GCSE medicine through time.

Prehistoric: before the invention of writing.

Prehistoric people lived as 'hunter-gatherers'. Modern men and women belong to a biological group known as homo sapiens. The first example of homo sapiens are known from about 150,000 BC. 

Without any writing we depend on archaeological findings such as; skeleton remains and burial sites and findings from caves that were used as shelters or religious sites. 

The hunters were nomads. Human waste was easily got rid of and people moved on before much dirt and waste had built up. 
There was no government. 
Cooking was not always successful and sometimes half-raw meat was eaten. 

Advantages: Good water, lots of exercise, food was plentiful as there was such few people. Land was largely empty of other people. 

Evidence: Bones. 

- last a long time
- tell us a lot about health and how people lived
- show that few men survived over the age of 40 + women often younger
- painful bone disease (arthritis) was common in Stone Age 

Trephining: a surgical operation in which a circular piece of bone is removed from the skull. We can also tell from the way the bone grows that holes were often made while people were still alive. This was to relieve headaches or remove a demon from the skull. 

Evidence: Cave paintings. 

- many show the animals that these people hunted
- some seem to be carrying out ceremonies or rituals 

a famous painting from France, a man is shown wearing the antlers of a stag, dancing. Known as 'The Three Brothers'. 

- believed that illness was caused by spirits.
- there were special sorcerers who used magic to make people better. 

Aborigines:
We can learn about prehistoric history as aborigines lived in similar conditions. 

- evil spirits entered the body and made them sick.
-  good spirits that live inside the body leave
- spirits entered/left due to witchcraft

Pointing bone:  used to create spells that make evil spirits invade the body; they could also be used to remove a good spirit from the body. Both causing illness. To cure a person the bone had to be found and thrown into water.  

Medicine men: a specialised person in curing people by the use of magic. 
Treated people by chanting repetitively, sending the patient into a trance and massaging the sick parts of the body. Also announced that they had removed the evil spirit and trapped it in a quartz crystal. 

Living in small family groups meant that knowledge didn't spread very quickly. 

Cures:

- They could treat *dysentery; by chewing the bulb of an orchid.

- Broken arms were placed in clay and allowed to heal. 

- Open cuts were bandaged with materials like bark or kangaroo skin. 

Some of these treatments are still used today. One example of this is Tea Tree Leaves. They burnt the leaves to make a vapour that was good for breathing problems. Today people use tea tree leaf as a treatment for cold symptoms. 

*dysentery: a painful and dangerous disease of the intestines, which involves severe diarrhoea. 

Human population began to rise and farming was introduced. (on the edges of the river Nile). This gave them time to develop their knowledge of medicine. They also learnt how to make bronze tools, this helped surgery. 

Disadvantages:
There were a development of diseases such as malaria. This was closely linked to agriculture. Malaria was caused by a parasite carried by the mosquito, and these mosquitoes thrived in agricultural land. 

People were not nomadic but instead settled into civilised societies. Houses were often dirtier than temporary camps of hunters, this caused disease. As villages grew and the first cities came about people were coming into contacting with each other allowing disease to spread. 

The introduction of cattle were a source of new human disease. 

Advantages: 
The introduction of writing with pens made from reeds onto soft clay. This made possible records of new scientific discoveries. 

They traded which meant they gained and shared their knowledge/ideas with other countries. 
 

Knowledge of the Egyptians. 

The surviving papyrus documents show that Egyptians had a good idea of the key internal parts of the body, including the heart and the lungs. They also understood some of the ways in which these parts of the body were connected together. They believed the heart was connected to the rest of the body by channels called 'metu', these channels were believed to carry substances around the body. 

If the metu channels get blocked by 'wehedu': rotten food and faeces people can become ill. People could avoid illnesses by pleasing God's.  

Hippocratic ideas:

Clinical observation: 
They recorded symptoms. (similar to the way doctors work today). Doctors kept detailed case notes recording how the illness developed over time. From building up lots of case notes they were able to predict how an illness would develop. 
These ideas are summed up into two Greek words that are still used by doctors today:
'diagnosis': the cause of a disease was identified by a careful consideration of symptoms.
'prognosis': the outcome of the disease was predicted. 

Rejection of supernatural explanations: 
 Hippocratic doctors saw magicians and priests who offered treatments for illnesses as rivals and tricksters. They believed illness was not caused by supernatural forces or that it could be cured by spells. 

Regimen: the importance of diet and exercise: 
They believed in preventive medicine. The best way of making sure humours stayed in balance was through exercise and diet. Regimen: healthy lifestyle. 

The Four Humours: 
They believed that they were four fluids or humours in the body. Blood, yellow and black bile and phlegm. Illness could occur when these humours were unbalanced. They thought the body naturally tried to get rid of excess humours:nose producing mucus during a cold. They used blood-letting andvomiting to keep these balanced. 

Hippocratic Oath: 
This stated that doctors would never mistreat their patients. Responsibilities were spelt out in a solemn promise made by new doctors. 

Aristotle is important to the history of medicine because of his work developing biology. He believed all biology should be based on a methodical observation of plants and animals in the real world. He carried out dissections of animals (not humans). This was to find out how they worked. 
Aristotle made a special study of how young creatures grew. He saw the heart as a key organ of the body. He studied the connection between blood vessels and the heart, although he did not understand the difference between arteries and veins. 
 Heart: a place where the body produced heat.
Brain: a kind of refrigerator that cooled down the body. 
He believed the heat of the body was regulated by these two organs working together.  
Aristotle has great influence on other scientists during the Middle Ages and through to the Renaissance period.  William Harvey based his own scientific method on the work of Aristotle. 

The Romans built a huge empire in Europe, which was very powerful and well-organised. People were forced to pay taxes that contributed to the wealth of the Roman government. 

At first, there was no full-time doctors in Rome. Families were expected to take care of their own medical problems. From about 200BC full-time Greek doctors began to appear in Rome. 

During this time the army was very important and was paid for by taxes. Taxes were also used to build large public buildings like bridges and aqueducts. Some soldiers were trained bother to fight and look after the wounded, these specialists were known as 'medici'. Through experience the Romans understood that epidemic diseases could spread quickly among an army.   

Water was carried in large pipes or conduits (open channels) made from stone or brick. These structures were called aqueducts. Some of these still stand today. 
Most aqueducts were not bridges; the pipes ran on or underground.
Most families had to collect water by hand from one of the public fountains.  

 Baths: 
Some baths were free; others made a small charge. They usually offered baths of different temperatures, as well as areas for gymnastics and other sports. Going to the baths was an important social event. 

Public lavatories and sewers:
Instead of toilet paper people used a sponge on a stick. They were rinsed after use and the reused. Some larger towns has sewers to carry away human waste from the public lavatories.  

Galen was greatly influenced by Hippocratic ideas. He accepted the idea of the Four Humours. Like Hippocratic doctors he carried out careful clinical observations. 
Galen developed more active treatments. He believed in the use of 'opposites'; treating symptoms with 'opposite' substances. For example, he gave pepper to patients who were too cold and cucumber to patients who were too hot. Galen also believed in blood-letting and increased the emphasis doctors put on blood-letting. He often recommended bleeding even in cases where the patient has already lost blood through a wound or illness.  

Galen cut up bodies of dead apes and pigs. He carried out public experiments on pigs in which he cut the nerves in the neck. These nerves controlled the pig's capacity to squeal. Once the nerves were cut, the pigs fell silent. 

Although he made mistakes:- 

- His dissection of animals led him to think wrongly that the human brain was linked to a network of nerves and vessels

- He incorrectly identified a connection between the liver and the stomach

- He also wrongly stated that blood moved from the right to the left ventricles of the heart via invisible pores. 
 

The Dark Ages: 
 There were several consequences for medicine: 

• Centres for the training of doctors disappeared
• Many of the key books of Greek/Roman medical knowledge were destroyed and lost
• Roman public health systems collapsed.
  
  

  After the collapse of the Roman Empire much of Western Europe no longer had strong government. They were not organised and didn't see the importance of hygiene. The Catholic Church was very powerful and there was return to the belief that God caused and cured disease. There were many wars and a break down in communication between countries. Some churches/monasteries wrote books about herbs and medicines but they were handwritten, rather than printed, so it was not easy to spread knowledge quickly.  

The Catholic Church had less control over people's lives and dissection was allowed. Printing press helped to spread new ideas.

Versalius: 

• Anatomy professors must base their work on dissection and must carry out dissection for themselves
  
  
• The evidence of the eye should be trusted more than the authority of old books
  
  
• Anatomy was the key to further increases in medical knowledge
  
  

  Versalius corrected many of Galen's mistakes:  

• The sternum has three not seven parts
• The liver does not have five parts or 'lobes'. 
• The septum of the heart is not porous.  

Pare did not agree with treating gunshot wounds by cauterising either with a red-hot iron or with boiling oil. Pare devised an alternative approach to dealing with these wounds in a more humane way. 

Pare campaigned against the use of 'panaceas';  these were exotic imported drugs that were meant to have curing powers for many ailments. He showed the king that a drug called bezoar was useless by deliberately poisoning a man. 

Pare developed the use of 'ligatures'. This was used after amputation. This involved tying cut veins and arteries to stop the bleeding. Pare was the first to give practical guidance as how it could be done. 

Pare tried to help injured soldiers by designing some pioneering false limbs, such as artificial hands.  

Child birth: Pare worked on a technique known as 'podalic version'; this involved turning the baby in the womb so that the baby would not be born feet first. 

Harvey showed that blood circulates around the body: the blood is pumped away from the heart via the arteries and returns to the heart via the veins.

Galen said that veins carry both blood and air. Harvey pointed out that when examined, veins only ever contained blood. 
Although Harvey could not see them, he established that there must be tiny channels that connected the artery system to the vein system so the circulation could take place.   

Harvey showed this by a tight tie or ligature around the arm to stop blood flowing out of the arm and also makes the veins and valves stand out so that they can be clearly seen.  
Harvey puts his finger just above a valve and strokes the blood upwards and out beyond the next valve. The empty vein becomes invisible. 
He tries to force blood backwards down the vein, this does not work because the valve only allows blood to flow one way, up the arm.  

The 19th Century brought industrialisation to Britain and with it over-crowded towns and cities and epidemics such as cholera/typhoid. 

Poorly built houses were damp and infested with disease-carrying animals and insects.

Lack of sewage systems led to pollution of rivers and wells.

Overcrowded accommodation spread infectious diseases.

Poor working conditions left people exhausted and less able to recover from illness

Low wages meant poor people were badly nourished and more likely to catch diseases

Lack of piped water meant unclean sources had to be used.
 

Dr.Snow:
Believed that cholera was not caused by poisons in the air but by drinking water contaminated by the excrement, or vomit of a cholera victim.
Dr. Snow

• Mapped where cholera victim lived
• Noticed the worst cases were round the Broad Street pump
• Removed the handle of the pump to stop the cholera outbreak.
  
  

  Boards of Health were set up in many towns to prevent the disease but most were disbanded when the outbreak stopped. 
  Before 1835, many towns did not have Town Councils to set these boards up. In this year, the Municipal Corporations Act set up elected towns councils who could raise a tax to pay for lighting, pavements, fresh water supply and sewage disposal.  

Jenner noticed that milkmaids who caught cowpox from their cows did not catch smallpox.

In 1796, he took pus from a cowpox sore on a girl and placed it in two small cuts in the arm of an young boy. Six weeks later he did the same with smallpox, but he showed no reaction. The cowpox had prevented him catching smallpox. 
Jenner called this vaccination, from the Latin word 'vaca' (cow)