Medicine through time

Ancient Egypt factors: Government- King-priests called Pharoahs rulled egypt, they employed palace priests e.g. Imhotep. 

Society-observation of irrigation channels by farmers lead to the channel theory, basic hygiene habbits such as baths, lantrines.

Religion- Mumifcation-advanced priests; increased knowledge of internal organs. the idea of cleanliness was a religious not medical concept.

Trade and travel-Traders brought herbs and spices, egyptian doctors were known all over the world.

Observation-Priests/doctors observed internal organs during mumification. They observed patients as part of their diagnoses. They recorded their results.

As the priests of ancient Egypt carried out their rituals of mummification, they learned a lot about the internal organs of the human body. They learned still more as they observed the natural world, and have left important writings that tell us some of what they knew. The blocked channel theory was a massive breakthrough for medicine. 

The theory was developed... Having observed the damage done to famers fields when an irrigation channel became blocked, the egyptians developed that disease occured when the evil spirit called the wehedu BLOCKED one of the body's channels.

The practical egyptians seem to have been able to perform some surgical operations.

The egyptians were good at practical first aid. They could reset dislocated joints, they could mend broken bones.

Egyptian doctors were excellent at bandaging, they could also stitch wounds.

Archaeologists have found stone carvings showing egyptian surgical intsruments, and there are egyptian papyri which speak of cautery and surgery. Egyptian surgery however, did not venture inside the body as it was unholy.

Egyptian men and women took great care in their personal cleanliness. Priests, for religious reasons, kept themselves clean-they regularly washed themselves, their clothes, their cups. 

The egyptians didn't kept themselves clean to keep disease away but because it appealed to their gods more. 

they didn't have a public health system in the modern sense. 

Different from the egyptians. they were ruled by a number of governments-some democratic (Athens), some dictatorship (Macedon), others were ruled by the military (Sparta).

Immensly wealthy and developed a cultural life that included drama, comedy, sculpture, politics, poetry and public debates. Phonetic form of writing.

Hippocrates had built on egyptian ideas. Greeks built on the ideas of Hippocrates.After philosophers like Aristotle decided the body wasn't needed in the afterlife, Greek doctors becan to dissect human boddies.Some even dissected the bodies of criminals who were alive (vivisection).

Based on the observation of their lives, Greek philosophers realised that prayers didn't help disease.This is when the theory of the four humours became most prominant. And from this the philosopher Pythagoras came up with the idea of the balance of the opposites. This gave the Greeks their bases for the knowledge of disease.  

The Greeks are known to have dissected corpses and examined the internal workings of human bodies. 

The Greek city states were constantly at war. Greek doctors became specialists in first aid.They also learnt about setting bones and dislocated bones. We have no evidence that surgeons successfully operated inside the body. Greek doctors didn't have anaesthetics and only had herbal antiseptics. 

The greeks didn't have an extensive public health system. there were no sewers, no supplies of running water.

Many Greeks however followed a programme for health. This included; keeping themselves at an even temperature, eating properly, washing themselves, cleaning their teeth and going for walks to keep fit. This was closely linked to the theory of the four humours. Pythagoras balancing opposites led greek doctors to advocate 'moderation in all things'. 

Hippocrates accepted that ordinary people were too busy or too poor to have a regime so they would therefore, be less healthy. 

Asklepions- healing centre for ancient greeks, based around the god Asclipius (god of healing) people would stay there when they were ill, they were big, clean monastries that worked by patients being clean, taking regular exercise, eating properly and of course praying to Asclepius and his 2 daughters to cleanse them. 

Roman civilisation developed in a different way from that of Greece. Instead of a large number of small city-states, the Romans developed a huge monolithic empire. This was ruled from Rome by an all-powerful emperor, who imposed his will through a single system of laws. Rome became immensly wealthy. They were down-to-earth people, their wealth went into practical things not philiosophy and culture.

So, the state directed their wealth into amazing engineering; baths, aqueducts and sewers. War was important in helping the Romans public health scheme...

the need for healthy army led Romans to think about public health.

the capture of slaves brought Greek doctors to Rome. 

the Roman army developed some of the earliest hospitals.

Anatomical and surgical skills developed as army doctors treated wounds.

The Romans did not allow dissection of human bodies, so they were limited in what they could find out about human anatomy. They also rejected many Greek ideas about medicine. These factors slowed down their progress, but they continued to explore new ideas about the causes and prevention of disease.

Galen had to work on the dissection of animals to gather any futhur anatomical knowledge. Galen recommended dissecting monkeys that walked on two legs, like men. 

Galen did manage to dissect some human bodies-corpses. However, most of Galen's books show a good knowledge of bone structure. he also studied the lungs, the muscles, the heart and blood and the nervous system. he conducted experiments on pigs, and when he cut the spinal cord he realised that the nervous system takes messages from the brain to the muscles. Galen excepted the four humours as the cause of disease however many other romans didnt: 

thought illness was caused by astrology (stars), creatures too tiny to be seen, poisonous vapours in swamps. 

the Romans are known to have had some knowledge of the internal workings of human bodies, particularly through the work of Galen. Through their practical work with gladiators and wounded soldiers they became excellent at practical first aid and external surgery. They could do a number of external surgery such as removing polyps up the nose and goitures from the neck. 

They also developed cesaerean sections, normally used on mothers that had died in childbirth to try and save the child. However, we have no knowledge if Roman's operated inside the body-they didn't have any anaesthetics and only had herbal antiseptics. 

The Romans developed the first ever public health system. Like the Greeks, the Romans believed in personal hygiene and health. Three important factors combined to cause them to create public health system. Their suspician of Greek doctors , their realisation of that the army needed hygeinic conditions to keep their soldiers healthy, and their engineering abilities. 

Settlements such as army camps, were sited in healthy places (not near swamps). In other places marshes were drained (Julius Caesar drained the Codetan swamp near Rome), which reduced malaria. 

Aqueducts: hich brought 222 million gallons of water a day into the city. They also built many great aqueducts throughout their empire. In Rome, special commissioners monitored cleanliness and a fair supply. 

Baths: Rome had nine public baths. Many of them were luxurious, 'covered with mirrors buried in glass lined with marble and silver'. For a fee of one sixteenth of a denarius bathers went from the hot 'caldarium' to the lukewarm 'tepidarium' and then dipped in the cold 'frigidarium'.

Sewers:  flushed by streams, and public latrines (seating up to 60 people). There was a force of 300 slaves who cleaned the streets and latrines at night while people were asleep.

Hospitals: The Romans built the first real hospitals in order to look after their soldiers.

The middle ages (or medieval period) is between the Roman Empire and the Renaissance. 

500AD-1500AD.  Barbarians (Goths, Vandals, Saxons and vikings) invaded Europe. Communications were difficult and dangerous so ideas, travelled slowly. Simarily, technology was limited, and most of the technical knowledge of the Romans was lost. 

Medical knowledge was hard to come by in the medieval period especially in the dark ages. when barbarian tribes roamed western Europe. The knowledge gained by the Ancient Greeks and Romans was lost to europeans , the superstitious reigned- although learning was more advanced in the Muslim Middle east. Knowledge from Greeks and Romans was replaced by speculation and superstition.

The church agreed with the ideas of Galen, and forbid the dissection of bodies so knowledge was hard to come by. And ignorance led to numerous erros and misunderstandings. 

Surgery did make some surprising improvements during the medieval period. This is due to barber-surgeons on the battlefield and to the discovery of some natural anaesthetics and antiseptics. 

Medieval people understood the connection with clean living and good health. Medieval towns did not have the sewers or water pipes like the Romans did. Garbage and Human waste were thrown into the streets. Rats, lice and fleas where everywhere in medieval peoples houses. However, they had their own version of the Greek Programme for Health. The doctor Alderotti encouraged people to stretch their limbs, wash their face, clean their teeth, exercise etc. The Pope's doctor realised the importance of a good diet.Monastries developed comprehensive systems of public health, including fresh running water, latrines with running sewers, wash rooms, clean towels and a compulsory bath four times a year. Nobels took regular baths. Towns had bath houses. Medieval kings past laws of the streets being clean. During the middle ages the first hospitals were built since the Roman times. 

Renaissance meaning 're-birth'. Governments such as Henry VIII were strong and rich, the economy boomed and people could afford doctors.

Artists such as michaelangelo, Leanardo Di Vinci and Titian revolutionised painting- this led them to study the human body more closely and was connected to improved knowledge of anatomy.

The renaissance saw the start of scientific methods.The discovery of America by Columbus meant that new foods and medicine were brought back from the new worlds.

Two key practitioners moved knowledge forward:

Versalius:

1536 - He discovered the spermatic vessels he also realised Galen was wrong about there being 2 bones in the jaw, and about how muscles connect with bone. 

1537- He became a professor in Padua and taught students that disection was very important. 

1543- He published 'fabric of the human body'. 

Harvey: 

1616- he calculated that it was impossible for the blood to be burned up in the muscles (as Galen had claimed) 

1628- He published 'Anatomical Account of the motion of the heart and blood' which scientifically proved the circulation of blood around the body. 

Ambroise Pare changed peoples ideas on surgery. He had is ideas from the 20 years he spent being a barber-surgeon. In 1536 he discovered that wounds healed better if they were treated with 'soothing digestive' of rose oil and yolks. He used ligatures to tie arteries together during amputations. In 1575 he published 'Apology and Treatise'. PARACELSUS a german alchemist and surgeon discovered Laudanum (a deritive of opium) was a painkiller that could be used on his patients. Doctors were often powerless in faces of disease like plague and syphilis. They did get some new drugs from the new world but generally treatment was superstiticious. 

Rats, lice and fleas were a part of peoples everyday lives. They did not have sewers or water pipes. Houses were made of wood so rats, lice and fleas lived in the houses with the people. It took the plague of 1665 to get the authorities going. 

During the 18th C quickening economic activity occured this is referred to as the industrial revoloution and continued through the 19th C. Huge progress was made in identifying and preventing disease. Humans becoming god-like in their knowledge and acheivements. 

-A great explosion of industry (more diseases came about.. lung disease) 

-Urbanisation (public health problems like cholera) 

-Growth of immense wealth (trade and industry) 

- advances in technology led to machines like the electrocardiograph. 

-Improved communication (allowed medical knowledge to spread)

- Growth in science and research (led to medical breakthroughs)

-Democracy and socialism (people believed they had the right to be in good health)

-New idead about evolution (Darwin)

- Wars on a greater scale. 

There was a general atmosphere of scientific research and advance throughout the 19th century, and this was reflected in the fast build-up of medical knowledge. Pasteur's discovery that germs cause disease was a crucial turning point.

William Beaumont (America: 1822) studied the digestive system of Alexis St Martin, a Canadian who had an open hole into his stomach.
Theodor Schwann (Germany: 1839) realised that animal matter was made up of cells, not 'humours'. This was the vital breakthrough of knowledge that at last destroyed belief in the old 'humoral' pathology of the Greeks.
Henry Gray (Scotland: 1858) wrote 'Gray's Anatomy', which had over 1,000 illustrations. Many people bought a copy to own at home. After the 1870s, pupils started studying anatomy in schools.
Starling and Bayliss (England: 1902) discovered the first hormone.
Casimir Funk (Poland: 1912) discovered the first vitamins, and realised that some diseases were caused simply by poor diet.

Louis Pasteur discovered that germs caused disease. Before his discovery doctors had noticed bacteria but they believed it was the disease that caused bacteria. Pasteur also disovered the Pasteursation of milk. 

Robert Koch. (Germany 1878) discovered how to strain and grow bacteria in a petri dish, he was able to discover which bacteria caused which disease; Septicemia (1878), TB (1882), cholera (1883). In the same period other bacteria was discovered, including those that caused; typhoid (1880s), Pneumonia (1880s), Plague (1894). 

Patrick Manson (Britain: 1876) discovered that elephantiasis was caused by a nematode worm, and that mosquitoes were the vector (carrier). This was abreakthrough discovery, because researchers soon found out that other tropical diseases were transmitted by vectors such as mosquitoes (malaria and yellow fever) or tsetse flies (sleeping sickness).
Charles Chamberland (France: 1884) found that there are organisms even smaller than bacteria that also cause disease - he had discovered viruses.

The 19th-century up-turn in surgery actually pre-dated anaesthetics and antisept1842: Crawford W Long (America) used ether as an anaesthetic while operating on a neck tumour (but did not publish details of his operation)...1845: Horace Wells (America) tried unsuccessfully to demonstrate that laughing gas would allow him to extract a tooth painlessly...1846: Dr JC Warren (America) removed a tumour from the neck of Gilbert Abbott using ether....1846: Robert Liston (Britain) removed a leg using ether - 'this Yankee dodge'...1847: James Simpson (Britain) discovered chloroform....1884: Carl Koller (Germany) discovered that cocaine is a local anaesthetics.For infection - antiseptics1847: Ignaz Semmelweiss (Hungary) cut the death rate in his maternity ward by making the doctors wash their hands in calcium chloride solution before treating their patients.1854: Standards of hospital cleanliness and nursing care rose rapidly under the influence of Florence Nightingale.1865: Joseph Lister (Scotland) - basing his ideas on Pasteur's Germ Theory cut the death rate among his patients from 46 to 15 per cent by spraying instruments and bandages with a 1-in-20 solution of carbolic acid.1890: Beginnings of aseptic surgery - surgeons started boiling their instruments to sterilise them - WS Halstead (America) started using rubber gloves when operating - German surgeons started to use face masks.For blood loss - blood transfusions1901: Karl Landsteiner (Austria) - discovered blood groups. Transfusions had been tried before but usually killed the patient because of clotting. Matching blood groups stopped this happening.1913: Richard Lewisohn discovered that sodium citrate stopped blood clotting during an operation.1938: The National Blood Transfusion Service was set up in Britain.

The Industrial Revolution / inventionsWilhelm Roentgen discovered x-rays - helped internal surgery.
Public demonstrations (eg of anaesthesia) allowed knowledge of new procedures to spread.
Scientific knowledge
The scientist Humphrey Davy had first discovered that laughing gaswas an anaesthetic when working on the properties of gases in 1800.
Joseph Lister lectured in King's College London, and published his findings in 'The Lancet'.
Social factors
Queen Victoria gave birth to her children under anaesthesia (after which the general public's fear of anaesthesia lessened). Edward VII's appendectomy helped reduce fear of operations.WarThe needs of army surgeons treating soldiers injured in battle (often requiring amputations) stimulated advance.

The Crimean War led to the development of nursing (Florence Nightingale at Scutari).
World War One led directly to the development of the National Blood Transfusion Service.

Doctors used machines to measure the functions of the body precisely:Carl Ludwig (Germany: 1847) invented the kymograph (which measured the pulse).Wilhelm Roentgen (Germany: 1895) discovered x-rays.Willem Einthoven (Holland: 1900) invented the electrocardiograph (which measures heart activity).That realisation was the start of an important chain of events.Louis Pasteur developed an effective inoculation against anthrax (1881), and rabies (1885).Albert Calmette and Camille Guérin (France: 1906) developed the BCG injection against TB.Emil von Behring (Germany: 1913) developed an anti-toxin against diphtheria.

Paul Ehrlich (Germany: 1890s) reasoned that, if certain dyes could stain bacteria, perhaps certain chemicals could kill them. He set up a private laboratory and a team of scientists. By 1914 they had discovered several 'magic bullets' - compounds that would have a specific attraction to disease-causing microorganisms in the body, and that would target and kill them. These were methylene blue (for malaria), trypan red (for sleeping sickness) and Salvarsan (for syphilis) - although Salvarsan was more effective than the other two.

Most vaccines, however (eg one developed by Robert Koch against TB in 1891), were not successful. And against acute infectious disease, doctors were largely powerless. The search for new ways to cure disease also gained momentum in the 19th century, and included the discovery of how inoculation could prevent disease. Charles Chamberland (France: 1880) discovered by chance (when he left bacteria exposed to air) that injecting chickens with an attenuated (weakened) form of chicken cholera gave them immunity to the disease (ie he discovered the principle of inoculation).

Public health provision was completely transformed as the 19th century progressed. Overcrowding, dirt, poverty and disease went hand in hand at the century's start, but by the 1900s energetic social reformers had comprehensively turned things round.In the early 19th century, the growing towns of Britain were characterised by overcrowding, poor housing, bad water and disease.In 1842, Edwin Chadwick argued that disease was the main reason for poverty, and that preventing disease would reduce the poor rates.In 1848, a cholera epidemic terrified the government into doing something about prevention of disease - through both public and individual health measures. In 1848 the first Public Health Act caused the setting up of a Board of Health, and gave towns the right to appoint a Medical Officer of Health.In 1853 vaccination against smallpox was made compulsory.In 1854 improvements in hospital hygiene were introduced (thanks in large part to Florence Nightingale).In 1875 a Public Health Act enforced laws about slum clearance, provision of sewers and clean water, and the removal of nuisances.

During the 20th century the pace of change, which had quickened during the Industrial Revolution, speeded up even more. There was an ongoing explosion of invention and scientific discovery. Huge progress was made in curing disease and manipulating the body.There was a great explosion of scientific understanding and technological innovation.Many societies became hugely rich, though wealth was still unequally shared.There was considerable urbanisation (explosive growth of cities).Communications technology made the world seem smaller and more cosmopolitan. This allowed medical ideas to spread rapidly, but also allowed diseases such as SARS to spread.There was more time for leisure, less time spent on work.People became less religious - so more inclined to look for medical solutions even to spiritual and psychological problems.Many societies were democratic, and thought the duty of the state was to care for its citizens - hence demands for a welfare state.American military and economic power, and American values, were dominant.Stress due to terrorism, the undermining of traditional values and the rapid pace of life took a great toll on people's general health.Wars, epidemics and famines killed more people in the 20th century than they had in the whole of the rest of history.

1910: Henry Dale (Britain) discovered the chemical histamine, which is produced by the body during an allergic reaction. This allowed him to understand allergic response and surgical shock.1921: Frederick Banting and Charles Best discovered insulin, which breaks down sugar in the bloodstream. Thus he found the cause of diabetes.1923: Edgar Allen (America) discovered oestrogen (the hormone that powers femaleness). In 1935 Ernst Laqueur isolated testosterone, the hormone that creates maleness.1931: The invention of the electron microscope allowed doctors to see bacteria and viruses for the first time.1951: The Mexican company Syntex developed norethisterone, which prevents ovulation - leading to production of the first contraceptive pills.1953:Francis Crick and James Watson (Britain) discovered DNA.1953:Leroy Stevens (America) discovered stem cells.1970s: Patrick Steptoe (Britain) developed IVF fertility treatment; in 1978 Louise Brown became the first 'test-tube' baby.1970s: Endoscopes - fibre optic cables with a light source - enabled doctors to 'see' inside the body.1972:Geoffrey Hounsfield (Britain) invented the CAT scanner, which uses x-ray images from a number of angles to build up a 3D image of the inside of the body.1980s: MRI scans were developed to monitor the electrical activity of the brain.1986: In the Visible Human project undertaken in the US, the bodies of two criminals (a male and a female) were frozen, cut into 1mm slices, stained, photographed and stored as 3-d images on the internet.1990s: The Human Genome project undertaken in the US mapped all the genes in the human body - 40,000 of them. Humans share their gene make-up with much of the natural world, leading scientists to joke that because of the genes we share, human beings are 60 per cent banana! In 1997 Scottish researchers bred Dolly, the first cloned sheep.

1940s: Archibald McIndoe (British) learned how to rebuild surgically the faces of airmen (the 'Guinea Pigs') burned in the war - this was very early plastic surgery. In 2002, nearly 7 million cosmetic surgical procedures were performed in the US alone.1950: William Bigelow (Canadian) performed the first open-heart surgery to repair a 'hole' in a baby's heart, using hypothermia.1952: First kidney transplant (America).1962: Surgeons at Massachusetts General Hospital re-attached the arm of a 12-year-old boy.Christian Barnaard, South African heart surgeon1967: Christiaan Barnard (South Africa) performed the first heart transplant - the patient lived for 18 days. (In 2002, there were 2,154 heart transplant operations performed in the US - 87 per cent of the patients lived for at least a year.)1970s: The development of plastic lenses allowed cataract surgery. Since 1991 laser eye surgery has obviated the need for glasses.1970: Roy Calne (Britain) developed the use of the immunosuppressant drug cyclosporine, which prevents the body 'rejecting' grafts and transplanted organs.1972: John Charnley (Britain) developed hip replacements.1986: Davina Thompson (Britain) became the first heart, lungs and liver transplant patient.1990s: Increasing use of keyhole surgery, using endoscopes and ultrasound scanning, allowed minimally invasive surgery.

Methods of diagnosis changed massively during the 20th century.X-rays, CAT scans, MRI imaging, ultrasound scans, endoscopy etc, together with histology and biopsies, started to allow accurate and exact diagnoses of most illnesses as the century progressed. Treatments had to keep up with all the information, so new drugs and procedures were constantly being developed.During the Second World War, Florey and Chain learned how to mass-produce penicillin - discovered (by chance) in 1928 by the Scottish bacteriologist Alexander Fleming - the first antibiotic.In 1921 Banting and Best developed insulin.In 1999, however, a healthy young man who volunteered for gene therapy to cure a congenital liver complaint died of a toxic response.

1918: After the First World War, the British Prime Minister Lloyd George promised the soldiers returning from the battlegrounds of Europe 'homes fit for heroes'. The government set itself a target of building half-a-million decent homes by 1933.1919: A Ministry of Health was set up to look after sanitation, health care and disease, as well as the training of doctors, nurses and dentists, and maternity and children's welfare.1921: Local authorities were required to set up TB sanatoria.Walter Elliot, Minister of Agriculture, with two children in 1934, during campaign for free school milk1934: Although the economic depression of the 1930s caused government to cut back on spending, it passed the Free School Milk Act and encouraged local councils to give poor children free school meals.1942: During the Second World War, the need to give people something to fight for led the government to commission up the Beveridge Report. Beveridge recommended a Welfare State, which would provide social security, free health care, free education, council housing and full employment.1946: The New Towns Act planned new towns such as Stevenage and Newton Aycliffe to replace the inner-city slums. The Town and Country Planning Act of 1947 set a target of 300,000 new homes a year, and identified 'green belts' where housing would not be allowed to continue to swallow up the countryside.5 July 1948: The 'appointed day' for the start of the National Health Service.1956: The Clean Air Act imposed smokeless zones in cities and reduced smog.1980: The Black Report stated that huge inequalities in health still existed between the rich and the poor in Britain.