Medicine Through Time

People were nomadic hunter gatherers and they lived in small groups. Life expectancy was low.

Beliefs

• Shamans and medicine men 'cured' people
• Illness was blamed on evil spirits
• Magic and Religion were also used as explanations                                                                 

Prevention and Cures

• Charms
• Simple surgery
• Setting broken bones - using clay, mud and wood
• Trephining - drilling/cutting a hole into the skull to release evil spirits
• Herbal remedies - coco leaves, antiseptics, tea tree oil, boiled leaves, ointments
• Massage                                                                                                                                                                                                                                              

Healers

• women and medicine men

There is no evidence from prehistoric times, so historians have to use archeology and evidence from more recent times.                                                                                                

Archaeology - The study of bones and cave paintings. However, as there is no written  evidence, historians have no evidence about beliefs.                                                                                         

Anthropology - study of tribes living in primitive conditions today. This tells historians    about beliefs, cures and causes of disease.

Although the Egyptian civilisation was more advanced and clean than the prehistoric groups, there were a lot of similarities between the types of beliefs and cures. 

Beliefs

• Godss/Goddesses 
• Evil spirits                                                                                                                                                                    

Prevention and Cures

• Charms/amulets
• Purging
• Cleanliness
• herbal remedies
• simple surgery
• drugs - opium and cannabis 
• healthy diet 

Healers

• Doctors
• Priests
• Gods
• Women                                                                                                                                                                                         

Factors

• River Nile - farming (blocked channels)
• Wealth - education (doctors)
• Technology - papyrus (allowed success and failures of cures to be recorded and passed on)
• Trade - new ideas
• Religion - embalming (increases knowledge of anatomy)                                                                                                                                                                                                     

However, Religion also held back the advance of medicine as disecting was not allowed. 

There are two main strands to greek medicine; Gods = supernatural, Doctors = natural.

Greece was very wealthy which meant wealthier people had the time to be dramatists, sculptors and artists. Maths, sciene and philosophy became very important. Some doctors started to look for natural explanations for disease.

Beliefs

• Gods
• The four humours                                                                                                                                                                                                  

Prevention and cures

• Asclepions
• Balance the four humours
• Herbal remedies
• Simple surgery
• Charms 
• Diet and exersise 

Healers 

• Asclepions
• Priests
• Women
• Doctors
• Physicians
• Surgeons

                                                                                                                                         Factors

• Hippocrates - Hippocratic Oath
• Wealth - education
• Trade - new ideas and remedies
• Technology - could write things down
• War - serious injuries caused an increase in the knowledge of anatomy                                                                                                                    

Religion hindered the growth of medicine as dissection was not allowed (outside Alexandria) and belief in the Gods discouraged the search for other remedies. 

Despite the new natural approach to medicine, supernatural causes continued to be more important. Asclepios was the God of healing and people went to his temples, called Asclepions, to be treated. 

At the Asclepion

1. Patients wet for a ceremonial washing in the sea

2. They then made an offering or sacrifice to Asclepios

3. Later, they slept in an abaton (builing with a roof but no walls) so they were open to the air

4. Whilst they slept, Asclepios visited them in a dream and cured them

5. Priests in the Asclepion also visited them and used ointments as well as rituals.                                                                                   

• Part of the ritual involved putting a snake on the patient (snakes were a sacred animal in the cult of Asclepios.) 
• Asclepios had 2 daughters, Hygeia and Panacea, who helped in the healing
• Epidaurus, Pergamum and Kos were the most important Asclepions. 

Hippocrates approach was based on natural rather than supernatural ideas.                                                                                                                

He developed the idea of clinical observation of the patient, rather than just the illness. This was an idea also used by the ancient Egyptians. 

 
He encourgaed doctors to record their ideas and to pass on their knowledge.                                                                                                 

He wrote the Hippocratic collection of books. They were used for 2,000 years.                                                                                                     

He promoted the use of natural remedies, rather than magic and myths.                                                                                                         

Created the Hippocratic Oath - commits doctors to help their patients over profits.                                                                                                          

Believed disease was cause by an imbalance in the body. 

Whereas Hippocrates had mainly concentrated on the observation of illness and it's symptoms, Artistotle developed his work into a theory about the causes and treatment of illness.                                                                                                                 

The Four Humours

• He said the body was made up of Four Humours; blood, yellow bile, phlegm and black bile. 
• This was The Theory of the Four Humours and it linked to the Four Elements.
• He said that any imbalance between the humours was the cause of illness.
• Treatments were based on 'balancing' the humours; e.g. bleeding, vomiting.                                                                                                           

Alexandria 

• Progress in medicine led to the founding of Alexandria in 332 BC by Alexander the Great.
• Aristotle had been Alexanders tutor, so he had sure it had a huge collection of books.
• Dissection of human bodies was allowed there as Artistotle said the soul left the body after death. 
• Alexandria became famous for it's study of surgery and medicine.

The Romans rejected many Greek ideas as they thought their culuture was better. Greek doctors were made slaves and their knowledge and skills feared. However, an outbreak in plague caused the Romans to turn to build an Asclepion and Greek doctors began to improve in status.                                                                                           

Beliefs 

• Galen said disease was caused by seeds floating in the air
• Supernatural - Gods

                                                                                                                                              Prevention and Cures

• Excellent public health; baths, toilets, aqueducts, fountains, sewers
• Treatment using Galens ideas of opposites
• Herbal remedies
• Simple surgery

Healers

• Physicians and Doctors
• Women
• Priests 
• Gods; salus, asclepios

Factors that helped

• War - huge empire needed defending and enlarging so a healthy army was needed, so they had clean water, sewers and special hospitals and doctors. More knowleadge about anatomy.
• Galen - theory of the opposites and developed knowledge of anatomy
• Government - strong government meant public health could be improved in the Empire

Factors that hindered

• Religion - dissection still wasn't allowed
• Belief in the four humours
• Technology - no microscopes meant knowledge about cause of illness couldn't improve

The developments in architecture and engirneering by the Romans were based on observation. They saw that more people became ill when exposed to bad smells, unclean water, swamps and dirty conditions. They noticed that even if temples were built in such places, people still became ill. This led to progress in public health.                                                                                                                                                            

The romans made several important improvements in public health:

• Aqueducts - built to carry clean water into towns and cities.
• Public baths - built for cleanliness.
• Swamps and marshes drained - to deal with fevers. This was based on the belief that bad smells cause illness.
• Toilets and sewers - carried waste away.                                                                                                                                                          

The richest roman citizens had their own facilities, however poor areas were not connected to the sewer system or given rnning water. They had to use public taps and fountains in the streets. 

Galen was a Greek Doctor who supported the ideas of Hippocrates and believed in the ideas of the four humours.

He trained as a doctor in an Asclepion and then at Alexandria. However, by then, human dissection had been banned and so only skeletons could be studied.

However, as he was a doctor to the gladiators, Galen could increase his knowledge of anatomy whilst treating their wounds.

He also gave lectures and wrote over 1,000 books.

He developed many treatments based on balance and treatment by opposites when the humours were out of balance. 

He also belived their were 'seeds of disease' floating in the air.

He fitted all these ideas into one system dealing with observation, diagnosis, anatomy and physiology. 

His work formed the basis of treatments for the next 1400 years. 

In 395, the Roman Empire spilt into Eastern and Western Empires because of pressure from tribes in the North and South. 

Ancient Rome then began to fall to these tribes and in 476 the Western Empire finally collapsed. The tribes then burned libaries and books including medical texts from Ancient Greece and Rome. 

This caused a regress to a more primitive approach to medicine and illness in the West. However, part of medical knowledge and culture was preserved in the Eastern Empire. 

A new Islamic Arabic civilisation began in the Middle East, based on the religion founded by Muhammed. By 1000 this civilisation had spread. 

They followed the ideas of Galen and Hippocrates, and they set up medical schools where doctors had to pass exams. 

Hospitals were also created as the Qur'an said to care for the sick. 

The arabic ideas began to spread to Europe as a result of trade and the Cristian Crusades. 

Ibn Sina - wrote 'Cannon of Medicine' (a complete medical system based on Galen and his own observations.) It was the main medical textbook in Europe until 1700.                                                                                                                                     

Rhazes - Followed the Hippocratic method of observation and so was the first person to note the different symptoms of smallpox and measles.                                                                                                                                                                  

Abul Kasim - He was the greatest arab surgeon and he also wrote a book on surgery.                                                                                                      

Ibn an-Nafis - He made many observations during surgery and discovered some errors in Galen's work. He said blood passed through the lungs, but no one else agreed, so the old views continued. 

500 AD - 1450 AD

The people who took over Rome believed in magic and superstition and so the Roman methods and public health system collapsed.

Most medical knowledge in Europe was lost.

Gradually, the Christian church re-established itself, but this only increased the belief in supernatural causes.                                                                                                                                                                                           

Beliefs

• God - Chrisitans believed people got ill if they had sinned
• Miasma
• Astrology
• Galen/Hippocrates
• Four Humours/Opposites
• Arab healer - Ibn Sinna                                                                                                                                                                

Prevention and Cures

• Prayers and Pilgrimages - influence of the church
• People flagellated themselves to show God they were sorry for their sins
• Cleaning up streets (After the black death - 1348) and nice smells
• Consulted Urine charts and other charts
• Simple surgery
• Bleeding and purging
• Herbal remedies                                                                                                                                                                                                           

Healers

• Physicians/Housewife Physicians
• Priests
• Women
• God
• Surgeons/Barber surgeons 
• Local monks - prescribed herbal medicine
• Apothecaries - sold drugs and medcine

Factors that helped

• Religion - Created hospitals runs by monks and nuns. Created medical schools. 
• War - Crusades took people from Western Europe to the Middle East which encouraged the trade of ideas. Arabs conquered Spain and brought new ideas with them.                                                                                                                   

Factors that hindered

• Religion - Church didn't allow dissection. Encouraged belief in the supernatural. Only taught about Galen in schools, and this stopped people from looking else where. 
• War - At the start of the Middle Ages (500AD - 1000AD) war disrupted trade, books were lost and Alexandria was destroyed.                                                                                                                                                                                 

From 1300, the church began to allow public dissections and new methods started to be put forward, but acceptance was slow. 

The romans had developed piped water, public baths, toilets and sewage systems. However cleanliness in the Middle Ages declined because there was no government proivision of public health facilities and rubbish and sewage was dumped in the street.

Some laws were passed to limit the dumping of sewage, but they were difficult to inforce, and sometimes rubbish was collected, but this wasn't regular.

The church also maintained some parts of public health:

• They had their own drainage and water supply systems.
• Dirty water was drained and used to clean toilets, which were kept in a seperate building
• Monks made sure the laver, towels and sheets were clean.                                                                                                                                            

When the black death hit, people had no idea what caused disease and there were both supernatural and natural explanantions. However, it was observed that it was contagious so this led to the isolation of plague victims. As there was no explanation for the cause, pieople relied on spiritual and magic cures. These included:

• carrying strong smelling posies.
• wearing overall suits - which did actually help to protect agaisnt fleas. 
• Ships newly arrived in the harbour had to wait 40 days before docking (quarantine.)

1450-1600

The Renaissance was the rebirth of learning as important works, such as Hippocrates and Galen, were recovered. This led to a renewed faith in the four humours, treatment by the opposites and herbal remedies. It also saw the new more scientifc approach to medicine, based on observation.                                                                                   

The invention of printing proved to be very important as it allowed for the rapid spread of ideas.                                                                                              

The works of Galen which came from the East in arabic were quickly translated into latin and then printed.                                                                                                                                                                                                                      

The reformation weakened the hold of the Roman Catholic church on education and learning causing new theories to be developed. 

His influence

Progress in the work of anatomy was made because of the work of Andreas Vesalius (1514-1564.)

• He did his own dissections and published drawings of his work.
• He found errors in Galen's anatomical work, but didn't reject Galen's work publicly at first.
• He published 'The Fabric of the Human Body' and rejected Galen's idea that blood passed through the septum.
• He criticised the current method of bleeding.
• However, he didn't offer any new theories about the causes or cures of disease.                                                                                             

His failures

• Even with Vesalius' findings, treatments throughout the 16th century continued to be based on the four humours, Hippocrates and Galen.
• Vesalius' findings had little impact on the treatment of illness.
• There was a wide range of alternatives to physicians for the majority of the population who used bleeding, herbal remedies and astrology. 

In 1603, the valves in veins were discovered by Geronimo Fabricus.                                                                                                                       

William Harvery (1573-1657) studied at Padua under Fabricus until 1602.                                                                                                            

Harvey did comparitive studies on animals and humans, and also dissected animals to find out about how the heart worked. He then began to apply his findings to humans.                                                                                                        

As a result of these findings, he was able to prove that Galen was wrong about blood passing through the circulation of the blood. He also identified the different between veins and arteries.                                                                                           

Harvery also showed how the heart acts as a pump and passes blood through the lungs.                                                                                                               

These discoveries were an important turning point in the dvelopment of anatomy. However, they didn't really change surgery or medical treatment in general. 

The period of 1650-1750 is often known as the scientific revolution as it is during this time that physics became more established:

• 17th century interest in science and experimentation continued through this period.
• The microscope was invented in 1693.
• Substances like hydrogen, oxygen and nitrous oxide were discovered. 
• Fahrenheit and Celsuis invented their thermometers.                                                                                                                                     

There were also several important advances in the 18th century:

• Developments in sugery.
• Investigation of the breathing and digestive systems.                                                                                                                                                       

However, despite these advances, older alternative forms of treatment continued:

• Most people could not afford to go to a qualified doctor and relied on informal healers.
• Belief that the 'King's touch' cured people of Scrofula.
• Supernatural and magical cures still used.
• Cures based on bleeding and purging were common.

The Scientific Revolution had led to an increased respect for physicians and doctors, which led to improved training and standards, and several hospitals being established.                                                                                                                    

Despite the new more scientific approach and the search for new knowledge, many old ideas still continued through the first half of the 18th century:

• The four humours
• Miasmas
• People sold useless pills
• 'Quack Doctors' sold anything as a cure
• '**** doctors' examine urine
• 'Evil worms' caused illness                                                                                                                                                                 

Despite the various discoveries and advances before 1750, doctors had little knowledge about the causes and cures of disease.                                                                                                                                                                

Many doctors had no know of Chemistry or Biochemistry and Physics was still limited. Although microscopes had been invented, they weren't very powerful. 

From about 1750, Britian underwent several changes. This industrial revolution had a mixed effect on Medicine and a negative impact of public health due to the rapidly growing towns.                                                                                   

Negative impact of the revolution:

• No building standards of regulations
• No central government intervention - laissez faire
• Overcrowed areas had poor public health
• Sewage dumped in rivers, over flowing cesspits and human waste being thrown onto the streets
• Smoke from closely packed houses and factories                                                                                                                            

Positive impact of the revolution:

• Increased confidence in science and improvements in technological aids for medicine
• More powerful microscopes
• Discovery thats germs caused disease
• Advances in chemistry led to research for new drugs 

Edward Jenner (1749-1823) discovered the method of vacciantion agaisnt smallpox in 1796 through observation of his patients.                                                                                                                                                                 

The old method to fight smallpox was innoculation.                                                                                                                                          

He experimented successfully on a young boy named James Phipps.                                                                                                                           

He published his results in 1798.                                                                                                                                                                          

Although he faced much opposition because he was unable to explain how his method worked, he had a lot more support.                                                                                                                                                                           

As a result of this support, he recieved money from parliment which, in 1840, made vaccination free for all infants.                                                                                                                                                                                               

In 1853, the government made vaccination compulsory - a very unusual decision. 

By 1800, many people believed in the theory of 'Spontaneous Generation.'

In 1849, Louis Pasteur began to work as an industrial chemist and, by accident, found the link between germs and disease. He discovered that a particular micro-organism was growing vigorously in a liquid and that germs were the cause of this problem. 

Robert Koch then went on to show how a particular germ caused a particular disease. 

In 1875, Koch discovered the Anthrax microbe and in 1878, he found how germs make wounds go septic. He then discovered the germs causing TB and Cholera. 

The steps to finding a cure for those already infected with a disease:

1. Pasteur and his team discovered a vaccine for chicken cholera and then went onto find a vaccine agaisnt anthrax in animals. One of his teams successfully demonstrated this in public.

2. In 1882, Pasteur set up a team to find a cure for rabies in animals and by chance he was forced to test it on a human and a series of injections stopped the boy from getting the disease.

3. One of Kochs assistants found that some animals produce an anti-toxin to fight the toxins produced by germs. He extracted the anti-toxins and injected them into humans. 

4. The first cure of an ill human by anti-toxin was in 1891. Soon, other anti-toxins were developed. 

Ehrlich

Antibodies were discovered in 1884 as being part of the bodies defence system by attacking germs. 

Ehrlich (1854-1915), a member of Kock's teams, called the antibodies 'magic bullets' as they fought the specific germs without harming the rest of the body. He tried to extract them, but this did not always work, so he began to look for synthetic chemical 'magic bullets' to cure disease.

When on Koch's teams, he used dyes to stain microbes and found found that the dyes could kill germs. He discovered dyes that attacked malaria and sleeping sickness.

He then began to search for the 'magic bullet' to cure Syphilis:

1. In 1909, he had tested over 600 dyes and eventually found number 606 worked - Salvarsan 606.

2. It was first tried on a human in 1911.

3. There was much opposition to this discovery as it was difficult and painful to inject and some feared it would encourage promiscuity.

4. It was over 20 years before he discovered a second 'magic bullet'. 

By 1900, the germs that caused most common diseases had been discovered.                                                                                                      

Domagk

Gerhard Domagk worked for a chemical firm in Germany and had already developed a cure for sleeping sickness.

In 1932, he found that a red dye (prontosil) stopped the microbes that caused blood poisioning from multiplying. 

His daughter had blood poisioning so he gave her a large dose. She recovered, siwth the only side effect being that her skin turned bright red. 

French scientists discovered the active ingredient was sulphonamide - a chemical in coal tar.

This led to a rage of new drugs based on sulphonamides. 

These drugs did not turn the patients skin red, however some had more serious side effects such as damage to the kidneys and liver.

These sulphonamides were also ineffective agaisnt the stronger microbes. 

Alexander Flemming was the first to discover the drug penicillin.                                                                                                                         

Whilst working in a militray hospital, Flemming bcame very interested in how to deal with infected wounds as he found that the antiseptics were not very effective.

In 1922, he found that lysozyme (found in tears) killed some germs, but not those causing disease. 

In 1928, he bgan to work on the germs that turn wounds septic, and one day discovered that some mould was growing on the petric dishes. However, no germs were growing near the mould.

A colleague identified the mould as belonging to the penicillin family. 

However, Flemming did not have the necessary chemical skills to purify the 'mould juice'.

He tested it on animals and it did no harm to the body tissues, so he tested it on a colleagues eye infection and it again did not harm to the body tissues. It was a big improvement from the 'magic bullets'.

In 1929 and 1931, he wrote up his results and called the 'mould juice' penicillin. 

The next step in the development of penicillin was taken by Howard Florey and Ernst Chain.

In 1938 they decided to study germ-killing substances and Chain came across Flemmings article on penicillin, so they tried to produce pure penicillin.

A small amount was produced using freeze drying techniques. A small amount was successfully tested on mice before use on humans.

Penicillin was first successfully tested on a human in 1940. At first he improved, but when the supply ran out, he died. 

Steps to producing large quantities:

1. Florey and Chain did not have the resources to make large amounts and the British government were too busy making explosives to help.

2. US chemical firms gave them financial help.

3. Pencillin began to be mass produced in 1943, and by 1944, there was enough to treat all the wounded allied forces in Britian.

4. After the war, even better methods of mass production led to reduced costs. So soon pencillin was used to treat a range of diseases. 

Although antibiotics were successful, not all killer diseases had been conquered fully.                                                                                     

Overuse had also led to some bacteria being immune (super bugs) and therefore antibiotics do not work against these bacteria.                                                                                                                                                                                     

TB has not been completely wiped out and the disease is recently making a comeback in both the developed and the developing worlds.                                                                                                                                                                              

Many diseases in developed countries are not infectious such as cancer and heart disease and therefore cannot be cured by antibiotics. 

High-tech surgery is highly successful and can be used to carry out complicated operations with low risk to the patient. 

Improvements in modern medicine:

• Nursing
• Specialist hospitals
• High-tech surgery; transplants, key-hole surgery, IVF treatment, plastic surgery
• New possiblities for curing or eradicating disease; discovery of DNA, new science of genetics and genetic engineering.                                                                                                                                                            

However, there are problems with side effects, costs, ethics and new health problems.

Problems with modern medicine:

• Moral and ethical concerns; embryo research, cloning, life-support machines, transplants
• Problems with some modern medicines e.g. thalidomide
• Complex surgery means mistakes can be made
• Some vaccinations can have side effects
• Many viruses and germs have become resistant to antibiotics

Since 1900, attitudes about the role of the government in health care have changed.

20th centruy goverments have intervened in areas such as waste disposal and housing.

1938, the NHS was set up, but the demand was much greater than expected. This caused a lot of problems and soon treatment was no longer free.

The rationing of resources due to high-tech machines, more expensive drugs and longer life expectancy has led to longer waiting lists. Some wealthier people have taken out private medical insurance to get quicker treatment. 

However, high-tech medicine has not led to the disspearance of traditional medicine.

Such methods include:

• herbal medicine
• 'natural' cures - diet and exersise
• acupuncture - theory of physiology
• spiritual healers                                                                                                                                                                                             

The number of people turning to such approaches has increased rapidly since the 1980s. 

Despite progress in surgery in the Islamic world, surgery during the Middle Ages was limited. Surgeons and barber surgeons had low status compared to physicians.

In fact, doctors often left surgery to low paid assistants and untrained barber surgeons. 

Some progress in the knowledge of surgery began to be made, with the discovery of the antiseptic properties of wine and opium being used an an early anesthetic.

Further progress was made in the 16th century the french surgeon, Ambroise Pare (1510-1590.)

He stressed the importance of first-hand observation. However, his work had little impact at the time.

In 1954, Pare worked for a public hopsital. Then in 1537, he became an army surgeon.

His methods of using an ointment rather than boiling oil to prevent infection in wounds, and using ligatures to tie of blood vessels rather than a cauterising iron influenced very few doctors. 

However, as their were no antiseptics, Pare's use of thread actually increased the chance of wounds going septic and the lack of anesthetics meant surgery had to be quick and simple. 

The first problem of surgery to be solved was pain - by the development of anesthetics:                                                                                            

1. The discovery of a reliable anaesthetic had to wait for improvements in the chemical industry from the industrial revolution.

2. In 1799, Humphrey Davy identified Nitrous Oxide (laughing gas) as a possible anesthetic, but it was ignored at the time.

3. In 1842, in the USA, Crawford Long discovered the effects of Ether. The idea spread to Britian and it was used by Robert Liston.

4. In1847, James Simpson discovered the possi bilites of chloroform, with was easier to administer than Ether. However, it caused liver damage, so surgeons returned to Ether in 1910.                                                                                

Anaesthetics allowed longer, more complex procedures, increasing risks from infection and bleeding. Death rates rose in the black period of surgery from 1846-1870.

Around the time anaesthetics were created, operations were still carried out in unsanitary conditions.

There were still no special, clean clothes for surgeons or sterilised instruments.

In 1847, Dr Ignaz Semmelweiss ordered doctors to wash their hands in chloride of lime before examining patients.

However, although this method led to a reduce in death rates, most doctors rejected the idea.

In 1861, Pasteur's Germ theory was published. It was read by Joesph Lister, who began to study the infection of wounds in 1865. 

In 1867, Lister used carbolic acid to disinfect bandages. In 1871, he developed a carbolic spray.

This was a break through and led to dramatic decreases in deaths, but doctors and nurses disliked the idea.

But as a result of Florence Nightingale's work, Lister's ideas spread, especially after 1878.

Then in 1887, asepsis techniques were discovered, and in 1889, caps, masks and gowns were developed. 

The idea of blood transfusions was developed in the 17th century however there was a big problem with clotting until 1901, when blood groups were discovered.                                                                                                                   

The injuries of the first world war led to the need for more extensive surgery. In 1914, it was discovered that glucose and sodium citrate stopped blood clotting on contact with air.                                                                                     

This discovery allowed blood to be stored more easily.                                                                                                                                      

20th century warfare resulted in a higher number of burns victims, developing a new specialism - plastic surgery.                                                                                                                                                                                              

Sking grafting had been used in the Renaissance period, but there was a problem with infection.                                                                                                                                                                                                 

During the second world war, another specialism progressed - heart surgery.                                                                                                                      

Attempts at heart surgery before the war were rare.

Modern, high-tech surgery:

• It was discovered that Barium meals allowed x-rays to be taken of the small intestine, while x-ray abosrbing dyes can be injected into the bloodstream.
• CAT scanners give doctors a 3-D image of the body.
• Fibre optics allow doctors to see inside a patient without surgery. This has led to key-hole surgery.
• Special microscopes have been developed with very fine sutures and needles. This has allowed for the development of micro-surgery. 
• The discovery of radioactive isotopes meant they could be used in diagnosis, radiotherapy, and immunosuppresants.                                                                                                                                                                      

Development of transplant surgery:

1. In 1903, the electro-cardiograph was developed.
2. First artificial kidney machine developed in 1943.
3. The first heart-lung machine developed in 1953. 
4. The first heart transplant was carried out in 1967.
5. Unfortunatly, the patient died as the heart was rejected. This problem wasn't solved until the invention of immunosuppresants.
6. Blue babies were operated on (babies with defective hearts).
 

In ancient civilisations, there were few trained doctors. Most people had to rely on informal healers, most of which were women. 

The role of women in medicine (pre 1500):

• In Ancient Egypt, some wall paintings show only women helping at births.
• Ancient Egyptian doctors were allowed to train their daughters in medicine if they had no sons.
• In Ancient Greece, women could be doctors (because of Asclepios' daughters).
• In Ancient Greece and Rome, midwives were taught by doctors.
• With the collapse of Rome, there was a return to informal healers, mainly women.
• Women doctors were allowed to practice in the Islamic world.
• Women worked in all areas of medicine; physicians, surgeons and midwives.                                                                                                  

In the Islamic world, it was thought improper for male physicians to treat women.

However, during the Middle Ages, when the church began to make medical training more formal, women were excluded from education and so therefore were excluded from medicine. 

However, as most people could not afford to go to a proffesional doctor, women continued to play an important role for most people who became ill. 

Developments 1500-1750                                                                                                                                                                            

The greater knowledge of anatomy after 1500 due to the Renaissance, and the insistence on formal training, meant women were excluded even more from medicine.                                                                                                      

Despite this, there were still a few women surgeons and doctors during the Renaissance and into the 17th century.                                                                                                                                                                                 

In 1620, the delivery forceps were invented. These needed good anatomical knowledge to be used properly and so women started to be excluded from midwifery.                                                                                                     

However, as trained doctors were scare and expensive, women still continued to play an important role in medicine for ordinary people.                                                                                                                                                

Women also continued to play important informal roles as housewife-physicians and local 'wise-women'. 

Developments 1750-1900

1. The first signs of change came in nursing following the work of Florence Nightingale.
2. Mary Jane Seacole also played an important role in improving nursing during the war. However, because she was a black, Jamaican women, she was not given much credit or allowed to work in England on her return. 
3. As a result of these developments, nursing became a respectable medical profession.
4. In 1859, Florence Nightingale's 'Notes on Nursing' was published and funded the Nightingale School of Nursing.
5. Other training schools followed. By 1900, there were 64,000 trained nurses.

However, there were still no women doctors as universities still refused to accept them.

Scoial attitudes to womens education began to chance from about 1850.

Elizabeth Garrett tried to qualify as a doctor. Although she was accepted by the Society of Apothecaries, no university would allow her to qualify as a Doctor of Medicine.

Sophia Jex-Blake (and 5 other women) completed a medical course at Edinburgh Univeristy in 1874, but weren't awarded a degree as they were only given to men.

In 1876, due to protests, medical qualifications were opened to women.

Changes since 1900

In 1919, the Registration of Nurses Act set out the qualifications needed to enter nursing.                                                                             

Nursing became a highly respected profession - many men now choose it as a career.                                                                                  

One of the main factors leading to equality for women in medicine was the world wars.                                                                                 

The first world war gave a greater need for doctors and nurses - giving more opportunities for women.                                                                                                                                                                            

As well as large numbers of women working as nurses, more acted as doctors and surgeons.                                                                           

More opportunities came with the second world war and the establishment of the NHS.                                                                                            

The Sex Discrimination Act, 1975, meant (in theory) all jobs were open to women as well.                                                                                     

However, despite all this, women are still under-respected in the medical profession. 

Ancient Civilisations and Middle Ages 

In Ancient Egypt, Priests washed regularly, changed their clothes and shaved their heads. However, there were no drainage systems for toilets, which were stone seats over jars. 

Although there was little change in Ancient Greece, the Romans made several important changes to public health, such as clean water, public baths, toilets, sewers and drainage of swamps. 

However, these mesaures dissapeared during the 'dark ages'.

In the Middle Ages, governments were unwilling to provide public health facilities. 

Instead, each town was left to itself, and decisions were made by its corporation (usually rich men) who did not feel that public health was their responsibility. 

As trade grew, the public health problems increased. Often, rubbish was piled in streets or rivers. 

Although some towns passed laws, these were difficult to enforce. Usually, action was only taken after a serious outbreak of disease.

There was no real understanding for the causes of these epidemics and the worst was the black death that first hit Britian in 1348.

1500-1750

There was not much imprivement in public health after the Renaissance because of the impact of frequent war:

• Armies brought diseases with them.
• Wars were very expensive so there was no spare money for public health measures and governments took little action.
• Sieges lef to starvation and associated illness.
• People often tried to build new houses within a towns walls as protection which led to overcrowding.                                                                                                                                                                                          

As a result of these problems, outbreaks of plaugue continued to happen all over Europe.

In Britian the worst reapperance of the plague was 1665-1666 - 100,000 people died.

Some steps were taken to try and control its spread, e.g. locking the infected in their houses.

The authorities also paid for bodies to be collected and for mass burials in plague pits.

The plague did not really end until the Great Fire of London in 1666, which sterilised large areas of the city. 

1500-1750

There was not much imprivement in public health after the Renaissance because of the impact of frequent war:

• Armies brought diseases with them.
• Wars were very expensive so there was no spare money for public health measures and governments took little action.
• Sieges lef to starvation and associated illness.
• People often tried to build new houses within a towns walls as protection which led to overcrowding.                                                                                                                                                                                          

As a result of these problems, outbreaks of plaugue continued to happen all over Europe.

In Britian the worst reapperance of the plague was 1665-1666 - 100,000 people died.

Some steps were taken to try and control its spread, e.g. locking the infected in their houses.

The authorities also paid for bodies to be collected and for mass burials in plague pits.

The plague did not really end until the Great Fire of London in 1666, which sterilised large areas of the city. 

The public health crisis 1750-1850

Most people blieved that governments should have a laissez-faire attitude.

As a result, there were no planning or building regulations, so therefore there was overcrowding, bad housing, poor water supplies, and inadequate drainage and sewage disposal. 

There was still no scientific understanding of the cause of disease, most people believed in 'miasmas'. Consequently, many problems across from a wide range of infectious diseases.

In 1831, a new disease hit Britian - chlorea.

Some boards of health were set up, but were abolished in 1832, when it appeared the disease had died out.

Edwin Chadwick looked into the links between poverty and ill health.  His report, published in 1842, recommended sanitary reform. His findings about the links between poverty and death rates were later support by William Farr and Dr South-wood Smith's findings. 

However, a public health bill was defeated in 1847.

When cholera struck again in 1848, parliment passed the Public Health Act.

This allowed councils to set up Boards of Health, which improved water and sewage disposal. 

Developments since 1850                                                                                                                                                                           

Despite the Public Health Act, little changed in most towns.

1854 - John Snow discovered the link between contaminated water and cholera.

The dicoveries of Pasteur and Koch proved Chadwick and Snow right.

Another cholera epidemic (1865-1866) scared the authorities into taking further steps.

1871 - government formed a Local Government Board.

Industrial workers were given the vote in 1867, this increased the pressure to reform.

In 1875, Parliment passed the Public Health Act. It was more effective as it was compulsory.

Greater awareness of public health issues, led the government to create the welfare state.

The most important change was the introduction of the NHS in 1948.