History - Medicine Through Time

• Science and technology
• War
• Religion
• Government
• Communications
• Chance

• No medical operations
• No writing
• Mostly hunted 
• Farming was introduced later
• They were nomads

• Use of trephining - cutting out holes in the skull to release headaches etc

• Common sense cures
  • Animal fats for wounds
  • Wooden splints for bones
  • Clay casts

Hunter Gatherers:

• Stayed in groups between 30-100
• They were in constant movement, so killed off the slow, sick, and some babies.
• Got good nutrients from the variety of foods.
• They stayed fit from their constant movement.
• Didn't get diseases from insects.
• They did not get smallpox/measles
• They suffered badly from worms and lice.
• They could be severely deformed.
• They often got rabies from animals/eating raw animal flesh.
• Gangrene was also a probem, as was arthrities/rheumatism.

Farmers:

• Settled into areas
• Began to keep and raise animals
• More food was available
• This meant that humans could spend their time learning other skills
• Mosquitos spread malaria throughout the groups
• There were diseases from the animals
• Polio, cholera and typhoid were all common problems.
• Contaminated water was a problem.
• They also suffered from many airborne diseases.

More on prehistoric people:

• They often made cave paintings, but these paintings have faded and are difficult to read and interpret.
• Skeletons from the age tell us many things: 
  • height
  • gender
  • injuries
  • cause and age of death
  • if the female had a child
• However, most skeletons are damaged or hard to find.

• Also in prehistoric medicine, they used "Pointing sticks." They pointed these at people and "stole" their spirits. The only way to retrieve the spirit was to steal the stick.

Extra info:

• They recorded every day speech so we know of their behaviour
• There are bones found from the time which represent the hard lives of the workers
• Craftsmen decorated their own tombs as a hobby, and these tombs contained drawings of life experiences.
• Flooding in the Nile made mud rich, so crops grew better.
• Women were equal to men.
• It was common to wear make-up and wigs.
• They believed that blocked blood vessels were in relation to the situation in the Nile - if a channel as blocked, the water stopped flowing.
• Vomiting/purging/bleeding was used.
• There is evidence of surgial operation.
• Willow leaves and willow barks were used as an antiseptic.
• There were many different gods for different purposes. (Sky, underworld, war, pregnancy etc)

• Rich
  • Pharoah
  • Vizier
  • High priests, Nobles
  • Doctors, Priests, Engineers
  • Scribes
  • Craftsmen
  • Slaves, Farmers
• Poor

By 1400BC doctors were loaned to foreign courts like Syria. As they could develop their skills in other things, they learnt how to build ships, and therefor could trade with far away lands. 

Because they could write and record, they could note down medical information and share this.

Several cures

• Diseased Eye: Clear up the pus - use honey balm from Mecca and gum ammonia.
• Tumour: Treat it with a knife and remove.
• Stomach Ache: HErbs and laxatives on three days in every month.

• Use of Mice in Medicine:
  • Mouse fat to refuse stiffness
  • Mouse head to get rid of an earache
  • Rotten mouse to stop hair from turning white
  • Chopped mouse to use for scorpion bites

• All doctors practised surgery, which was mostly cutting out swellings.
• Alcohol was used to numb the pain.
• They used trephining but survived, which is evident from several skulls as the bone had grew back.
• Fresh meat oil, honey, extrement, blood, animal fat, stitching and bandages were all common treatments.
• Herodotus called Egyptians "the healthiest of men."
• Egyptians believed in keeping clean as it kept them at peace with the spirits.
• Egyptians washed constantly and cleaned their houses often.
• Cleanliness was their own responsibility.
• Egypt was far away from other countries so did not need to train an army.
• Nile helped grow crops so they spent less time worrying about food and more time rworking on skills.
• Religious mummification alloed them to better understand the human body, but prevented further analysis.

• Alexander the Great formed the great library of Alexandria, holding many books of famous doctors and philosophers.
• People like Aristotle argue that dissection should be allowed, as their soul left the body when they died.
• They held public dissections in Alexandria, and allowed anyone to come and watch.
• Herophilus discovered the connection between the nervous system and the brain, but he thought vessels were to carry "the life force."
• Erasistratus also thought this but rejected the idea when he discovered the nerves were hollow.
• Medicine in Alexandria never progressed much as they relied heavily on the works of doctors before them, so never persued their own studies.

• Romans did not know about germs.
• They bathed regularly.
• In public toilets, they used the same sponge, but washed them off to be used again.
• They believed in prevention rather than cause or cure.
• They didn't have any doctors before Galen.
• Romans didn't trust Greek doctors, because they were weak enough to be taken over. Greek doctors were used as slaves.

Galen:

• He was trained in the great medical school of Alexandria.
• He was first a surgeon to gladiators, and from this he learnt a lot about human anatomy.
• He turned into a doctor after this.

Galen Continued:

• He has written over 100 medical bookes.
• His work as majorly influenced by the theory of Four Humours.
• He studied animal bones once Alexandria banned dissection, also studying human bones through other means (such as flooded cemetaries etc.)
• He mainly studied apes and pigs, but also other domestic animals. This was a problem as they have different bone structures to humans.
• He figured out that urine was made in the kidneys.
• However, he thought that blood was made in the liver, and that humans have 2 jawbones.
• People believed all of his work was true, considering how famous he was and how many books he had written, so no one attempted to study more into the subject of anatomy.
• His books were used as criteria for all doctors.

Public health - Water

• Water is collected from rivers and springs. The soil determined the quality of the water.
• It flowed along large stone channels the size of doorways.
• Channels get closer to the Roman cities and emerge from the hills. 
• Aqua Claudia's swept the water into the city.
• The water was cleaned by the use of settling basins and reservoirs on its journey to the city.
• Water was piped underground to street fountains, public baths, and lavatories.
• RIch people and businesses paid a fee to have water pumped to their workshops.

• Every fort had a public bath and fresh water.
• The Romans worked heavily on producing good soldiers.
• They believed in a good diet, and a good exercise regime.
• The Romans left Britain in AD410.
• The Roman's ideas had built up a strong government in Britain, but once the Romans left, this government fell into despair.
• The water and sewer system completely stopped working.
• Anarchy began in Britain.
• Small British Kingdoms fought against Saxon invaders.
• All medical books were destroyed, and all of those who had learnt skills from the Romans, had died.
• This left Britain a lot less developed than it was previously.

Fall of the Roman Empire

• In the late 14th Century (AD), the Roman Empire was in decline.
• Tribes of goths, huns and vandals were threatening and over-running the empire.
• The Empire was over-run and competing tribes went to war to become the next ruler of Rome.
• As a consequence, the Empire split into two parts in AD 395. The Western was ruled from Rome. The Easten Empire was ruled from Byzantium.
• The Roman way of life and knowledge of medical health had therefor survived, and moved east into Asia Minor and onto Arabia.
• The works of Galen and HIppocrates were translated into Arabic and were used for centuries to come, shaping medicines development.
• By AD476, the last Roman Emporer was defeated by a Germanic Chieftan.

• Greek Medicine: Gods could cure illnesses or injuries.
  • Roman Medicine: Only as a last resort. During the Greek Plague, they used natural remedies, but also relied on the Goddess of health, Salus.
• Greek Medicine: Doctors observed patients and recorded symptoms.
  • Roman Medicine:  Galen wrote many books, and encouraged doctors to keep records of their patients.
• Greek Medicine: Herbs were commonly used as treatments.
  • Roman Medicine: Romans tried age old remedies based on herbs, e.g opium as anaesthetic.
• Greek Medicine: Doctors frequently recommended exercise and changes in diet.
  • Roman Medicine: They believed in prevention rather than cure and centred a lot on exercise and good diet.
• Greek Medicine: Doctors successfully carried out simple operations.
  • Roman Medicine: Trephining was used, eye operations, e.g cataracts.
• Greek Medicine: Doctors were interested in discovering causes.
  • Roman Medicine: Romans were not interested in causes.

• Greeks were famous for having theories and ideas for everything.
• Romans were less interested in theories and were much more practical.
• Greeks only had small cities, and not many contagious illnesses.
• Romans had large cities with too many people too close together.
• Greeks were independent cities, with no individual government.
• Romans had a strong government, which let ideas spread quickly.
• Greeks had wealthy people who could afford to pay for medical care.
• Romans had even more wealthy people than the Greek Empire.
• Greeks had a small army for each city that only got together during war.
• Romans had hundereds of thousands of soldiers, permanently stationed over the Empire, constantly at war.

More on Roman Public Health

• By building houses far apart after the big fire in AD64. Houses were too close together so they caught on fire easily.
• People were hired to check  that food was of selling quality and that it was safe to eat.
• Burying the dead inside the city walls was banned, and this began cremation.

In took nearly 2000 years for Europe to have decent health facilities after the fall of the Romans.

The Romans built **** impressive facilities because they knew it helped keep disease away. They had an empire to defend and they must be kept healthy to do so. They were also skilled engineers and buldings, and preferred working on prevention (i.e sewer construction) rather than looking into causes of disease.

Main Five criticisms of Roman Health

1. Most poor Romans lived in a crowded tenement block, and depended on wells and water carriers. These wells could become contaminated easily.

2. Rome suffered from many huge epidemics of malaria and the plague.

3. They used lead pipes for their piping system, leading to lead poisoning.

4. The sewers emptied into the river, most likely polluting it and causing even more water contamination.

5. They built few hospitals. The Army had them, but Doctors used homes for rich people. Large houses had slave hospitals but most populations didn't have access to a public hospital, or any hospital at all.

• In the 14th Century, the use of astrology became important in medicine. This was because more Greek books were being translated. These books said that Hippocrates told doctors to study the sky and stars so they could forecast the weather. This would affect the Four Humours so doctors would be able to diagnose and treat patients better.
• Doctors had also began to accept that the planets and the signs of the Zodiac had an impact on health and illness. This is because the body is made up of the same elements as the planets.
• The three deadly diseases in the Middle Ages were the plague, typhus, and measles.
• The average life expectancy was 29 years old.
• They tried to cure illness through praying, amulets with Christian engravements, and holy oil.
• Becket's Blood cured blindness, leprosy & deafness.
• The King cured Scrofula by touching peoples heads.

The Growth of Christianity

• In 313, the Emporer Constantine had been converted to Christianity and had made it the official religion. 
• Christians thought the soul was more important than the body. Their main concern was to save peoples souls. 
• Disease was thought to be a punishment from God, therefor cures should only be from God. 
• Christians had believed that Christs second coming was near. This would be the "Day of Judgement" and the ending of this life on Earth. This made earthly problems seem unimportant.
• As time went by, and the second coming didn't happen, Christians began to take more interest in medicine. 
• In the Gospels there are examples of Jesus healing people. Christians argued that they had to follow Jesus' example and show compassion for fellow humans by caring for the sick, though it would be God providing the cure through this care.
• Many monasteries cared for the sick. The benedictine monks believed that the care of the sick is to be placed above and before other duty.

Dissection:

• In 1299 the Pope banned dissected corpses from being buried in a grave pit - he wanted them to have a proper burial. The Church didn't stop dissections as long as the doctors used the body of an executed criminal.
• Human dissections were used in some universities to teach students about the body. However, the dissections did not lead to more knowledge about the body because:
  • The Church was not keen on tampering with bodies
  • They did not use dissections to question Galen's ideas
  • Sometimes they had no human bodies and had to use animals
  • Some teachers did not do dissections as all the answers were in Galen's books
  • Dissections only took place in winter and were very rushed.

Treatments and Cures

• Mostly plants and things like onions and garlic (anti-biotics), copper salts (excellent ointment for infected eyelids), lichen (for wounds) and animal fats were used in Anglo-Saxon medicine. 
• However, they had no anaesthetics except for a few herbs which mildly helped the pain.
• They also used blood letting and vomiting, which did more harm than good.
• They used some "magic" for medicine, and thought it was very important.
• They could do little surgery and lacked in antiseptics. 
• Most treatments were taken from the Romans or carefully developed themselves.
• Anglo-Saxon society was at the mercy of disease on the one hand, and medical ignorance on the other. Apart from basic herbal mixtures, they had no means of treating serious illness.

Leper Houses:

• A leper is someone with leprosy. Leprosy leaves people with physical symptoms such as parts of the body being slowly eaten away, leading to scaly and decaying flesh.
• Lepers had to wear certain clothes. 
• They could not wash in rivers or springs.
• They were confined to leper houses.
• They were to be kept separate from anyone else. 
• Medieval people thought sexual intercourse caused leprosy, or that it was a punishment for sinning.
• Leper houses were built separate from towns or populated places.
• Leper houses were built to keep lepers away from the general population.
• By 1600, leprosy had died out in Europe.

• In the middle ages in Western Europe, everyone was a Christian and therefor was Catholic.
• Religion controlled every part.
• The Parish church was the centre of village life. People went there nearly every day.
• Villagers went there to pick up news. Markets, festivities, and games were also held there.
• People believed strongly in heaven and hell, and so by going to Church they think they'd go to heaven.
• The Church was the centre of learning, therefor they controlled the universities and all the hospitals.
• All doctors were trained in a university so they had to follow Church teachings, and the Church picked certain medical believes that fitted in with their views.
• The sick could be treated by monks, but they could also be treated by doctors/apothecaries/local knowledgeable men and women.

• Many people would go on pilgrimages to places like Cantebury to repent.
• The planets were also said to be responsible for disease. Doctors had to be good at astrology to chart the progress of the planets.
• Trained doctors used the ideas of the Four Humours, theory of opposites. They also studied urine.
• Doctors also used herbal remedies, however a bitter herbal cure was believed to drive the evil spirit causing the disease.
• Many Doctors used Vademecum to diagnose disease and illness. This was a book containing tables, charts and cures based on Astrology.

Common herbs and spices:

• Clover, knapweed, dock, sugar, ginger, cloves

Common magical remedies/spells:

• Elephant tusks, powdered horns of a mythical unicorn, verbena

The herb verbena could cure the bite of a rabid dog, reduce fever, restore a nursing mothers milk, stop bleeding, and keep away the plague.

• The old and weak would often have leeches attached to their skin, that were taken from clean streams, stored for a day with no nourishment, then applied to open wounds and swellings.
• Women and children were cupped - a heated glass or brass vessel was placed on the skin which had been scratched with a knife.
• Some patients bled to death during blood letting, if their artery was cut.
• Bleeding from the vein between the finger and thumb was thought to get rid of a migraine.
• Blood letting from the vein under the ankle was thought to rid of diseases of the bladder.

Women and Medicine

• The Church was suspicious of women, and saw them as weak/unclean/corrupt. Galen had said that women had more of the cold, wet humours, and were less capable than men - they were weak willed, fickle, and more prone to madness.
• Women were allowed to train as doctors until the 14th Century.
• Women were expected to look after the health of their families.
• Treatments were handed down from mother to daughter because of this tradition.
• The church disapproved of wise women and faith healthers that used charms and herbal medicines.
• They were cheaper than Doctors, so they would have been disliked for "stealing business."
• Women were also employed to care for the sick and to be midwives.

Why were monasteries important?

• The Monasteries studied the writings of Galen and HIppocrates, and monasteries were the only places to learn until 1100 when medical universities were made. They copied old books so could spread this knowledge.
• Most monasteries encouraged taking care of the sick, and they became key medical centres - they had infirmaries for sick monks and a seperate hospital for the public.
• Most monasteries has a lot of money so they could afford to stay healthy. Toilets were built over the river, and the laver was a stone where monks washed.
• Features of a monastery that helped public health/hygiene: Hospitals, clean water, bathing areas, toilets that got rid of waste, water pipes and reservoirs.

Why the plague spread so quickly in London:

The streets of English Towns in the 14th Century were very unhealthy. This was one of the main causes of the spread of the plague in 1348. The filthy streets and tightly packed houses made perfect breeding grounds  for rats and fleas that carried the Black Death. Unfortunately, people at the time did not know that fleas and rats were the carriers, so they did not think to clean up their streets to stop the spread of disease.

The Black Death killed 50 million people in the 14th Century, 40% of England's population.

Symptoms of the bubonic plague: Fever, headache, tiredness, painful swellings (buboes) the size of apples in the groin and armpits. Small, oozing red and black spots appeared all over the body, giving the disease the name "Black Death." Many patients only lasted a few days before a painful death.

It wasn't until 1894 that it was discovered that the bubonic plague was caused by germs carried by the fleas. 

Public health in 14th Century London:

• Butchers were put into the pillary with meat burning infront of them, if they were caught selling rotten meat.
• 1343 - Butchers ordered to use segregated areas for butchering animals.
• 1345 - The fine for throwing litter on the street was raised to 2 shillings.
• 1347 - Anyone with filth outside their house was fined 4 shillings.
• Houses next to streams had their latrines built over them.
• Butchers carried waste through the city, loaded it onto boats and threw it into the middle of the river at low tide.
• The public toilets were built over the Thames.
• The wells for fetching water were often very close to cesspools for dumping sewage.

Back in 1349, people had very different ideas about the cause of disease.

• Breathing "bad air"
• Annoying God
• Touching a victim
• Looking at the victim
• Drinking from poisoned wells
• An imbalance of the four humours
• Position of the planets.

Cures:

• Eat arsenic powder
• Strap a live shaved chicken to the sore.
• Sit in a sewer (worse air to drive the plague air away.)
• Left the blood out of the patient.
• Eat crushed emeralds.
• Put herbs on the fire to make the air smell sweet.
• Go from town to town whipping yourself. (Flagellents.)

3 Islamic Writers:

• Rhazes (AD 850-923) wrote 237 books on medicine. Most of his work was based on Hippocrates and Galen. He wrote "he who studies the works of the ancients, gains the experience of their work as if he himself had spent thousands of years investigating." He produced the first descriptions of smallpox and measles.
• Ibn Sina (Avicenna) (AD 980-1037) produced 100 books. These were copies and commentaries on Greek writings. He was mainly responsible for bringing Greek writings to Europe.
• Ibn al-Nafis (AD 1200-1288) corrected Galen about the heart. His discovery was made 300 years before the same discovery was made in Europe. 

• The Chinese believed that disease could be cured by the restoration of harmony and balance between the five basic elements of earth, water, fire, wood and metal. They also believed that all human beings were made up of two sorts of energy, Yin and Yang, which together with blood constituted the vital substance with circulated the body.
• Yin is dark, moist and female, while Yang is masculine, light and dry. Illness was caused by an inbalance between the two. Balance could be achieved by methods such as acupuncture which were used to control the flow of energy within the body.
• Another method used in Chinese medicine as moxibustion. This involved placing a cone of moxa (the powdered leaves of the mugwort plant) on particular acupuncture points and setting them alight. This was believed to increase the amount of Yang in the body.
• Chinese doctors concentrated on examining the pulse in a variety of ways; they believed it indicated the flow of vital energy within the body. As human dissection was forbidden in ancient China, physicians knew little about anatomy.

• Muslims had great respect for learning.
• They translated, preserved, and studied Greek writing - particularly Galen.
• Writers often added their own commentary.
• If it wasn't for Muslim writers, Greek ideas might have been lost.

Muslims believed:

• Disease was a punishment from Allah
• Both prayer and the four humours could cure disease
• Allah cured people through doctors - people were encouraged to visit them
• Dissection was banned.

Treatment:

• Clinical observation was very important.
• Doctors looked at behaviour, swelling pain, pulse, faeces and urine.

Surgery was looked down on, and was only carried out by untrained people. Cauterisation was the most common form of surgery.)

Medicines:

• They had lots of knowledge of plants and animal products to use in medicines.
• Laudanum was used as a painkiller.
• Alcohol used as antiseptic.
• Bezoars (stone from a goats stomach) used against poison.
• Pharmacies set up.

 Public Health:

• Islam taught that people should keep clean, and sick people should be looked after in hospitals. 
• Hospitals more advanced than European ones, e.g Cairo had seperate wards for different diseases, a pharmacy, and a medical library.
• Hospitals concentrated on medical treatment and not prayer. Open to rich and poor.
• Towns no cleaner or dirtier than European towns.

The Asclepion:

• Step One: You will go and make an offering to the God of healing, Asclepios, and his daughters Hygeia and Panacea. You may offer anything - Gold, cups, bowls, jewellery. This will please Asclepios and is a way of thanks. 
• Step Two: You will go bathe in the sea to cleanse and purify yourself for the healing process.
• Step Three: You will sleep in the open-air abaton for one night, in complete darkness and complete  silence. While you sleep, Asclepios shall visit you, accompanied by his two daughters and maybe even snakes. They shall heal you in any way that is necessary.
• Step Four: Hit the town with your health restored! 

• A Greek story helped them to form the seasons
• Lived in independent city states
• The children were carefree
• Anyone who was not Greek was called a "barbarian"
• Greek Gods were very "human"
• Men were usually always trained to be soldiers
• The lives were different in seperate places - in Athens, they were more laid-back, where as in Sparta, everyone had to centre lives around physical health
• Women were always tied to domestic work

Clinical Observation:

• The doctors should always ask about the patients past and present behaviour (e,g way of life, work, diet and exercise). They should ask the patient about symptoms. They should examine the patient carefully: Listen to the breathing, take the pulse, take note of any smells, examine the body and any excretions. Ignore nothing, and make a record of everything.

The Theory of the Four Humours:

• Summer: Yellow Bile is increased, especially among young people, and led to fevers and vomiting.
• Autumn: Fever would reduce but black bile would increase, especially among aldults. Historians were not sure what black bile was, it was said to show in vomit and extreion, "hissed, bubbling and burning". It could have been dried blood.
• Winter: Phlegm increased in the winter, especially among the old because the weather was chilly and wet.
• Spring: Blood increased, especially among young children. 

Natural Treatments

• "A healthy body is a body of balance."
• These remedies were usually to keep the four humours in balance.
• Hippocrates said it was the doctors job to keep the patient in check - this could mean blood letting, vomiting, eliminating blood, rich foods (red meat), encouraging a balanced diet, encouraging a sensible amount of exercise, bathing, sleep, and even sex.
• He believed that doctors should not interfere too much and to leave a lot to nature. They were not keen on using drugs, rather using drinks. They also encouraged a healthy lifestyle.

The Hippocratic Oath:

• The Hippocratic oath is still used and is important to doctors today. Because Hippocrates is seen as the father of medicine, the oath sums up most of what doctors must do. The oath centres the doctors' work around the best intentions of the patient.

Why were Greeks able to make such advances?

• Eventually some of the priests from the Asclepions began to focus more on medicine rather than religion. They had learned a lot about illnesses and treatments, and began to move from town to town, treating the sick. Their experiences and knowledge were finally collected together in the great library of Alexandria in around 280 BC. This collection of about 130 books is called the Hippocratic Writings - we do not know if Hippocrates actually wrote them, but they are named after him and seem to follow his theories.

• The only issue with the Hippocratic writings, are that they say nothing about anatomy and physiology. They also say little about surgery. Most of the ideas in the books can only be followed properly if you're wealthy.

What were Greeks not good at?

• The only people who could afford a healthy lifestyle were the rich people.
• Athens in the 3rd Century BC was dirty and filthy, with dirt and mud everywhere and with no clean water. They also had bad housing and a bad street layout.
• The Greek people had to wash their feet before entering their own homes due to the filth.
• The city authorities said keeping the streets clean was a citizens responsibility, and that they should have cleaned it themselves.
• Human dissection was banned so they explored anatomy through human skeletons, which is not entirely accurate.
• Doctors did not carry out surgery.
• Surgeons could only: Treat factures, cut out tumours, squeeze out pus, cauterize wounds, or small operations. 

Factors:

• Buildings: The Greeks were great builders. They could easily build facilities for medical uses, but temples may have caused them to rely on religious cures.
• Stadiums and Gymnasiums: Taught the Greeks that exercise kept people healthy, and it was regular as they enjoyed sport. 
• Art: The Greeks began to draw and sculpt the human body very accurately, which made people train in art and communication. This also could have helped if they had further studied anatomy, as they would be able to further convey their ideas through diagram.s
• Science, literature, history, philosophy: The Greeks produced many great thinkers who developed new ideas. 

Other Factors:

• Geography: Greece is near Egypt and also Crete. The Greeks could have learned ideas about medicine from the Egyptians who they could have traded with and also learned from the Minoan people.
• Organisation: Greece had a number of independent city-states, which were democracies where people voted. It allowed more progress as everyone could contribute, but allowed space for regression as everyone was split up.
• Ancient Greek: Everyone shared the same written language, allowing to write books and spread medical knowledge.
• The Greek Gods: They shared the same ideas of Gods, and these beliefs did allow them some freedom to express their own ideas and skills. People were allowed to look into medicine without necessarily being limited by religion. They could find natural cures rather than relying only on supernatural cures.

1450 - 1700 AD.

Other changes:

• Art - Art began to look more realistic. This was because of more access to dissection. This gave doctors better knowledge on the body and helped for extra accuracy.
• Science and Technology - The Printing Press was invented, which meant medical books could be produced at mass, with less mistakes.
• The Church/Reformation - The protestant church was set up, which meant that doctors did not have to stick by the Catholic ideas and were free to explore parts of medicine that the Catholic church did not previously allow.
• In 1531, Johannes Guinter published a Latin translation of Galens' "On Anotomical Procedures." This book was based on an actual skeleton, and stressed how human dissection was necessary.

• Vesalius was born in 1514 in Brussels.
• He studied medicine in Paris, between 1528 and 1533.
• He resorted to stealing skeletons once dissection was not available to him.
• He worked as a professor, and with surgery once again from 1537.
• He drew detailed pictures of the "Tabulae Sex."
• This drawing shows the ideas of Galen, of anatomy.
• The smaller version of his drawing shows two-lobed liver instead of five.
• Vesalius disagreed with taking small amounts of blood from the opposite side of the sick area. 

• Vesalius: Printed books and also illustrations. His books helped spread ideas. 
• Pare: He happened to run out of oil and find a working ointment through chance. Without the wars, he would've never found the ointment. He also printed books.
• Harvey: Used machines to understand how the body works, i.e pumps. He was taught by others.

• Harvey published his theories in 1628. He did not get his physiological system right, and he put the heart in the middle, with only one lung. He compares the heart movements to machines where one wheel mothers another, and also to the mechanical device fitted into a firearm.
• He was born in 1578 and studied medicine at Padua between 1598 and 1602. Fabricus taught him anatomy. After leaving Padua, he worked in London first as a doctor, and later as a lecturer in anatomy at the ROyal College of Surgeons. From 1618 he was also a physician to James I, and then Charles I. 
• He used animals to study the heart as he could not use humans. He studied frogs hearts, as they are cold-blooded, so he could still see the way the heart pumped blood. The other mammals would stop pumping blood too quickly.
• The heart pumped blood when it contracted, this happened at the same time as the pulse felt into the neck. Blood was not being replaced all the time as Galen had thought. There was a fixed about of blood circulating in the body. Valves in veins meant blood flowed in one direction. Harveys theories made the treatment of blood-letting seem like nonsense.

The 1665 plague of London

• Worst plague since 1348
• London lost roughly 15% of its population.
• The earliest causes of disease occured in the spring of 1665.
• Within the first week, 7156 Londoners died.

How did they attempt to cure it?

• Dead to be buried before sunrise, meaning no one could catch the plague if out on the streets during burial. 
• Killing all dogs and cats - this stopped some spreading of fleas, but also took away the animals that could kill the rats.
• Women were appointed to search and report cause of death, killing off more women.
• Smoking tobacco and going to church... neither of these worked.
• Taking hallucogenic drugs - this would just give them hallucinations.
• Cut a pigeon in half and apply to the buboes - the pigeons could have been carrying disease thus causing more issues.

The Death of Charles II: He was 54 years old and suffered a stroke. He lost his speech and had convulsions. 12 doctors came to treat him.

Treatments tried:

• Blood letting - To balance the four humours. 
• Sacred Tincture - A Religious or magic cure, also using lucky charms. Through use of old herbs and drinks, it was to restore health.
• Barley water and syrup - Healing through herbs and drinks.
• Laxatives - purging was one of Hippocrates ideas about restoring balance. Old and used mostly in Greece.
• Peruvian Bark - An old Holy remedy.
• Bezoar Stone - Said to be "magical", and to immediately cure disease and poisons. This was proven completely wrong by Pare.

These treatments reveal that Renaissance medicine had little impact at the time. Instead of being treated with the new methods of Vesalius, Pare and Harvey, the King was treated with old ideas from the ancient ideas of the four humours, as well as many religious and supernatural remedies.

• Anthony von Leeuwenhoek invented the microscope in 1683.
• Fahrenheit and Celsius invented the thermometer in 1708 and 1742.
• Hydrogen, oxygen and nitrous acid were invented.
• This is an example of Science and technology being developed.
• These discoveries and inventions only made an impact in the 18th Century.
• 1721: Guys hospital was set up
• 1718-1752: William Cheselden removes Gall stone.
• 1742: The Company of Surgeons set up in Britain. The Middlesex hospital in London founded.
• 1728-1793: John Hunter forms a large collection of anatomical specimens in London.
• 1800: Royal College of Surgeons set up.
• Despite all the advances, the setting up of new hospitals and colleges of surgeons, doctors were no closer to understanding what caused disease by 1820 than they had been before.
• Doctors didn't study chemistry, and operations were performed in filthy conditions. No anaesthetics were around and many patients would die from pain, or blood loss.

Edward Jenner & Smallpox.

• Inoculation is the process of giving someone a mild dose of a disease so their body is immune during the next epidemic. 
• Lady Mary Montague brought this idea to Britain.
• The problem with inoculation was that improper dosage could give you the full on disease, and that the use of unclean tools could cause other problems.
• Edward Jenner was a doctor in Gloucestershire. He noticed that is people have cowpox, they were not likely to catch smallpox. He gave James Phipps cowpox, and then tried the same with smallpox, yet James had no symptoms. This was repeated 25 times.
• He opened a clinic and was eventually in America. Vaccination was made a law.
• Some found it pointless. Other doctors thought Jenner was stealing their business. It was dangerous because of the unclean tools.

• Louis Pasteur discovered that germs were the cause of disease. He was a chemist and in 1857 he discovered this by accident whilst investigating why the sugar in fermenting beer/wine soured unexpectedly.
• In the 1860s, scientists made discoveries about the reasons behind diseases.
• Spontaneous generation -> By 1800, scientists knew about germs but they thought that they were the product OF disease. 
• Flies and maggots along with microbes come from decaying matter, according to this theory.
• Miasmas - the most common believe about disease was that it was caused and spread by pollution fumes and bad smells.
• In the late 1600s, a Dutch Clockmaker called Anthony von Leeuwonhoek discovered micro-organisms (germs). 
• Joseph Lister made a microscope that magnified 1000 times without distortion. He was a British scientist and did this in 1830.
• Louis Pasteur discovered that germs cause disease, rather than being the product of it.

The discovery of Penicillin

• in 1928, Fleming was appalled at the conditions of infected soldiers and vowed to find the cure. He once went away, leaving some culture disease around. When he got back, they were covered in mould - which is usual. However, he noticed that the germs were almost trying to move away from the mould. He began experimenting with it, and discovered it as a bacteria killing mould.

The Great Stink

• In London, there was a problem with smell in the River Thames. It could be smelt from 60 miles away. 
• 10,000 people died from cholera, and methane was released.
• They didn't develop better sewage systems at the time, and had been depositing waste by throwing it out of windows and into cess pools.
• Waste collectors were no longer used because London grew and prices fot higher, and they had to travel further, so people did not want to pay.
• In 1850, parliament passed an act which allowed waste to be pumped straight into the Thames.
• 1592 - John Harington produced a water closet.
• By the end of the 18th and 19th Century, it became a middle class status symbol.
• People could no longer drink waters from wells, and poor people were getting leakage from cesspools as they could not afford water closets.

The Great Stink Continued

• In 1840, 1 in 30 people died of cholera.
• The miasma theory was that the disease came from the bad smell.
• John Snow thought disease did not come from back smells.
• In 1858, they wanted the temperature to rise to make it smell horrific, so that the MPs would be forced into building a new sewage system. 
• Bazalgette designed sewers from bricks, which was good because it could be customized into shapes fully, and was also stronger.
• He built 500 miles of main trunk sewers and 1300 miles of smaller sewers, which took him 18 years.
• Steam Engines pumped sewage into the sea.
• He finished his work in 1875, though it was forgotten for a long while because most of his works weren't on view.
• He had achieved getting rid of most typhoid and cholera, and also the Great Stink itself.

Public Health after 1850

• 182 towns set up local health boards. Because of this, water supplies and sewage improved.
• Many areas in Britain did not have health boards, however.
• In 1854, the Central Health Board was abolished because many water companies, landlord, and builders hated its existence.
• Chadwick thought that improved water and sanitation prevention, was the key. Yet doctors insisted that curative methods were more effective.
• Dr. John Snow showed the links between water and cholera, which helped convince the government to improve.
• Pasteur published his germ theory in 1864, also convincing the government.
• Stats in 1870s proved poor living conditions were linked to disease.
• In 1867 many more men were allowed to vote, including some workers, and this helped them get better support with their health.

In 1939, Ernst Chain, a biochemist who had fled to Britain from Nazi Germany, came across Alexander Fleming’s published work on penicillin. He was greatly interested, and soon began working on isolating penicillin. Together with lab supervisor Howard Florey, he isolated the antibacterial agent in greater quantity than Fleming had been able to achieve, and then tested the extract by injecting it into two mice which had been infected with a bacterial disease.

The mice recovered, and the two men then tested the penicillin further in a much larger trial run with fifty mice. They subsequently made enough of the substance to use it in two or three people who were dying from bacterial infections. These experiments proved that penicillin would work effectively in humans, but there was a huge stumbling block, in that it was enormously difficult to isolate enough penicillin to treat even one person. With the Second World War underway, the situation was becoming desperate.

• More on Penicillin:

Ernst Chain was the driving force behind isolating and testing penicillin, but when it came to manufacturing on a large scale, it was Howard Florey who made more of a contribution, by locating several U.S. companies which were willing to provide resources when U.K. factories were occupied with the war effort.

By the end of the war, U.S. companies were making 650 billion units of penicillin every month – staggering in comparison to the 400 units made between January and May 1943.

For their contributions to the discovery and development of penicillin, all three men—Alexander Fleming, Ernst Chain, and Howard Florey—were awarded a Nobel Prize for Medicine in 1945.