Edexcel Medicine Through Time

The chances are you won't need this for an actual exam question, but it's useful to compare to. 

• Formal religion - Mummification taught priests about the working of the body. Some priests became doctors.
• Cleanliness for religious reasons - Priests washed themselves, clothes and cups
• Egyptians invented skills of writing and calculation. Ideas could be documented and shared. 
• Channel Theory -  (the heart is the centre of 46 tubes/channels and they had specific purposes) developed from irrigation. When someone was sick, they believe Wehedu was blocking one of the body's channels.
• They could mend broken bones and dislocations. Evidence of surgery from paintings and papyri, however it didn't venture inside the body. There were no proper anaesthetics, only herbs. Successful surgery would be hard.

• Greeks developed a phonetic form of writing that was more flexible than the Egyptian Hieroglyphs.
• Ancient Greeks still believed in their gods, but took many scientific routes too.
• Hippocrates created the theory of The Four Humours. (which was incorrect). This was believed for thousands of years.
• Most doctors followed the word of Hippocrates. All doctors had to take the Hippocratic oath, and his symbol is on all ambulances today.
• He was believed because he used both natural, medicinal remedies as well as religion.
• Hippocrates also invented the method of Observation (looking at symptoms), Diagnosis (the identification of an illness and it's cause) and Prognosis (the likely outcome of an illness) which is still used today. Some remedies were beneficial, like a change in diet, but others could be fatal like bleeding. 
• Greeks also invented Asclepions, named after the god of healing Asklepios. These were places Greeks could go to feel better (observation, diagnosis and prognosis took place), medicines would be described as well as just being relaxed by going to the baths, massage etc. Some claim to be cured at night by Asklepios, Panacea and Hygena who bathed them.

The Four Humours was a theory that the body was made up of four fluids, and when these were unbalanced you became ill. To get yourself well again, you'd need to put your body into opposite conditions. Eg. if you were hot and wet, you had too much blood. The remedy would to be in dry and cold conditions.

The balance of opposites theory was made by Pythagoras and was developed in 80 books by Hippocrates

• Romans also used Galen's methods of observation, diagnosis and prognosis, as well as believing in the theory of The Four Humours.
• A key figure was Galen
• They dissected both animal and human bodies, so they knew more about anatomy.
• The Romans realised the brain controlled the body, not the heart.
• Most doctors were in fact Greek Prisoners of War.
• Romans still used bleeding as a "cure"
• Still belief in gods, but lots more exercise, change of diet and herbal remedies. The first two would be heavily influenced by the army. 
• Leeches used for healing skin
• The Romans managed successful cataract surgery and artificial limbs. 
• They also developed public health, with "toilets", bathhouses, fountains, gymnasiums.
• They drained swamps and marshes which reduced malaria from mosquitos. 
• Aqueducts were built to transport clean water
• Sewers were built to remove excrement from the streets.

The Romans were very clean compared to those before them in history which reduced disease and sickness, but disease rates were still high because of huge population density. 

Galen was a Greek born in AD129. Aged 16 he started studying medicine. He practiced as a surgeon at a gladiator's school to treat wounds, and he became famous when he travelled to Rome and was doctor to the Roman Emporer. He taught other doctors his knowledge.

He emphasised Hippocrates' methods of observation, diagnosis and prognosis. 

Galen dissected human bodies in Alexandria for increased knowledge, however in Rome dissection was only allowed in animals, meaning some details were wrong; this is why he encouraged his students to dissect human corpses whenever possible.

Like Hippocrates he believed in the Four Humours, but expanded on them. He used "opposites" to balance them.

Galen wrote 60 books in his life, which combined Greek thoughts and his knowledge. However, most information in these were wrong, and consequently people believed these for 1500 years. 

500AD - 1500AD

The Middle Ages were a time of decline for health, because the Roman way of life was eradicated. Disease became more common, and public health plummeted. 

There was almost no thought of public health - open sewers, throwing excrement onto the streets, dirty water. In fact, most people drunk ale, as the water was so bad. Some monastries tried to keep clean, but that was about it. 

The influence of Galen was still around, because it agreed with the Christian beliefs, which meant that for 1400 years, people were still treating sickness wrongly. 

Medieval surgery wasn't regarded highly, so it was mostly done by barber surgeons. Antiseptics (wine) and anaesthetics(hemlock, opium and henbane) were tried out, but they weren't adopted. People didn't know that germs caused infection, so infection rates were high. There weren't really any doctors, so it was mostly "wise women", barber surgeons and physicians that treated the sick.

In 1300 corpses were used as teaching aids for dissection, which eventually brought the knowledge of anatomy back to the standard of the Romans. 

400-800AD - Saxon York. 

• Lots of bone and joint diseases from poor diet. 
• Women dying young, especially in childbirth
• Short life expectancy
• High infant mortality rates

• Stone buildings from Romans still standing
• 600AD - Important centre for the Church
• Patches of marsh and wood around the centre of York

800-1080AD - Viking York

• Animals roamed freely
• Diet varied and nutritious, especially from fish
• Lots of worms and parasites.
• Town made of tightly packed streets and houses - spread of disease
• Viking settlers traded with homeland

1080 - 1400AD - Norman York

• Becoming cleaner
• Cesspits lined with stone and emptied when full
• Abbey of St. Mary had a stone built sewer

• Norman Conquest
• 1/6 of houses destroyed for 2 castles
• Improved harvests
• Stone foundations for houses

1348 - 1350

The Bubonic plague killed around 1.5 million people in England, as well as millions more in Europe. It was called the Black Death because of the dark marks which formed around buboes. It's believed that the disease came from bacterium in fleas, which came to Europe from the Gobi Desert which jumped on by rats in Europe. Due to bad santitation and a lack of knowledge, many preventable deaths occured. Symptoms included buboes that filled with pus, delirium, high fever, vomiting, bleeding of the lungs, extreme fatigue and eventually death.

There is now a vaccine for the bubonic plague, however people believed:

• Worshipping God would save them. Flagellants whipped themselves in the hope that their sins would be forgiven
• Bad air (miasma)was to blame. This was partially true, but people didn't know about bacteria, so they carried bags of dried flowers (which was ineffective)
• "Cures" included: washing wounds with vinegar and rose water; cutting the buboes then filling them with lillies, tree resin and human exrement; bleeding; the burning of all cats and dogs as well as waste (this was the most effective solution); witchcraft.

After the Romans were conquered, public health regressed. People had to drink ale to try to not get cholera and people dumped their excrement in the street, as only the rich had toilets (which were built over rivers).

The government knew there were problems regarding the lack of cleanliness and sanitation, but they couldn't afford to provide like the Romans did. Instead, they passed laws, like how it was compulsory to bathe 4 times a year. however the laws didn't work as they weren't reinforced. 

Some private individuals contributed to the improvement of public health more than the government. For example, Alderotti advised daily stretching and the washing of face and teeth. Nobles took regular baths, as did those in monastries. 

Hotel Dieu in Paris in the 7th century was the first hospital to care for sick people (although it was caring not curing). Other hospitals were build through donations, and were usually run by Benedictine Monks. In 1249 there were the first female nurses (which had to be 50 or over) at the Great Hospital of Norwich. Almhouses were created in the 14th century for the 'deserving' poor and old. 

HELP

• Caring for sick - monastries' 'hospitals' and leper houses to help 'normal' people
• Search for treatment - along with religious practices they performed miracles and herbal remedies.
• Women were allowed to be midwives and surgeons
• Monastries regarded fresh water as a priority; waste water washed latrines;sewers built
• Individuals inside the church wanted to know more about sickness and disease, like Roger Bacon.
• The French Church allowed dissection
• 900AD - the first university medical school in Europe. 

HINDER

• Some people weren't allowed into the hospitals - sins, degree of sickness etc
• Cures weren't highly sucessful - only 10% of monastries cared for the sick
• Women weren't fully trained
• Every new medical or scientific idea was compared against the Bible. If it didn't agree, it was banned. 
• Only priests and monks learned to read, so they had all the power. Priests told people how to behave and what to do. 
• Belief that illness was created by God and the Devil as punishments. 
• They encouraged Galen's theories because he believed everyone has a soul.
• Until the 14th Century dissection was banned by the Church.
• When Roger Bacon told people to ignore Galen and do their own reseach, the Church and government imprisoned him for heresy.

1400-1700. A period of rebirth, examining new ideas and questioning things. 

• 1436 - Guttenburg's printing press stopped the church controlling everything. New ideas could be formed and spread. 
• 1543 - Versalius wrote a book that contradicted Galen's beliefs. He was known as the Father of Anatomy
• 1575 - Fabricus showed physicians how to set bones in the correct positions
• 1685 - Charles II died of a stroke, meaning Ambroise Pare could promote treatments.

WILLIAM HARVEY

• Showed that veins only carry blood, not blood and air.
• Proved that blood isn't constanly made by the liver and used around the body, but is in fact repeatedly circulated throughout the system.
• He had theories about capillaries in veins, but had no proof

ANDREAS VERSALIUS

• Published The Fabric of the Human Body. 
• He showed that several of Galen's theories were wrong, such as 

        -The body contained muscles and nerves

        - Facts about different organs, like the liver not having lobes

- The heart's septum does not contain holes

- Humans had a single jaw bone

The Renaissance had a limited impact on the understanding and treatment of illnesses. Why?

Even though many discoveries from Versailius were made about anatomy, such as muscles, nerves and organ, he did not go into disease. He made treatments for bones easier, as he realised the sternum was made of 3 parts, not 7, and the jaw only 1. This meant that if broken, being set was easier. However, this didn't help the cause of diseases and sickness, and prevention wasn't achieved either.

The same thing goes for William Harvey. He made a lot of progress with blood, how it is produced by the liver and realted things such as a theory about capillaries (even though there was no proof at the time due to a limited range of technology). Yet again these discoveries didn't help the prevention of illnesses, as some discoveries still weren't fully understood. 

Ambroise Pare was a French surgeon in Renaissance times who discovered a new way to treat war wounds and amputations. He spread his knowledge through books (Method of Treating Wounds, Les Ouvres etc )

When at war he ran out of oil to cauterize wounds, so he made a dressing out of rose oil, egg whites and turpentine. He observed his patients and realised that the soothing remedy was more successful that cauterization, as well as causing less pain.

Pare also used ligatures to tie off blood vessels after an amputation, as he realised it was more effective than using hot iron/oil to stem blood flow. Even though this was less painful and worked, his idea wasn't widely accepted by other surgeons, as they were complicated and could lead to infections which could cause death.

Ambroise Pare set up a school for midwives in Paris and taught them how to turn a baby around inside the womb. 

He also disproved that a Bezoar Stone could cure all poisonings. 

The Great Plague (also bubonic) killed an estimate 100,000, 20% of London's population.

It differed from the Black Death because:

• Those who were sick were quarantined to prevent the spread of disease
• Hospitals had a more caring role
• People began to send themselves and others to the countryside - no infection.
• Some sick were actually tied down to beds to stop them walking around the streets
• Herbalism was used to attempt plausable cures. (apothacaries used)
• Many types of doctors - physicians, barber surgeons, wise women, monks, witch doctors

It was similar to the Black Death because:

• Sick were quarantined with their families, so the sick were kept with the well
• Miasma was still believed to be how the disease spread; no knowledge about fleas & rats
• Superstition was still very influencial 
• Anyone, regardless of class, got the plague
• God believed to have caused the plague; praying heavily relied upon
• There was no cure

The Great Plague made people scared, as they knew the effects of the previous Black Death. The plague brought many effects such as:

• Local authoraties ordered a clean up with tar burning; barrels of tar were burned in the streets
• Laws were created to stop the plague spreading, such as banning theatres
• Dogs and cats were killed
• Mass graves for the dead
• Isolation and quarantine didn't really work as the plague was spread by disease, however people realised that the illness spread. 
• The women were those to find the dead
• Women's roles changed, as they were more involved in medicine. They were more often than not the primary care givers

Death in the Industrial Revolution:

If you were a labourter it was common to die in teen years. Middle and Upper Class people lived until around 30-35. A tradesman usually didn't live past 40. It was quite rare to live over 50. 

People were dying because of:

• Pollution and smoke
• Animal waste
• Rubbish in the streets
• Poorly venitlated houses
• Food left out in the open near horses and other animals (contamination)
• High population density and overcrowding - disease spread quickly
• Food wasn't fresh
• Prostitution; a rise in STIs

Table showing 4 key diseases in the industrial revolution and whether urbanisation increased the spread of the illnesses.

Jenner observed that milkmaids got cowpox, but never got smallpox. He decided to inject cowpox into a child and then injected smallpox. The child did not get ill. This was because the cowpox was a weaker straint of the smallpox disease, so the body was able to fight back against smallpox. 

He tested again, each time on humans not animals, which was new at the time. 

The government was interested in his work, as it showed that innoculations worked, at least for preventing smallpox. They gave him £10,000 for initial research, and later provided another £20,000. Jenner gave away his information as he was more concerned about people's health that his bank balance; this was the start of medical research for everybody's gain. The government paid for free innoculations for people, which showed the government thought it was important enough for everyone to receive. Eventually in 1872 the smallpox vaccination was compulsory, and in 1979 the World Health Organization announced smallpox was eradicated. 

Scientists and doctors believed that diseased caused bacteria - spontaneous generation. Louis Pasteur (in the1860s) realised the truth, that bacteria causes disease. This helped him to create pasteurisation. 

Robert Koch (from 1878 -1883 ) found a way of staining and growing bacteria in a petri dish. By doing this he discovered septicaemia, TB and cholera. Around the same time, difference scientists discovered typhoid, pneumonia and the plague.

Both Pasteur and Koch found causes and answers to disease around the same time (19th century). Both made massive progress in medical knowledge, as well as inspiring others, such as the invention of the combination microscope. They also both worked in teams.

However, Koch was a microbiologist and Pasteur was a chemist. They also came from different countries - France and Germany. Pasteur changed the food and drink industry, whereas Koch made advancement in the discovery and cure to disease. 

• Florence was home taught by her father
• She felt that God had called her to help others
• She went against her parent's wishes and trained as a nurse
• Florence was asked to go to the Crimea to help wounded soldiers
• She worked at Barrack Hospital at Scutari. It held thousands of sick and not enough beds. It was very dirty; at first nurses only cleaned but eventually doctors needed help.
• She returned to Britain as a heroine. Songs were written about her and awards given
• Florence then wrote pressuring letters to those in power for better hospitals
• Later, at St. Thomas' hospital she set up a training school for nurses

• Born in Whitechapel; able to attend a good school
• She was expected to marry well and lead the life of a lady
• She wanted to become a doctor, which was unheard of in 19th century Britain
• Enrolled as a nurse at Middlesex Hospital
• After she passed her exams the Society of Apothecaries banned women from doing this again.
• Met James Anderson, whom she married
• Elizabeth obtained a degree at the University of Paris. Her qualifications weren't recognised.
• She then created the New Hospital for Women in London. This was the first time a woman could be treated by a woman.
• She appointed Elizabeth Blackwell 

• .Her mother was Jamaican, her father Scottish
• Learned nursing skills from her mother who helped invalid soliders
• She visited Cuba, Haiti, the Bahamas, Central America and Britain, and picked up traditional and European medical ideas.
• In 1854 she wasn't allowed to go to Crimea as an army nurse
• Consequently, she funded herself to go there and established the British Hotel near Balaclava
• She was compared to, and rivals with Florence Nightingale

• Pharmacy - a place you go for medical drugs
• Pharmaceuticals - medical drugs you purchase

In 1884 William Brockedon created a machine to make pills and tablets contain the same quantity of each ingredient and in the same sizes. These were then sold to pharmacies, not apothecaries.

Patent medicines were mass produced and recognisable brands. There were the same quanities in each medicine.

In Victorian times anyone could be a pharmacist, despite the dangerous chemicals (opium; cannabis) and strange ingredients (such as boiled earthworms).Most people were still vague om what caused sickness and disease. The working class couldn't really afford pharmaceuticals and the upper class went to a doctor.

Paul Ehrlich

• Young scientist who joined Robert Koch's research team
• Interested in antibodies
• Believed you could kill specific areas without harming the rest of the body
• He started his own team.
• He found dyes that attacked malaria and some sleeping bugs 
• Ehrlich tester over 600 chemical compounds to search for a microbe to target and kill syphilis
• Work with Behring led to a cure for diptheria.

• 
• An antibody is a chemical which attacks a microbe that makes you ill. They can be produced naturally or artificially.
• A magic bullet targets the cell this needs to be destroyed without harming anything around it. 

Louis Pasteur greatly influenced Joseph Lister, due to Germ Theory. He concluded that preventions should happen to stop germs in the air getting into wounds. He cleaned the wound of a boy, and then gave him a dressing which was doused in carbolic acid, as he knew it was a disinfectant. The boy did not suffer from gangrene (as was common). 

Lister later invented a carbolic spray for the operating theatre, and also insisted that the operating theatre was kept clean, that surgeons should wear clean clothes and that instruments were regularly disinfected. 

After Pasteur and Koch developed Germ Theory, people could understand disease better. Lister's progress meant that surgeries were cleaner, but carbolic spray wasn't suitable for everyday use. 

One day in the lab, Fleming accidentally discovered a mould on culture dishes. He noticed that the mould stopped the germs developing in that area. 

It was identified as penicillin. Fleming used it on animals and there was no ill effect, and it cured a colleague's eye infection. Fleming had discovered the first antibiotic. 

However, he did not have the funds to develop and produce his work, so at the time his findings had a limited impact. 10 years later, Florey and Chain created a team to develop penicillin, but unfortunately, due to the small amount of it available, it didn't last long. It kept people alive for a little while, but once it run out they died. It didn't build resistance. 

It wasn't until WW2 when an American team mass produced penicillin that it became a drug. Up until this point the discoveries had a limited impact. 

The NHS meant that: 

• There was free healthcare for everyone; the working class could afford it.
• Vaccines and innoculations given. 
• It was on a national scale; healthcare could be regulated. 
• There was a huge push for progress as everyone teamed together
• There were more jobs
• A bigger need and faster advancement in technology

However it also meant:

• Money shortages resulted in sections being closed
• People had to pay for prescriptions and dental care, so not everyone could afford it in the end. 

- Found in chromosomes, which are found in the nuclei of all cells except red blood cells. 

Factors that led to the discovery of DNA

• Gregor Mendel studied plants and recorded how genetic characteristics could be passed onto the next generation
• Electron microscope developed
• It became known that each body cell contains DNA
• Scientists at Cambridge University investigated the structure of DNA. Crick and Watson realised the structure.
• 1990 - The Human Genome Project began to map every single gene in the chromosomes in every cell in the body.

The electron microscope and X-Rays were needed before it could be discovered. Also, the information could be shared and stored on 5CD-ROMS rather than 80,000 books. This is why technology was fundamental to the discovery. 

DNA meant a better understanding of genetic diseases, new techniques for skin grafts (eg cloning), a better production of insulin and stem cell research.