too much blood. This was a hot wet element. Meanwhile, a person suffering from a cold had too much phlegm, which was cold and wet. They would shiver and the excess phlegm would run out of their nose. The humours were linked with the seasons. For example, in winter, which is cold and wet, it was thought that the body produces too much phlegm, causing coughs and colds as the patient tries to get rid of it. Galen developed the Theory of the Four Humours to include the idea of balancing the humours by using the Theory of Opposites. For example, he suggested that too much phlegm, which was linked to water and the cold, could be cured by eating hot peppers; a fever, or an excess of blood, could be treated with cucumber, which would cool the patient down when eaten. Galen also theorised that the circulatory system circulated blood generated in the liver, and the blood was then disturbed around the body.

Urine charts:Urine was never blamed for making people ill but it was examined to make a diagnosis. It was thought

that this was one of the best ways to check the balance of the humours in the body. Physicians would check the colour, thickness, smell and even taste of the urine before making his diagnosis. This was seen as a very important part of medieval medicine: Norwich Cathedral Priory, for example, employed a full-time physician to examine urine.

Galen: Galen was writing in the time of Ancient Greece and Rome but was very popular during the medieval period because of 3 reasons: the influence of the Church; the importance of book learning and the lack of alternatives. Galen wrote that the body was clearly designed for a purpose and that the different parts of the body were meant to work together in balance, as first proposed by Hippocrates. Galen also believed in the idea of the soul. This theory fitted in very well with the ideas of the Church, who believed that God created man in his image, and so they promoted Galen’s teaching and, by extension, those of Hippocrates. Since books were

produced in monasteries, and libraries were maintained by the Church, their choice of texts were the ones that were widely read, preached and believed. Having read the works of Hippocrates and Galen was proof that a physician was worth the money he was being paid. The authority of these classical texts was so strong that people believed them even when there was actual, physical evidence that suggested they were wrong. There was a lack of scientific evidence to support any other kind of theories of the causes of disease. Dissections were mostly illegal, because the Church taught that the body needed to be buried whole in order for the soul to go to heaven.

Miasma:A miasma was bad air that was believed to be filled with harmful fumes. Hippocrates and Galen both wrote about miasmata (which is the plural of miasma) and suggested that swamps, corpses and other rotting matter could transmit disease. Smells and vapours like miasmata were also, unsurprisingly, associated with god. A clean and sweet smelling home was a sign of spiritual cleanliness, and incense was burned in churches to purify the air. If a person was unwashed other people would avoid them, in case they breathed in the bad miasma and contracted a disease. This was also why people avoided lepers.

Medicine in Renaissance England c1500-c1700What

changed

Renaissance means ‘re-birth’. There was a re-born interest in all things Greek and Roman and with the developments in printing new editions of Greek and Roman texts were published which made people more aware of the fact that the Greeks and Romans questioned everything. This opened the idea of people’s ability to question things, this changed people’s attitudes. Of course not everyone agreed and some people were clear in their belief that you shouldn’t question Galen or tradition, so a lot of the Renaissance period was about the fight between new ideas and traditional ideas. The following things changed a lot:

The Theory of the Four Humours:This is a complicated area as a lot of physicians didn’t believe this by the end of the 17th century. However, it was still used in diagnosis despite the fact it wasn’t believed. Disease was starting to be seen as something that was separate from the body which needed to be attacked.

The Human Body: There was a much better understanding of how the body worked which was in part due to the work of Thomas Sydenham, William Harvey and Andreas Vesalius.

Diagnosing using urine:Physicians had now realised that there was no link between a person’s urine and their health.

There was a little change in the following things:1) The use of medical books – physicians still used books but also

worked from observations.2) The influence of the Church – Generally people accepted that God

didn’t send disease but during times of panic, such as the Great Plague, people turned back to religion.

3) Supernatural causes such as astrology – Same as the influence of the Church people generally accepted it didn’t work but during a period of panic it was referred back to again.

What changed

There was no change in the following things:Miasmata – this didn’t change throughout the entire period and people believed bad smells and evil fumes caused disease.

The Influence of the Printing Press

The Work of the Royal Society

Philosophical Transactions

In approximately 1440 Johannes Gutenberg, a German goldsmith, created the world’s first printing press. A printing press is a machine that can print text of pictures – this meant multiple copies of something could be made without someone copying it out which is how it used to done. This meant that there was less room for mistakes as people couldn’t edit the piece as they were copying it out – or make mistakes. It also meant that scientists could publish their work and share it with other scientists around the world. Before the printing press it was down to the church to copy out books and make copies. This meant that the Church could edit and change things

Scientists wanted to share their ideas and discoveries with each other so the Royal Society was developed. The Royal Society met for the first time at Gresham College in London in 1660. It’s aim was to carry out experiments to further the understanding of science. They also heavily promoted the sharing of scientific knowledge and encouraged argument over scientific theories and ideas. The group even received the Royal Charter from Charles II, the Royal Charter was a document from the monarch granting a right or power to a particular person or group. This meant that people supported the organisation as they officially supported by

This was the worlds first scientific journal – it is even still published today, it celebrated its 350th anniversary in 2015. This journal provided a vitally important platform from which scientists could share their work. This then meant that ideas could be spread much further and easier – as a result more ideas could be developed. The Royal Society offered funding for translations of European scientific texts and encouraged people to write their reports in English instead of Latin. This meant that it was easier to transfer ideas and develop new ways of thinking. When Leeuwenhoek’s work was received by the Royal Society, they gave it to their

How did

communicat

ion improve?

that they didn’t approve of but with the printing press this was no longer an option. An example of this is that critics of Galen could now publish their work criticizing Galen.

the king. microscope enthusiast, Robert Hooke. Hooke used his own microscope to confirm what Leeuwenhoek had seen.

The Theory of the Four Humours:This is a complicated area as a lot of physicians didn’t believe this by the end of the 17th century. However, it was still used in diagnosis despite the fact it wasn’t believed. Disease was starting to be seen as something that was separate from the body which needed to be attacked.

The Human Body: There was a much better understanding of how the body worked which was in part due to the work of Thomas Sydenham, William Harvey and Andreas Vesalius.

Diagnosing using urine:Physicians had now realised that there was no link between a person’s urine and their health.

There was a little change in the following things:4) The use of medical books – physicians still used books but also

worked from observations.5) The influence of the Church – Generally people accepted that God

didn’t send disease but during times of panic, such as the Great Plague, people turned back to religion.

6) Supernatural causes such as astrology – Same as the influence of the Church people generally accepted it didn’t work but during a period of panic it was referred back to again.

There was no change in the following things:

Miasma – this didn’t change throughout the entire period and people believed bad smells and evil fumes caused disease. Thomas Sydenham:Thomas Sydenham was nicknamed ‘English Hippocrates’ and he was a well-respected doctor in London in the 1660’s and 1670’s. At this point the Theory of the Four Humours was starting to loose popularity, Sydenham was really important in moving medicine in Britain away from the classical ideas of Galen and Hippocrates. Sydenham refused to rely on medical books when diagnosing a patient’s illness. Instead he made a point of closely observing the symptoms and treating the disease causing them. One of Sydenham’s most controversial ideas were like plants and animals, in that they could be organised into different groups. Sydenham did not believe that treatment should vary from person to person because of the balance of humours being different. He encouraged his students to observe their patients, note down their symptoms and then look for remedies to tackle the disease. Sydenham wasn’t able to identify the microorganisms that caused the diseases but he could identify that measles and scarlet fever were separate diseases.

William Harvey:Harvey’s Research One of Harvey’s main interests was blood and how it flowed around the body. When Harvey was at Padua he was taught by his professors Vesalius’s theory that the

veins in the body contained valves which was proof that the blood in those valves flowed towards the heart. When Harvey started to dissect bodies he found the evidence that he needed to prove this theory. When he tried to pump liquids through the veins the other way it did not work. This proved that the blood only flowed towards the heart which contradicts what Galen thought about the blood. Galen’s theory about blood was that it was made in the liver and it flowed through the body to provide energy. It was then thought that the blood was used up much like logs are in a fire and the liver just made more.

Harvey worked out that the liver would need to make 1,800 litres of blood a day for the person to survive!

Discovering the circulation of the bloodHarvey used to cut open human corpses and living cold blooded animals to see how the blood flowed around the body. Through this research he famously proved that arteries and veins were linked together in one system. This was done by tying a tight cord around somebody’s arm and cutting off the blood flow in the artery leading to the arm. Due to the fact that the artery in the arm is deeper than the vein loosening the cord would allow blood to flow into the arm but stopped it from flowing out and the veins swelled with blood. Harvey’s theory was that blood must pass from arteries to veins through tiny passages that were invisible to the naked eye. Today we know about these blood vessels – they are called capillaries.

Factors enabling Harvey’s discoveries1) Institutions (such as the Government, King Charles I) 2) Individuals (Harvey’s own abilities)3) Scientific breakthroughs (dissections becoming more common place) 4) Attitudes in society (people being more accepting to change in the

‘medical renaissance’) 5) Technology (mechanical firefighter pumps that provide water –

perhaps the human body worked the same way with pumping blood)Vesalius had previously proved parts of the work of Galen wrong which meant it was easier for later scientists to do the same thing. Due to the fact that Harvey was employed by King Charles I gave him credibility which meant that his work was respected. Also, the decline of the power of the Church also enabled Harvey to be critical of Galen’s teachings. There was more interest in science and in solving some of the puzzles of the human body. People had begun to search for rational explanations for things.

The Impact of Harvey

Harvey did not consider himself a modern scientist as he still followed the views of Aristotle. Aristotle believed that the body was designed by a higher power, and thought that the soul was responsible for how the body worked. Harvey wrote An Anatomical Account of the Motion of the Heart and Blood in Animals which is widely considered to be the beginning of modern physiology. The most immediate impact of what Harvey was doing is that he encouraged other people to start experimenting on actual bodies. Harvey had proved that the liver didn’t make the blood that circulated the body but that left a question, what was the liver actually for? This posed a lot more questions for thinkers and scientists at the time for example how the body absorbed nourishment. However, there were limits of Harvey’s discovery which is due to the lack of practical use it had in medical treatment. He paved the way for a new understanding into how the body worked but due to the fact it couldn’t be applied to the body doctors ignored what he had to say. Some people even went as far as to openly criticize them as no one likes to be told they have been doing things wrong for years. They also argued that no one recovered from disease by simply knowing that the blood flowed to the heart and English medical textbooks continues to use Galen’s account until 1651. Harvey’s idea about the circulation of blood only started being used in universities from 1673 onwards.

Andreas Vesalius:The most famous anatomist of this period was Andrea Vesalius. Vesalius had a deep interest in the human body and was keen to share his discoveries with the rest of the world. His first publication in 1537, Six Anatomical Tables, showed the different parts of the human body labelled in Latin, Greek, Hebrew and Arabic. Three of the six drawings showed a human skeleton, which Vesalius himself had assembled. He used the publication in his lectures: they were very popular with his students and his colleagues. Six years later Vesalius published the book for which he is most famous: De Humani Corporis Fabrica, or On the Fabric of the Human Body. He had been able to carry out a large number of dissections thanks to a local magistrate who allowed him to use the bodies of executed criminals. Vesalius noted that Galen had made some errors in his original theory on the human body. In all, Vesalius found around 300 mistakes in Galen’s original work on anatomy. These included:• The human jaw was in one part not two

• The vena cava (the main vein leading out of the heart) did not lead to the liver.

• Men did not have one fewer pair of ribs than women• The human liver did not have 5 separate lobes• The human breastbone was in three parts not seven

As well as correcting these mistakes, Vesalius encouraged other doctors to base their work on dissection rather than believing old books. He wrote that it was vital that anatomy professors carry out dissections for themselves, and claimed that this was really important if further advances in medical knowledge were to be made.

Medicine in 18th and 19th century c1700-c1900

The 18th century was very exciting time, especially for science. There was no longer a belief that Church was the most important influence and science was becoming increasingly more important. This time in history is referred to as the Enlightenment and it promoted the idea that people could think for themselves. Some historians argue that there were two halves to the Scientific Revolution:

1) In the first half, starting with the Renaissance in the 16th century, old theories were discredited.

2) In the second half, new ideas began to replace old, this started in about the 18th century.

The theory of the Four Humours was no longer accepted and the miasma theory, although was still believed, was starting to be less popular. Scientists in the early 18th century developed the theory of spontaneous generation as an alternative to theories of the Four Humours. Improvements in the quality of the glass lenses used in microscopes meant that scientists could see microbes present on decaying matter. In the 18th century, this was just a theory, and scientists were unable to prove that spontaneous generation was correct. It took until the 19th century for scientists to make a solid link between these microbes and disease.

What changed

?

3) In the first half, starting with the Renaissance in the 16th century, old theories were discredited.

4) In the second half, new ideas began to replace old, this started in about the 18th century.

The theory of the Four Humours was no longer accepted and the miasma theory, although was still believed, was starting to be less popular. Scientists in the early 18th century developed the theory of spontaneous generation as an alternative to theories of the Four Humours. Improvements in the quality of the glass lenses used in microscopes meant that scientists could see microbes present on decaying matter. In the 18th century, this was just a theory, and scientists were unable to prove that spontaneous generation was correct. It took until the 19th century for scientists to make a solid link between these microbes and disease.

Pasteur proved that the idea of spontaneous generation was wrong and published his ‘Germ Theory’. He was a French scientist and was able to observe that there were unwanted bacteria in wine and vinegar which turned the liquids bad. Pasteur also theorised that germs might also be the cause of disease in humans. He observed this in France’s silkworms but didn’t publish his

theories until 1878.

How much influence did Pasteur have?Reasons for a big influence Reasons against a big influence 1) Joseph Lister read Pasteur’s

germ theory and linked it to the infection problems his surgical patients had experienced.

2) Tyndall discovered that there were small organic particles in the air. In January 1870, he gave a lecture, linking his discovery

1) To begin with Pasteur’s work had almost no impact on British ideas about the causes of illness and disease.

2) He was not a doctor, and his work focused on decay and spoiled food, not disease.

3) In Britain, the theory of

Louis Paste

ur

with Pasteur’s germ theory and Lister’s work on wound infection. Tyndall theorised that dust particles carried the germs that caused disease.

spontaneous generation continued to be important until the 1870s. It was promoted by Dr Henry Bastian, who was one of the most powerful doctors in the country. Because he was so well-respected, few people disagreed with him.

4) Tyndall was not a doctor, he was a physicist which meant people didn’t trust him over Bastian.

5) Lister’s ideas were doubted and he couldn’t prove his theory.

Pasteur discovered microbes and their role in decay but it was Koch who successfully identified that different germs cause many common diseases. Koch discovered the bacteria that caused tuberculosis, in 1882.

1) The microbe is present in every case of the disease.

2) Once taken from the body, the microbe can be reproduced into a pure culture. (bacteria grown under controlled conditions)

3) The disease can be reproduced in test animals using that culture.

4) The microbe can be taken out of the test animals and used to start a fresh culture.

In 1883 he discovered cholera and in 1884 he proved that it was spread in water supplies where he found it in the drinking water in India. This also provided proof for John snow’s theory. Koch made it easier to study bacteria by developing a new method for growing them, using agar jelly in a petri dish. This made it easier to study the bacteria under a

Robert Koch

microscope. Later Koch also developed a method for staining them with industrial dyes, to make them easier to see. Koch’s research inspired other scientists. Over the next two decades, they went on to discover the microbes responsible for other diseases such as diphtheria, pneumonia, meningitis, the plague, tetanus and various other infections. Koch received the Nobel Prize for medicine in 1905. He is considered the father of bacteriology (the study of bacteria) and his methods and still used when seeking out microbes responsible for decay today. The identification of microbes that caused particular diseases was an enormous breakthrough in the diagnosis of disease. Whereas before, doctors had studied and treated symptoms, now they studied the disease itself. The medical profession had begun to recognise that the microbe created the symptoms of the disease, and it was the microbe that needed to be removed. In 1883 the microbe that caused diphtheria was found. Diphtheria is a nasty disease that mainly affects children and it caused a painful cough and a fever. Since the microbe had been found the doctors could now treat it directly instead of just treating the symptoms.

Medicine in modern Britain - c1900 - present

It was generally accepted that microbes caused disease in 1900. By 1900 a German scientist, Mendel, had theorised that genes come in pairs, and one is inherited from each parent. These were known as the fundamental laws of inheritance. Unfortunately, he did not have scientific proof that his laws were correct.

James Watson was an American biologist. Francis Crick was an English physicist. In 1953, they were both working at Cambridge University, where they shred an office. Even though neither men were investigating DNA, they both had a strong interest in researching and finding out more about human biology.

Genetics

Crick and Watson saw the x-rays provided by Franklin and Wilkins. They built their model of DNA and shared it with Franklin, who made a correction based on her x-rays. Wilkins also shared clearer photographs that they had managed to take of the DNA. Due to this additional input, Crick and Watson were able to solve the puzzle of the structure of DNA. They discovered that it was shaped as a double helix, which could ‘unzip’ itself to make copies.

Watson and Crick published their paper in April 1953. Crick suggested that they had discovered the secret of life. Understanding the shape of DNA meant that they could now begin to look at its structure and identity the parts that caused hereditary disease.

The Human Genome

Project:This was started in 1990 and it was originally lead by James Watson. For a decade a team of scientists tried to map out the human genome and so understand DNA. The first draft wasn’t released until 2000 but once this happened it became possible for scientist to blueprint human DNA which meant they could understand the consequences when the DNA went wrong. For example, scientists have

now been able to identify the gene that is sometimes present in women who get DNA. This knowledge is used to PREVENT disease by telling people they have the DNA to cause the disease so they can do something about it before it starts, by having a double mastectomy for example. Key Words:Genome – The complete set of DNA containing all the information needed to build a particular organism. In humans, this is more than three billion DNA pairs. It is unique for every human being, except identical twins. Haemophilia – A genetic disease passed from parent to child that stops blood clotting. Sufferers from haemophilia must be careful, as an open wound will not heal correctly. Mastectomy – Surgery during which a person has one or both of their breasts removed.How has technology helped the development of genetics?The electron microscope was first developed in 1931 by Ernst Ruska and Max Knoll. These microscopes work by using a beam of electrons to illuminate the sample being examined, instead of regular light. This allows for much more of a powerful magnification and therefore a clearer image. Advances in the microscope allowed scientists to study the DNA and then see where there had been errors in the sequence for people with conditions such as Huntigton’s disease.

Blood Tests:This was developed from the 1930’s onwards and it is a needle that takes blood from your arm. The blood sample is taken to test for an enormous number of conditions without the need for invasive diagnosis methods. This helps doctors to work out what is wrong with the patient.

How can

technology help make

a

Blood sugar monitoring:This was used from the 1960s onwards and it is specifically used for diabetes. It checks their blood sugar level to make sure their sugars are under control. If this machine didn’t exist we wouldn’t be able to diagnose their condition and they would be more susceptible to hypos.

X-rays:This was used from the 1890s onwards. This is a machine that is used to see what is inside the body without actually cutting the body. Since the start of the 20th century, they have helped diagnose problems such as broken bones. These were used on the battlefields in World War One.

MRI Scans:

These were used from the 1970s onwards to discover if there was any damage to the body beyond just broken bones. They use magnets and radio waves to create an internal image of the body. They are better suited to diagnosing soft tissue injuries, such as ligament damage, than using x-rays.

CT Scans:This was used from the 1970s onwards and are a more advanced form of x-rays. They are used within diagnosis of cancer as they can show up tumours and other growths in the body.

Ultrasound scans:

How can

technology help make

a

These were used from the 1940s onwards and are also known as sonograms. The machine uses sound waves to build up a picture of the inside of the body. They are helpful for diagnosing things like gall stones and kidney stones. They are also used to monitor a growing baby inside a pregnant woman.

ECG’s:These were used from the 1900s onwards and ECG is short for electro cardiograms. These are used to measure the heart rate and it is tracked through electric impulses.

Endoscopes:This was used from the 1900s onwards. It is a small camera on the end of a thin, flexible tube to see inside the human body. They are most commonly used to investigate digestive symptoms, such as vomiting blood. Sometimes they can be used to assist in

treatment, by carrying small surgical instruments into the body.

Blood Pressure monitors:This was used from the 1880s onwards. It is a cuff that is put around your arm which measures your blood pressure and whether or not it is high or low.

Unit 2: How treatments of disease changed?

Medicine in medieval England c1250-c1500

Throughout the 20th century doctors no longer referred to miasmata, the four humours or the supernatural. This is the first period where doctors work solely with scientific discoveries. During the 20th century there was a move towards laboratory medicine with more examination of samples. These samples might include skin or blood, or more detailed samples of flesh gathered from the patient in a procedure called a biopsy. The biggest change in diagnosis in the 20th century was that, instead of being based on symptoms, and the experience and knowledge of the doctor, it was now based on medical testing.

Religious and supernatural treatments:Religious treatments included:• Healing prayers and incantations • Paying for a special mass to be said • Fasting (going without food)

There was also pilgrimages to tombs of people noted for their healing powers. This was beneficial to the locals as tourists arrived and were spending money but it also helped individuals to become saints if they were associated with healing people. There were other methods such as amulets and chanting incantations but the Church did not approve of this. The Church did also often say you shouldn’t look for cures as the disease was sent by God to clean your soul and although you may live you will risk not getting into heaven.

Astrology:Treatments varied depending on the horoscope of the patient. The alignment of the planets was then checked at every stage of the treatment prescribed: herb gathering, bleeding, purging, operations and even cutting hair and nails all had to be done at the right time.

What changed

?

Blood-letting:Phlebotomy, or blood-letting, was the most common treatment for an imbalance in the humours. The idea behind it was that bad humours could be removed from the body by removing some of the blood. This was usually done by barber surgeons and wise women, demand was so high that even some people with no medical background offered the service. Patients would die from blood letting if too much blood was let out. There are examples of cases, such as that of William le Paumer, who collapsed after a blood letting but no one was held responsible for killing him.

Purging:A common treatment was to purge the stomach of all its contents by making the patient sick or by giving them a laxative. Making people sick was usually done through poisons such as black hellebore. Laxatives were also very common with extreme cases requiring an enema. For example, a famous English surgeon, mixed water with honey, oil, wheat bran, soap and herbs such as mallow and camomile. He would squirt it into the patient’s anus using a greased pipe fixed to a pig’s bladder, while the patient rubbed his stomach.

Remedies:Sick people in the period c1250-c1500 were also treated with remedies – usually herbal infusions to drink, sniff or bathe in. Some of these are still used today for example aloe vera. Other ingredients that were used a lot which we still use today are: mint; camomile; rose oils; tamarind; almonds; saffron; butter; absinth; turpentine and corals. Different foods were prescribed to encourage the balance of the humours as the humours were thought to be out of balance because of what you ate.

Bathing:Warm baths were regularly prescribed to help the body draw in heat to help dissolve blockages in the humours. This

meant that you could steam out impurities from your body. You could also be given herbal remedies this way as the remedies could be added to the bath water to help. Some of the remedies were less than pleasant and based on superstition. People who were suffering from paralysis were advised to boil a fox in water and then bathe in it. This was because it was thought that the quick and nimble properties of the fox would be transferred to the patient through the bath water.

Medicine in Renaissance England c1500-c1700

The belief in the humours continued so did the treatment of bleeding, purging and sweating were all popular ways of removing too much of a particular humour. A new popular theory in this period was the idea of transference. This meant that the disease could be transferred to another object, for example there was a popular theory that you could get rid of warts by rubbing them with an onion. Herbal remedies continued to be popular but the way they were used changed slightly, often remedies were chosen because of their colour or shape. For example yellow herbs such as saffron were used to treat jaundice. New herbal remedies were used and they were taken from the new world (North and South America). Some physicians believed that within each country were herbal remedies that could treat diseases from that country. The growth of alchemy also had an impact on medical treatments. People began to look for chemical cures for diseases instead of relying on herbs and blood letting. This new science was known as iatochemistry or medical chemistry. The Pharmacopoeia Londinensis, published by the College of Physicians in 1618 as a manual of remedies. There were 2,140 remedies where there were 122 different chemical preparations including mercury and antimony. In small doses, antimony promotes sweating which fitted with the idea of purging the body of disease.

Apothecaries continued to mix remedies and surgeons continued to perform minor surgeries. Apothecaries were organised into guild systems between c1250-c1500. This meant they would carry out an apprenticeship. Education for both types of professions increased considerably. Both surgeons and apothecaries had to possess licences to

Apothecaries and Surgeons

be able to practice their trade. They both continued to provide services to those unable to afford physicians.

Similarities Differences• Continued to be trained in

universities. • Some new ideas but they

were slow to take effect. • Most learning was still from

books.

• As new ideas about human anatomy and iatrochemistry started to be shared, doctors were inspired to challenge the old teachings and investigate for themselves.

• Dissection was now legalised – but it was difficult to get hold of corpses to dissect.

Medicine in 18th and 19th century c1700-c1900

By 1700 there were only 5 hospitals left in the country and they were all in London. The country did not invest in new hospitals. New hospitals did begin to appear in other cities in the 18th century which were founded from the wealthy in society making donations. Some doctors offered their services free of charge to these new hospitals so they could practice their skills. Hospitals increasingly became places where sick people were treated as opposed to places where sick people could rest and pray. Doctors visited patients regularly and a small staff of untrained nurses cared for the patients. However, hospitals were still not places people often chose to be treated. The rich received medical treatment, and even surgery, in their own homes, which was much safer. Unfortunately, as more people starter to attend hospitals they became less sanitary. They became less strict about turning away infectious patients. The hospitals did have different wards for those who were contagious but doctors would go from patient to patient without washing their hands or changing their clothes. This mean that diseases spread quickly. People did not understand that germs caused disease so they did not take steps to avoid spreading the germs.

Apothecaries and Surgeons

Physicians

Florence Nightingale went and volunteered in the Crimean War and she made a lot of changes in the way men were treated:

1) Nightingale and her nurses demanded 300 scrubbing brushes to get rid of any dirt near patients being treated.

2) Nurses were organised to treat nearly 2,000 wounded soldiers.

3) Clean bedding and good meals were provided.

By the time that Florence came back she was a hero and was known for improving the hospitals.

Once she came back she had two very big impacts on the way that hospitals ran:

1) The way hospitals were designed. 2) The training of nurses.

Nightingale opened a nursing hospital called the Nightingale School for Nurses in 1860 at St Thomas’ Hospital. She also promoted the ‘pavilion style’ for hospitals where separate wards were built to ensure infectious patients could be kept separate. Hospitals also went through a lot of changes:

1) Many different wards split up infectious patients from those requiring surgery.

2) Hospitals focused on cleaning up germs using antiseptics.

3) Doctors were a common sight, particularly junior doctors who were training getting more hands-on experience.

4) Trained nurses lived in nearby houses provided for them.

5) Hospitals had become a place where the sick were treated. Despite the improvements in hospitals there were still 3 major problems with surgery:

1) Bleeding 2) Pain 3) Infection

Simpson and Lister set about trying to solve this problem!

He was a young surgeon from Edinburgh who believed laughing gas was not the best anaesthetic to be discovered. He decided to conduct and experiment and several of his friends to smell a variety of chemicals to see what the effects would be. After sniffing chloroform the entire party passed out and were discovered some time later by Mrs Simpson.

James Simps

on

However, there were some serious side effects that weren’t detected by Simpson’s experiments.

1) The dose had to be carefully controlled, as it was easy to overdose a patient and kill them.

2) The chemical sometimes affected the heart, which caused some healthy and fit young people to die shortly after inhaling it.

Despite the problems that could be seen with chloroform it was started to be used as a painkiller. One particularly famous example was Queen Victoria during the birth of her son in 1853, chloroform became even more popular in Britain. James Simpson was the first person to be knighted for services to medicine. This was because of the positive impact that regular use of anaesthesia had on surgery. Some historians suggest that the use of anaesthetics made it possible for doctors to attempt lengthier and more complex operations. However, because anaesthetics

allowed for deeper surgery to be attempted, infection and bleeding became even bigger problems.

He was an English surgeon who had noticed that in infected wounds it was the flesh rotting away. Lister compared his results with the recently-published work of Pasteur, who had identified germs as being responsible for decay. Lister theorised that, if microbes in the air caused vinegar to go bad, perhaps microbes also caused flesh to rot.

Hannah Greener, a 14 year old girl who was having an infected

toenail removed in 1848, became one of the first patients

to die from an overdose of chloroform.

Joseph

Lister

In 1865 he operated on a patient with a broken leg and added a bandage soaked in carbolic acid. The wound healed cleanly. From this, Lister developed a series of steps to ensure that wounds did not become infected, this included spraying carbolic acid in the air during operations. This theory didn’t catch on quickly even after Lister published his results in The Lancet which was a medical journal. Doctors weren’t aware of the germ theory that Pasteur had developed so didn’t believe there were germs in the air. Lister himself stopped using the spray in 1890 and it was only popular for a short amount of time but the key here is that it created change. The attitude of surgeons towards antiseptic and aseptic (surgery where microbes are prevented from getting into a wound in the first place, as opposed to being killed off with antiseptic) changed. Surgeons finally understood that performing safe surgery was not only possible but it was their duty. This lead to other surgeons looking at different methods of preventing infection. Due to this by 1900 the following was taking place:

1) Instruments were steam cleaned2) Operating theatres were scrubbed

spotless3) Rubber gloves and surgical gowns

were introduced4) Surgeons used face masks during

operations

Edward

Jenne

Smallpox was a terrible threat to the health of the population of Britain. There were nationwide epidemics in 1722, 1723 and 1740-42. The problem was particularly bad in London, where there were 11 epidemics in the 18th century. The worst of these occurred in 1796, when 3,548 people died. They had no symptoms for between seven and 17 days. However, once this period was over, the following symptoms occurred:

1. high fever2. chills3. headache4. severe back pain5. abdominal pain6. vomiting

These symptoms would go away within two to three days. Then the patient would feel better. However, just as the patient started to feel better, a rash would appear. The rash started on the face and then spread to the hands, forearms, and the main part of the body. The person would be highly contagious until the rash disappeared. Within two days of appearance, the rash would develop into abscesses that filled with fluid and pus. The abscesses would break open and scab over. The scabs would eventually fall off, leaving pit mark scars. Until the scabs fell off, the person remained contagious.How did people deal with it?People didn’t know what was causing the disease but they did notice that people who had a mild form of the disease didn’t ever get the disease again. This lead to a belief in inoculations. This means deliberately infecting yourself with a disease to order to avoid a more severe case of it later on. This was expensive though – one doctor named Thomas Dimsdale was made a baron, paid £10,000 and awarded an annual salary of £500 after he inoculated Catherine the Great and her children in 1768.How did Jenner discover the vaccination?Edward Jenner was from Gloucestershire and a doctor in the late 18th century. Jenner noticed that when there was a smallpox epidemic those milkmaids who had previously got cowpox didn’t get ill. He decided that the two must be related. Jenner needed to test his theory though so in 1796 he

Edward

Jenne

infected a boy named James Phipps with cowpox. 6 weeks later he infected him with smallpox and although he did get a little ill he did make a complete recovery. In 1798 he published An Enquiry into the Causes and Effects of the Variola Vaccinae and named the technique vaccination after the Latin word for cow ‘vacca’. How did people react?

The British government favoured the new method of vaccination from the first half of the 19th century. This was because it was a safer and more reliable alternative to inoculation. It was also cheaper, because recipients of vaccines did not need to be put into quarantine.

What were the consequences of the vaccination?It quickly became popular overseas and by 1800, 100,000 people around the world had been vaccinated. The French commander Napoleon had his whole army vaccinated in 1805. There was anti-Jenner propaganda in Britain. Sometimes people still contracted smallpox because the doctors carrying out the procedure mixed up the smallpox and cowpox samples or reused needles, this discouraged people from trusting it. The Royal Jennerian Society had been founded in 1803, 12,000 British people were vaccinated in the space of two years. The number of smallpox cases fell dramatically from 1872, when the government started to enforce compulsory vaccinations – this meant that everyone had to be vaccinated for smallpox.

Jenner’s work inspired other scientists, like Pasteur and Koch, to search for vaccines to other diseases. Jenner managed to create something that stopped smallpox from spreading.

Medicine in modern Britain - c1900 - present

The term ‘magic bullet’ was used to describe a chemical cure that would attack the microbes in the body causing disease, whilst at the same time leaving the body unharmed. Doctors now understood that the body produced anti-bodies to fight diseases that had previously infected. Doctors now started to look for artificial or chemical antibodies that would work in the same way. The first breakthrough was with syphilis which was cured by arsenic the problem was that arsenic is poisonous so it was difficult to find it in a format that didn’t attack the body.

The way that we treat disease is almost unrecognisable from the way people treated disease before 1900. This is largely due to advances in science and technology. Scientists are now able to treat patients even if they can’t be cured because of these treatments such as diabetes and cancer. Improved scientific understanding has also lead to better testing and trialling of new treatments before they are given out to patients. In the past drugs didn’t have to go through this process and as a result mistakes were made. These images show what happens when drugs aren’t properly tested. A drug called Thalidomide was prescribed to mothers to help with morning sickness but it caused these deformities in their babies.

Alexander Fleming was born in Ayrshire on 6 August 1881, the son of a farmer. He moved to London at the age of 13 and later trained as a doctor. He qualified with distinction in 1906 and began research at St Mary's Hospital Medical School at the University of London under Sir Almroth Wright, a pioneer in vaccine therapy. In World War One Fleming served in the Army Medical Corps and was mentioned in dispatches. After the war, he returned to St Mary's.

In 1928, while studying influenza, Fleming noticed that mould had developed accidentally on a set of culture dishes being used to grow the staphylococci germ. The mould had created a bacteria-free circle around itself. Fleming experimented further and named the active substance penicillin. It was two other scientists however, Australian Howard Florey and Ernst Chain, a refugee from Nazi Germany, who developed penicillin further so that it could be produced as a drug. At first supplies of penicillin

Penicillin

were very limited, but by the 1940s it was being mass-produced by the American drugs industry.Fleming wrote numerous papers on bacteriology, immunology and chemotherapy. He was elected professor of the medical school in 1928 and emeritus professor of bacteriology at the University of London in 1948. He was elected fellow of the Royal Society in 1943 and knighted in 1944. In 1945 Fleming, Florey and Chain shared the Nobel Prize in Medicine. Fleming died on 11 March 1955.

Alexander Fleming was a scientist who was working on staphylococci. These are the germs that make wounds go septic. Whilst cleaning the culture dishes one day he saw a mould growing on one of the plates. This in itself was not unusual, but on this occasion there were no germs growing around the growth. Curious as to what caused the germs to stop growing, and eager to find out what the mould was, Fleming grew more of it and experimented. He found that the mould acted against anthrax and diphtheria without creating any harmful side effects. This was the first occasion that an antibiotic drug had been developed (an antibiotic is something naturally produced by living organisms, rather than being a chemical compound). The new drug was a member of the penicillin notatum family, known popularly as penicillin.

Fleming however did little with his discovery. It wasn't until 1935 when researchers Florey and Chain at Oxford University saw Fleming's research papers that the drug was developed further.

Florey and Chain were scientists. They stumbled across Fleming's research papers and were intrigued by his findings. They were sure that, if Fleming was right, this discovery could save a lot of lives, prevent pain and make it much easier to fight infectious diseases and prevent other infections.

Florey and Chain developed a system of growing penicillin: which was complicated initially, and tested its effectiveness on mice. The tests were successful and the two men became convinced that the drug would cure many people who would otherwise die.

Florey and Chain were unable to expand on the development of the drug, as mass production was not financially feasible at the time. The penicillin drug became widely available following the United States introduction

into the Second World War during 1941. Once involved in the conflict, the Americans were easily persuaded to develop and produce the drug for the benefit of Allied Servicemen. The experimentation and development of the research previously conducted by Fleming produced astounding results. Florey and Chain had discovered a drug that combated the spread of infection, would allow sick and wounded men a chance of recovering and gave the medical profession a drug that kept the inside of the body as clean as the tools that were now being treated with antiseptics.

Florey and Chain, along with Alexander Fleming each received the Nobel Prize for the development of the penicillin drug in 1945.

Medicine in medieval England c1250-c1500

Unit 3: How have ways of preventing disease changed?

Most people believed the best and most important way of preventing disease was keeping free from sin. Regular prayers, confessions and

offering tithes to the church worked together to ensure any minor sins were forgiven quickly.

Keeping yourself clean was considered another way to stop disease from starting and the methods for keeping yourself clean were detailed in

Regimen Sanitatis. The Regimen Sanitatis was a loose set of instructions provided by physicians to help

maintain good health. Ideally, a physician would provide a regimen sanitatis written especially for the patient

depending on what their needs are. However, this was really expensive so it was usually only the really wealthy who would be able to afford this. Bathing was important

for treatment of disease it was also used as a preventative measure. However only the wealthy could afford a private hot bath. Although no matter how much money you had everyone washed their hands before and usually after every meal. They believed cleanliness was close to godliness, so it was important to stay

clean.

The humours were thought to be associated with what you eat therefore this needed to be considered when there was an imbalance. Eating too

much was strongly discouraged. A lot of the medieval kings died through eating so much so people were not encouraged to eat a lot. People were

so concerned about what they were eating that they often purged themselves (getting rid of everything from inside their stomach).

Medieval people attempted to keep the air free from miasmata by purifying it. They did this by spreading sweet herbs such as lavender. Local

authorities also tried to keep towns clean to stop the spread of disease. They tried to make

sure there were no rotting animals left lying around and pulled down or cleaned particularly

smelly toilets.

Medieval Medics – Although a physician could expect to be paid a lot more money for providing treatments for disease, there was a strong focus on following various regimes to prevent

getting sick in the first place.

Physicians:New universities were set up in Oxford, Cambridge, Paris, Bologna, Montpellier and Padua. This meant medicine became more professional and a medical degree took 7 to 10 years to complete. Medical doctors were known as physicians – the word – ‘doctor’ did not become common until the 17th century. The main role of a physician was to diagnose illness and recommend a course of treatment. They didn’t often get involved in the treatment that was for less educated midwives, apothecaries or barber surgeons. If you were lucky enough to afford a physician they would follow the following three stages:

1) The physician would look at a sample of the patients urine, faeces and blood, all of which would be collected and sent to him.

2) He would also consult the astrological charts under which the patient was born and at the time they fell sick.

3) Based on this, and the humoural tendencies of the patient (whether they were naturally sanguine, choleric, phlegmatic or melancholic), the physician would create a course of treatment.

For most of this period, this was due to the fact that many physicians were clergymen, who were forbidden from carrying out procedures such as bleeding. Physicians were very expensive, because they weren’t many of them.

Apothecaries:

Apothecaries mainly mixed herbal remedies. They had a good knowledge of the healing power of herbs and plants thanks to studying herbal manuals such as Materia Medica. They were not considered to be educated and were only meant to mix the ingredients the doctor would ask them to. However, seeing the doctor would be very expensive and

apothecaries would be cheaper so the doctors saw them as a threat to their livelihood. Apothecaries could also prescribe poison which goes against the rules that the doctors should always care for patients. This is called the Hippocratic oath that is still agreed today by doctors and it started with Hippocrates. Apothecaries were not bound by this rule and so didn’t have to do the best by their patients. They also didn’t have to go to university to set up their business. Apothecaries also worked with alchemy and the supernatural, providing amulets and charms for patients who wanted more cures. This is not something that was condoned by the Church and so caused problems. As most physicians were also priests it made the gap between physicians and apothecaries even bigger.

Surgeons:Barber surgeons were probably the least qualified medical professionals in England. Due to the sharp knives they had access to the barbers would carry out surgery such as pulling teeth and bleeding patients. Some surgeons were highly trained. In medieval England a skilled surgeon could set a broken limb, remove an arrow or even successfully remove cataracts from the eyes. Surgery was usually very good as it was based on experience and not knowledge learned from books.

Hospitals:About 30% of hospitals were run and owned by the church in the middle ages which were run by monks and nuns. The rest were

paid for by an endowment – where a wealthy person left money in their will to pay for a hospital. The Church taught that charitable donations would help to heal

disease so it is unsurprising that there were a lot of hospitals built in this way. The Church ran many of these hospitals as well. Medieval Church didn’t care for people in the same way

we do today but they were great places to rest and recover. The hospital was very clean with bed sheets changed regularly as this was the nuns job. This meant that

it was very clean so those patients who went there without a terminal disease were probably looked after really well there. This worked in the Churches favour as recovery proved God existed. Many European hospitals employed physicians and surgeons but there is no evidence that English hospitals did the same. Infectious or terminal patients were often rejected from hospitals as prayer and penance could do nothing for these people. The majority of sick people were cared for at home – it was expected that women would be the ones to care for the family when it was needed. This involved making the patient comfortable and mixing herbs. Women would grow herbs and healing plants in the garden so they were ready when they were needed, for example marigold and clover. It is believed that women were well respected for their healing capabilities. It is suggested that women even carried out minor surgeries and bleedings in the home but there are very few records of it. This might be because it was taken for granted that women cared for the sick so nobody bothered to record it.

Medicine in Renaissance England c1500-c1700

Preventing disease was still considered to be the best way to avoid dying from it. People believed you could avoid disease by practising moderation in all things, as well as avoiding draughts, exhaustion, rich and fatty foods, too much strong alcohol and being too lazy. Condition at birth was important, if you were born small or weak that might explain why you got sick in later life. Cleanliness was still important – both the home and the body needed to be kept clean and free from bad smells. Bathing was not encouraged however unlike in the medieval period. This was partly due to the spread of syphilis in the public baths – this was probably mainly to do with the fact the baths were also used a brothels. It got so bad Henry VIII had to close them all down in the early 16th century. People continued to try to avoid catching diseases by practicing regimen sanitatis. The idea that certain weather conditions or the surrounding atmosphere spread disease was becoming more common. New instruments like barometers and thermometers were used to measure and record weather conditions over a long period of time, to see if there was a link

between the weather and disease. More steps were also taken to remove miasmata from the air. Homeowners in English towns were fined for not cleaning the street outside their house.

Pest HousesOne change in hospital care in this period was the appearance of hospitals that specialised in one particular disease. Versions of these existed in the Middle Ages, when there were lazar houses for people suffering from leprosy. There was a growing understanding that disease could be transmitted from person to person (even though people didn’t understand how or why this happened). This meant that new types of hospital began to appear that catered only for people suffering from plague or pox. These were known as pest houses, plague houses or poxhouses. These new types of hospital provided a much needed service. Traditional hospitals would not admit patients who were contagious, but people suffering from serious, contagious disease had to go somewhere or risk infecting their families. Community CareIn spite of changes to hospitals, most sick people continued to be cared for at home. Local communities were very close knit which meant that there were plenty of people around to give advice and even mix remedies. Women continued to play an important role in the care of the sick. This included the rich and the well born ladies like Lady Grace Mildmay (1552-1620), who kept detailed notes of the healing and treatment she carried out. It also included poor women working in big cities to support their families. We don’t know a great deal about these women, but we know that a lot of them were prosecuted by the London College of Physicians for practising medicine without a licence. They usually mixed and sold simple herbal remedies to purge the body or cure a particular ailment. Records suggest that they were very popular, probably because they were cheaper than going to a licensed physician or apothecary.

Hospitals:Some changes began to take place in English hospitals by the early 16th century. In the period before travellers, pilgrims, the elderly and a few sick people would have attended hospital for food, shelter and prayer. There can be changes in the patients seen in the records which show many people went to hospital with wounds and curable diseases such as

fevers and skin conditions. They didn’t spend very long in the hospital before being discharged: this suggests that they got better. A patient in the 16th century could expect:

1) A good diet – the restorative effects of food were still important, as many people didn’t have access to a lot of food that was good for them.

2) A visit from a physician – hospitals had contracts with doctors, who would visit the patients sometimes twice a day to observe the symptoms and treat them.

3) Medication – many hospitals had their own pharmacies and an apothecary to mix the medicines.

However, the dissolution of the monasteries in England in 1536 dramatically changed the availability of hospital care in England. Henry VIII created the Church of England in 1533 to

divorce his first wife Catherina of Aragon and took away the money and power of the monasteries. Since the vast majority of

hospitals were connected to the church, very few were able to stay open after the dissolution of the monasteries. With the convents and

the monasteries gone, the hospitals also went. Saint Bartholomew’s hospital in London, which was founded in 1123 only survived because Henry VIII re-founded it himself in 1546. Some smaller hospitals opened to fill the gap left by the dissolution of the monasteries, funded by charities, but there was a big change in the amount of medical treatment provided by hospitals. Many hospitals reopened without their religious sponsors. However, it took a long time for the amount of hospitals to return to what it had been before the dissolution of the monasteries.

Medicine in 18th and 19th century c1700-c1900

The government used to have a laissez-faire attitude and believed that it was not their responsibility or right to interfere in the way that people lived. Laissez-faire is a French term that means leave it be. After the 1800’s attitude began to change especially as more men now had the right to vote so there was a need to make the masses happy. From the 1860’s onwards the government began to take more action to improve living conditions for people in cities.

1) In London, 1,300 miles of sewers were built by 18652) In Birmingham, slums were demolished3) In Leeds, a local business obtained a court order to prevent sewage

from being drained into the river from which they got their waste

The Second Public Health Act was passed in 1875 and city authorities had to follow the rules it set out.

1) Providing clean water to stop diseases that were spread in dirty water

2) Disposing of sewage to prevent drinking and washing water from becoming polluted

3) Building public toilets to avoid pollution 4) Employing a public offender of health to monitor outbreaks of

diseases5) Ensuring new houses were of better quality, to stop damp and

overcrowding6) Providing public parks for exercise7) Inspecting lodging houses to make sure they were clean and healthy8) Creating street lighting to prevent accidents

The Secon

d Public Health Act

The First

Public Health Act

9) Checking the quality of the food in shops to make sure that it didn’t contain anything that could cause somebody harm.

Who was John Snow?He was a surgeon who had moved to Soho in 1836 and had become London’s leading anaesthetist. It was Snow who gave Queen Victoria chloroform during the birth of Prince Leopold in 1851 – he was popular and well respected. In August of 1854, cholera broke out in Soho, where Snow lived. This prompted Snow to investigate the 93 deaths in his local area.

Snow wrote On the Mode of Communication of Cholera after the epidemic of 1848-49. In it he noted that:

1) Cholera could not be contagious through a miasma. 2) Drinking water was contaminated with faeces of people who were

infected with Cholera. The conclusion that Snow came to was that the water must be part of the reason for the epidemic.

The 1854 epidemic:

Cholera in

London,

1854

Snow started to investigate the 93 deaths in his local area and so he created a map to show where the deaths had occurred. After looking at the map Snow realised that a lot of the deaths were focused around a water pump on Broad Street. Snow realised it was the pump causing the problem and so he removed the handle of the pump to stop people from using it and as a result the cholera epidemic went away as quickly as it had arrived. A later investigation realised that the cesspit that was close to the water pump had been damaged and infected waste was making its way into the water making it now unsafe to drink.

How important was Snow?In 1855 Snow presented his findings to the House of Commons. The government did eventually agree to invest in a new sewer system, which

was planned by Joseph Bazaigette and completed in 1875. However this was not just the work of John Snow as there had also been what is known as the ‘Great Stink’. The Thames was low and the stench of the exposed sewage on the riverbanks heating up. Although Snow had plenty of practical evidence to show that cholera was spread in water, he had no scientific evidence to show what caused the disease. It would be another 7 years before Pasteur published his Germ Theory – 3 years after Snow had died – and another 30 years before Koch finally isolated the bacterium that caused the disease.Who was more important Snow or the Government?Government John SnowEncouraged local councils to clean up their cities and provide clean water

Observed the pattern of cholera cases

Listened to John Snow’s evidence about cholera

Carried out an experiment to prove that dirty water caused cholera

Arranged for a new sewer system to be built in London

Stopped people from drinking the dirty water by removing the handle.

Passed the 1875 Public Health Act to force other cities to clean up

Told the government what he found out to convince them to do something about it

Medicine in modern Britain - c1900 - present

The NHS

The NHS developed in two phases. The first phase was to improve the access to care and phase two was to improve high-tech medical and surgical treatments in hospitals. The aim of the NHS is to provide medical care for the entire population of Britain and it was to be paid for by National Insurance contributions (tax from wages). The government aimed to provide the same level of care for everybody in the country no matter how rich or poor they were. After 1948, women were able to get treatment for painful conditions like varicose veins, which might previously have been left untreated. The government took over all the hospitals to make sure everyone got access to care but that now meant the government was responsible for 1,143 voluntary hospitals and 1,545 city hospitals which was a lot to manage. Many of the hospitals and GP surgeries under the control of the

government needed improvements. Some of the GP’s themselves needed improving as the government realised ¼ of GP’s were not satisfactory. The NHS meant more people could use the GP so waiting times for an appointment increased and appointment times decreased. During the 1960s the government implemented changes to improve the NHS. This meant plans were made to make sure hospitals were evenly spread out across the country. Treatments that we consider to be routine like hip replacements or blood transfusions (having more blood put into your body if you lose it) did not exist before 1900. The development of new machinery to treat the body and even replace parts of it that had stopped working also improved treatment in hospitals. There is now something called robotic surgery whereby doctors can now use computers to control instruments inside the body which allows for more precise surgery with smaller cuts. There are now robotics used within medicine where prosthetic limbs are now produced and work effectively enough to allow amputee patients to compete in Olympic games. A lot of these developed after soldiers were losing limbs from bomb attacks which would have previously killed them.

In the 20th century medical science had made a huge improvement from 1900. In 1900, 25% of deaths was caused by infectious diseases whereas by 1990 that had fallen to only 1%. However, scientists are still faced with a series of problems when dealing with treatments:

1) Some viruses are difficult to develop a vaccine against because they constantly change for example the flu virus.

2) New diseases keep appearing which are immune to the treatments we have.

3) There are lifestyle factors which can lead to certain problems such as heart disease or liver failure.

4) Some bacteria is resistant to anti-biotics for example MRSA is drug resistant.

Things have also improved with access to care as in 1900 most people were still treated in their homes but this started to change in the first half of the century. The government set up the Ministry of Health in 1919 to try and set up universal care across the country. This also lead to rapid development of care after 1948 with the NHS a free healthcare service for everyone.

The government had started to take a more active role in people’s health as opposed to their old system of Laissez-Faire where they just let people get on with it.

Why did Laissez-faire end?Increased understanding of cause Increased understanding of

methods of preventionNow that we understand what causes disease, the government recognises that its intervention can have an impact. Without this understanding, the British government would not have acted in the same way.

Once the causes of disease and health problems were understood, methods of prevention could be tested and introduced. These include:1) Compulsory vaccinations 2) Passing laws to provide a healthy environment 3) Communicating health risks

Compulsory vaccinations

Passing laws to provide a healthy environment

Communicating health risks

Diptheria campaign - this was introduced during World War Two to immunise all children against Diptheria.

Polio was another vaccination that was enforced and as a result the last recorded case was in 1984.

The government has passed laws to provide a healthy environment for the population. Examples of these were the Clean Air Acts of 1956 and 1968. They were triggered by bad episodes of smog in London in 1952.

Charities such the British Heart Foundation creates adverts encouraging people to protect their heart by giving up smoking, eating less fat and exercising.

Medicine in medieval England c1250-c1500

Black death was a contagious disease that spread right across Europe. It is thought to be carried on rats when they arrived in ships by merchants. The fleas that lived on the rats carried the disease and they would jump off the rats, onto the people and bite them which would infect them with

the disease. What did the medieval period believe about the cause of Black Death?Religious and supernatural Natural causes Common beliefs• It was caused by God

deserting mankind. Black Death was a punishment for the sin in the world.

• Astrologers noticed that there was an unusual positioning of Mars, Jupiter and Saturn which meant either something

• Impure air meant the four humours were out of balance.

• People believed the miasma originated because of an

• There were lots of conflicting views.

• In Europe many people blamed the Jews but they had been expelled from England in the 13th century so this wasn’t the case in England.

Unit 4: Medical Moments – Case Studies

really good or really bad was about to happen.

earthquake or a volcano.

What did the medieval period believe about the treatment of Black Death?Supernatural Natural Common Beliefs

1) You needed to confess your sins and ask God for forgiveness through prayer.

2) People believed that if you caught the disease it was clearly God’s will and there would be no cure available.

3) Firstly they started to bleed or purge the victim like would be the treatment for other diseases but this actually made people die more quickly.

4) Physicians recommended strong smelling herbs like aloe and myrrh, these were believed to have cleansing properties.

5) Theriaca was believed to work for lots of ailments.

6) Lighting a fire and boiling vinegar to cleanse the air.

7) The buboes could be lanced and occasionally, people whose buboes burst survived.

8) People would have gone to confession and prayed – as well as seeking traditional cures like bleeding.

9) Priests and physicians were incapable of curing the disease.

10) Apothecaries sold remedies and herbs were mixed in the home but they had uncertain and unpredictable results.

What did the medieval period believe about ways to prevent Black Death?Supernatural means

Natural means Common beliefs Government Action

1) Pray to God

2) Go on a pilgrimage

1) Escaping the plague was the best prevention

1) One Italian physician prescribed doing joyful

1) The government put into place new quarantine laws to try and control the

or make offerings to God

3) Show how sorry you are to God by self-flagellation (whipping yourself).

advice. The physician to the Pope, Guy de Chaulic, said “Go quickly, go far, and return slowly”.

2) People were advised to carry a posy under their nose to prevent them from smelling the bad air.

3) People were also advised to avoid bathing as it was believed it would open up your pores to the miasma in the air.

things, listening to cheerful music and avoiding anything that made people sad. This shows you how little the physicians were able to do about Black Death.

2) People knew to avoid people who had caught the plague – they were so scared they avoided even their house.

spread of the disease. If you were new to an area you had to stay away from everyone in that area for 40 days to make sure you weren’t carrying anything.

2) Houses were the plague had broken out were quarantined – no one was allowed in or out.

3) They even considered banning preaching and religious processions to stop large crowds from gathering.

4) However, the government couldn’t really enforce this as they didn’t have much power – rich and the Church could do anything they liked.

5) The belief of miasma causing a disease meant the local authorities stopped cleaning the streets – it was thought this would cause the miasma causing the disease to go because of the smell of rubbish and rotting disease.

Medicine in Renaissance England c1500-c1700

Astrology Punishment from God

Miasma Other People

There had been an unusual alignment between Saturn and Jupiter in October 1664 and between Mars and Saturn on 12th November. This was considered to be unlucky and could have caused the plague to arrive. There had even been a comet spotted which was an even worse omen to see.

There is a common belief that it was sent by God as a punishment for mankind’s wickedness and God was cleaning up his world.

This was the most popular theory which was a change from the Black Death outbreak in 1348. People believed that this miasma had been created by the stinking rubbish and dunghills that were a feature of 17th century life. It was believed that the vapour would stay in the soil while it was cold but as it got hot the vapour would rise and pour out of the earth as a plague carrying miasma. The theory seemed to fit with when most people were getting sick as people were getting ill in the

By 1665 many people also believed in the correct idea that disease could be spread from person to person. However the problem was there wasn’t any proof of this so it wasn’t the most popular theory. Plague victims were however still quarantined (put in isolation) as even people who believed in Miasma believed that once infected a person could pass the disease on.

The Great

warmer months.

The Treatment:There isn’t a lot of evidence about how the Plague was treated as a lot of people spent time in quarantine so there is little evidence about how people tried to save plague victims. As was fashionable at the time it was advised by physicians that the patients be wrapped in thick woollen cloths and laid by a fire so that they could sweat the disease out. Other methods included:

1) Transference – strapping a live chicken to the bubo or lancing it with a feather plucked from a live chicken were meant to transfer the disease to the bird or feather.

2) Recipes for herbal remedies continued to be extremely popular. These took the form of medicines, poultices or rubs.

3) People didn’t understand what caused it so were still not able to treat it – the best advice had stayed the same, don’t catch it in the first place!

There was a problem of quack doctors (a phrase that is still used today) which is someone who didn’t have any medical qualifications but sold their services as a doctor or an apothecary. People did this and claimed they had fabulous cures to make some easy money.

Preventing the Plague:There was a list of general advice given out by the College of Physicians:1) Pray and repent (say sorry for your sins). 2) Quarantine anyone with the Plague. 3) Carry a pomander to drive the miasma away (a pomander was a ball

containing nice smelling substances). 4) Lots of different diets were suggested from eating nothing to eating

a diet heavy with garlic and sage fried in butter. 5) Plague doctors wore special outfits when treating the plague called

plague masks. These were beak shaped masks that had sweet smelling substance (such as flowers) in the beak. A bird was used because it was believed birds would attract the miasma so the disease would go into the mask and leave the patient. A more practical feature of their uniform was that their cloaks were treated

with wax to make sure none of the pus or blood from the patient soaked into it.

There was advice given from other healers not just the College of Physicians. People turned to local healers to help them ward of the plague.

1) Recipes for Plague water were popular among apothecaries. 2) Smoking tobacco was encouraged to ward of the miasma. 3) Some people believed that because buboes were symptoms of both

syphilis and the Great Plague that catching syphilis would prevent them from catching the Plague. This meant that people went out of their way to catch the disease but it didn’t stop them getting the plague as well.

What did the government do?This time the government did more than last time and so did the King, Charles II. The

King released a decree that said people should fast regularly and made a list of actions to stop the spread of the Plague. These were carried out by local government officials of each city including the mayor. Public meetings, fairs and even large funerals were banned to try and contain the spread. Theatres were closed, streets and alleyways were swept and cleaned. Fires were set to burn on street corners, often in barrels of tar or strewn with sweet smelling herbs, to drive away the miasma. Around 40,000 dogs and 200,000 cats were killed because they were thought to be spreading the disease. The mayor also appointed searchers and wardens to monitor the spread of disease. Searchers would go from house to house, checking to see if there were any plague victims in each one. If a household was infected, the inhabitants were either taken to a pest house or quarantined inside the house for 28 days. The house was painted with a red cross together with the words, ‘Lord have mercy on us’. The parish officials were in charge of bringing them food and other necessities. Every day, carts would travel through the city to collect the bodies of the dead. People realised that the best way to avoid the Great Plague was the same as it had been in 1348, run away. Rather than attempt wild treatments, they put their energy into stopping the disease from spreading, or into escaping completely.

Medicine in 18th and 19th century c1700-c1900

Who was John Snow?He was a surgeon who had moved to Soho in 1836 and had become London’s leading anaesthetist. It was Snow who gave Queen Victoria chloroform during the birth of Prince Leopold in 1851 – he was popular and well respected. In August of 1854,

Cholera in

London,

1854

cholera broke out in Soho, where Snow lived. This prompted Snow to investigate the 93 deaths in his local area.

Snow wrote On the Mode of Communication of Cholera after the epidemic of 1848-49. In it he noted that:

1) Cholera could not be contagious through a miasma. 2) Drinking water was contaminated with faeces of people who were

infected with Cholera. The conclusion that Snow came to was that the water must be part of the reason for the epidemic.

The 1854 epidemic:Snow started to investigate the 93 deaths in his local area and so he created a map to show where the deaths had occurred. After looking at the map Snow realised that a lot of the deaths were focused around a water pump on Broad Street. Snow realised it was the pump causing the problem and so he removed

the handle of the pump to stop people from using it and as a result the cholera epidemic went away as quickly as it had arrived. A later investigation realised that the cesspit that was close to the water pump had been damaged and infected waste was making its way into the water making it now unsafe to drink.

How important was Snow?In 1855 Snow presented his findings to the House of Commons. The government did eventually agree to invest in a new sewer system, which was planned by Joseph Bazaigette and completed in 1875. However this was not just the work of John Snow as there had also been what is known

as the ‘Great Stink’. The Thames was low and the stench of the exposed sewage on the riverbanks heating up. Although Snow had plenty of practical evidence to show that cholera was spread in water, he had no scientific evidence to show what caused the disease. It would be another 7 years before Pasteur published his Germ Theory – 3 years after Snow had died – and another 30 years before Koch finally isolated the bacterium that caused the disease.Who was more important Snow or the Government?Government John SnowEncouraged local councils to clean up their cities and provide clean water

Observed the pattern of cholera cases

Listened to John Snow’s evidence about cholera

Carried out an experiment to prove that dirty water caused cholera

Arranged for a new sewer system to be built in London

Stopped people from drinking the dirty water by removing the handle.

Passed the 1875 Public Health Act to force other cities to clean up

Told the government what he found out to convince them to do something about it

Medicine in modern Britain - c1900 - present

Before more advanced technology had been discovered lung cancer was diagnosed using an x-ray machine. The doctor would then examine the x-ray and look for a tumour. This was of diagnosing was not ideal often cancer was misdiagnosed when it was actually an abscess or worse and abscess was misdiagnosed as a tumour. Look at the diagram below to see the stages of diagnosis:

If lung cancer is diagnosed early the doctor can perform an operation to have the lump removed from the individual’s lungs. This can range from the removal of a small piece of the lung to the entire lung.Transplants:

How do we treat lung

Lung Cance

r

It is sometimes possible to give someone a new lung from a healthy donor. However, this causes an ethical question as to whether the person deserves a new lung if they have mistreated the one they had from smoking. Radiotherapy:During radiotherapy concentrated waves of radiation are aimed at the tumour to try to shrink it. Small tumours can be treated this way instead of with surgery. Larger tumours can be prevented from growing bigger using radiotherapy. The radiotherapy can either be administered as beams of radiation directed at the tumour from outside the body or by placing a small piece of radioactive material directly next to the tumour using a very thin tube, called a catheter. Chemotherapy: During chemotherapy patients are injected with many different drugs which shrink the tumour before surgery, prevent the cancer from recurring or provide relief from the symptoms of lung cancer when surgery is not possible. Patients are likely to receive a variety of these treatments and not just one individual method. Genetic Research: It is not yet possible to use genetics to treat lung cancer. However, scientists have been studying the genes of lung cancer sufferers in order to help doctors prescribe more effective treatments. There are some treatments that work better for some people than it does other and they are researching why that is. It shows that a prescribed treatment for the individual rather than a one size fits all approach is more effective. This idea of tailoring treatments to a person’s DNA is a growing field in medical research known as pharmacogenomics.

What did the government do?In 2007 the government banned smoking in all workplaces. People were no longer allowed to work in pubs, cafes, restaurants or offices. In 2015 the ban was extended to cars carrying children under the age of 18. In 2007 the government raised the legal age for buying tobacco from 16 to 18. Increased taxation on tobacco products was introduced to encourage people to stop smoking. The government banned cigarettes being advertised, adverts on TV

How do we treat lung

were banned in 1965. The government banned cigarette advertising completely in 2005 which included the sponsorship of major sporting events in the UK, such as the Grand Prix. The government has produced many campaigns to advertise the dangers of smoking such as adverts on the TV and the consequences of smoking being put onto cigarette packets. All cigarette products in shops must be removed from display. This was decided based on government research conducted in 2012 suggesting it was important to discourage young people from smoking. Education to discourage young people from smoking is now included in schools.