Medicine

Hippocrates: (ancient Greece)

• He thought it was important to observe and record symptoms
• He encouraged doctors to find natural cures/treatment for disease
• Created the Hippocratic Oath which is still used today to give people confidence in doctors
• known as the father of medicine
• Came up with the theory of the 4 humours

Galen: (ancient Rome)

• Addapted the theory of the 4 humours (blood, phlegm, yellow bile and black bile) thought an imbalance caused you to become ill
• Developed the idea of oppositess (if a patients symptom was too much phlegm then it was considered to be caused by a cold and so heat was used as a treatment)
• Believed physicians should find out as much as possible about the human body (agreed with dissection)
• He wrote about his discoveries in books

Living Conditions:

• Streets were covered in human and animal waste - disease ridden and encouraged rats
• Water was dirty and disease ridden
• Public toilets were dirty and rarely cleaned
• Most families lived in 1 room with as many as 10 people living together

Treatment:

• Doctors studied urione charts and used astrology to help diagnose and treat patients
• Hospitals were places for rest and recuperation not typically for treating infections or for terminally ill patients

Causes:

• An imbalance in the 4 humours
• Bad air
• Punishemnt form God

Church:

• taught that all illness was a punishment from God
• supported Galens ideas
• Sick people were encouraged to pray (each ailment had its own saint)
• Majority of doctors trained by reading books (apporved by the church)
• Peopel were encouraged to live according to religious rules (eg. attend church everyday) to avoid getting ill
• Hospitals were set up and run by nuns and monks
• Nuns and monks only looked after the patients as they believed God knew best
• Dissection was banned

Government:

• Kings and rulers ahd little interest in medicine so not many people did
• Church had more power over medicine

War:

• Soldiers who travelled to the Middle East to fight in the Crusades brought medical knowledge back with them
• Disrupted trade, destroyed important cities eg. Alexandria and led to key books being lost

• Doctors tested urine and used astrology to diagnose and treat patients
• herbal remedies were popular
• Believed in the theory of the 4 humours
• Healers/wise women were used to mix up remedies to treat symptoms

Black Death:

• Bubonic Plague
• Travelled on trading ships so quickly spread around Europe
• First symptoms included: fever with chills and shivering
• Main symptoms include: swellings (buboes) in the groin and armpits followed by blisters all over the body, high temperature, unconsciousness
• Eventually led to death
• Suspected causes included: bad air, punishment from God, imbalance on the 4 humours and allignment of the planets
• Treatments included: flagellants, purging or bleeding, praying and inhaling perfume

Hospitals (1350):

• Run by monks and nuns - medical care was focused on praying 
• No medical professionals to look after the ill - hospitals didnt admit infectious/incurable patients
• Mainly run as care homes for the elderly

Hospitals (1750):

• Run by trained physicians
• Some hospitals now admitted infectious patients
• Herbal remedies and minor surgery were common
• Prayer still heavily featured

• Age of new discoveries
• Encouraged students to experiment and carry out practical training
• Church no longer controlled medical training
• Dissection was common (although bodies were in short supply)
• Invention of printing allowed ideas and discoveries to be spread more easily

Influence:

• He carried out his own dissections and published detailed drawings of his work.
• He contributed to the progress of anatomy
• He criticised the method of bleeding
• He published the first anatomical textbook
• He disagreed with Galen - mainly due to Galen dissecting animals and Vesalius dissecting humans
• However, he didn't offer any new theories about the causes or cures of disease
• He disagreed with Galens theory that blood passes from left to right in the heart

• He claimed that the heart acted as a pump, pushing blood around the body
• He carried out simple experiments to show that arteries carried blood away from the heart and veins carried the blood back.
• He discovered that valves in the veins forced the blood to move in a one-way system
• Proved Galens idea that blood was produced in the liver wrong

Although these are huge discoveries they didn't lead to many changes at the time

Problems:

• Lots of animals roaming round - their poo added to the problem
• Water came from rivers and wells (often polluted and disease ridden) so most people drank ale as it was safer
• Butchers slaughtered and cut up tehir animals in the street
• Some people dug holes for toilet waste but this could leak into the water supply
• Waste ran down into rivers that were used for drinking water and washing
• Sewers were open (often no more than a channel down teh middle of the street)
• Lots of people living in a small area led to problems with waste disposal

Actions taken by the Government:

• Some kings tried to make laws to improve conditions to prevent waste being emptied in streets
• Rakers were employed by the local authorities to keep the streets clean(there were very few)
• There was no organised rubbish collection
• Pipes were built but were often damagedand unreliable

Attitudes and Beliefs:

• Society begant to worry more about the poor

Government:

• Changed their attitude due to pressure from social reformers
• Wanted to help so ordered poor law unions to use funds to build hospitals and asylums
• Had previously had a laissez-faire(leave it alone) attitude towards its people

Role of Individuals:

• Doctors became more aware of the importance of hygiene and began to encourage washing hands (Pasteur)
• Sterilisation introduced (Joseph Lister)
• florence Nightingales work improved the standard of care in hospitals

• In 1976 he discovered the vaccination against small pox due to observing that people who had coxpox did not catch small pox
• He carried out an experiment by: taking pus from the sores of a cowpox sufferer and rubbing the pus into some cuts on the arms of a small boy, he treated the young boy for cowpox - six weeks later he attempted to infect the boy with smallpox but the boy didnt catch it (he repeated it 23 times to be certain)
• He created the very first vaccination showing that prevention against disease was possible
• In 1840 vaccinations were made free for all infants
• In 1853 vaccinations were made compulsory
• Before the treatment for small pox was innoculation
• To begin with he faced resistance from the public as he was not able to explain how the vaccine worked

• In 1864, Pasteur accidently discovered the germ theory whilst working as a chemist
• He discovered that the micro-organisms that made wine turn sour were called germs and when he heated the liquid the germs were killed (pasteurisation)
• He published his germ theory in 1861
• Koch studied Pasteurs germ theory
• With funding from the government he grew bacteria in agar jelly and used dyes so the microbes were more visible 
• He discovered that microbes caused anthrax in sheep and that they cause tb  and cholera
• In 1879, Pasteur developed the vaccine for chicken cholera and anthrax in sheep

Factors:

• War- Pasteur was from France and Koch was from Germany. France had lost the war in 1871 so they were rivals
• Government- Both governments were willing to fund the scientists as they wanted the glory for their country

Changes Between Renaissance and Industrial Revolution:

• Doctors were required to study medicine at university
• Teaching hospitals became more popular so that students could shadow doctors
• Students still watched dissections, but were sometimes able to carry out their own

Impact of New Technology:

• Stethoscope - invented in 1816 and developed in 1860 - allowed doctors to listen to a patients chest to look for sounds of infection
• Microscope - increased in power (in 1830 Lister developed one with a magnitude up to 1000 times) - allowed doctors to analyse cells in more detail
• Thermometer - invented in 1866 - allowed doctors to test for fever among patients
• Blood Pressure devices - invented in 1881 - allowed doctors to check a patients blood pressure and look for problems

• She worked in the Crimean war as a nurse
• She didnt like the conditions the sldiers were being treated in (dirty wards, cramped, no privacy...)
• Her training in Germany had shown her the impact of bad conditions and poor nursing on a patients health
• She used her own money to improve conditions by providing better meals for patients and building a ward block...
• The death rate of the patients dropped dramatically despite resistance from other doctors
• When she returned to London she gave a report to the government of what needed to be changed

Role of women (1350-1850):

• Women werent allowed to go to university
• Wise women provided herbal remedies
• Women acted as midwives
• Nuns nursed terminally ill patients
• Women treated sick family members

Significance of her work:

• Eventually led to a 50% drop in army hospital death rates
• She opened the first nursing school in Britain in 1861, with the money she gained from her work being covered by the press
• Nursing became increasingly proffesional and the role was more highly valued
• She wrote over 200 books on nursing and hospitals
• By 1901 there were 68,000 trained nurses in Britain - In 1950 there had been none

Problems with Public Health:

• By 1900 the population of Britain had grown massively and most people had moved from the countryside to the cities to be near the factories and jobs - this made people more wealthy, but also more unhealthy
• The factories were coal fired and so the air was filled with smoke and soot
• Houses were put up quickly near factories - these were poor quality slums and they had no clean water or sewage pipes as there were no laws requiring them
• Overcrowded conditions helped disease to spread
• These poor living conditions made lots of people unhappy causing them to turn to alcohol to cope which lead to liver disease and miscarriages

Improvements:

• Rakers collected rubbish from peoples homes, but there was no organised system
• Private companies provided water to standpipes on street corners, but they were only turned on at certain times of the day
• People were supposed to pay night soil men to empty their toilets but many couldnt afford to

Why were the governmnet slow to change the industrial cities?

• The government had a laissez-faire attitude, so there was not enough people who wanted to change it and local governments didnt have enough power to enforce the rules
• People could see that there was a link between rubbish and disease but they didnt know what it was. They believed that bad air caused disease and so there was not enough understanding to change it
• Tackling public health is very expensive. Britain was a rich country through trade, but the money was in the hands of people who didnt want to spend their money on improving public health in the cities. They already thought that they were paying too much in local taxes to support the poor. There wasn't enough money to enforce this change.

• He worked for the Poor Law Commision
• He became a member of the National Board of Health
• He wrote a 'report on the sanitary conditions of the labouring population' in 1842 - this said that the poor lived in terrible conditions that could make them ill, and that the rich should pay higher taxes to help the poor
• He pushed the government to pass the 1848 Public Health Act after a cholera epidemic

• He was a doctor and a surgeon
• He theorised that cholera was spread by water not air in 1849, but no one believed him
• In 1854, during a cholera epidemic, he mapped the deaths near his surgery and traced the outbreak back to a single water pump
• When he removed the handle of the water pump so that it couldnt be used the outbreak died down
• It was before the discovery of the germ theory and so he couldnt prove why it worked
• It had little impact short term, however he proved that cholera came from water

• The first chemical cures (magic bullets) were developed which killed the disease without affecting the person

Magic Bullet 1: The Salversan 606

• Developed by Paul Ehrlich in 1909
• Funded by the government
• Combined dye with various chemicals to target only disease causing microbes
• The 606th compound tested was effective
• It was the first time that chemical drugs had been used to cure illnesses

Magic Bullet 2: Prontosil

• Developed by Gerhard Domagk in 1932
• Attacked the microbes which cause blood poisoning
• The active ingredient was isolated: sulphonamide - other sulphonamide drugs were developed to cure other illnesses eg. pneumonia
• He had to test it on his daughter who was dying from a pinprick on her finger

Fleming:

• He discovered penicillin
• He noticed that mould on his petri dish was killing the bacteria and wrote up his findings
• He could not get funding to develop his theory further

Florey and Chain:

• They pick up Flemings research at the beginning of ww2
• They recieve government funding and so are able to develop penicillin to treat humans (they tried it on mice first)
• They tested it on a man who was seriously ill. The penicillin made him recover, however he died later as they did not have enough penicillin to cure him completely
• The US government donated $80 million to drug companies to fund the mass production of the drug
• Penicillin was heavily used by allied troops after D-Day

• Established in 1948
• The 1911 National Insurance Act was established by the liberal government as part of a social reform. People who were employed paid into a sick fund to help them pay for medical care (it only helped those who worked)
• WW2 - many people were offered free health care to keep them healthy for the war effort
• The 1942 Beveridge Report - he recommended a NHS paid for by the National Insurance contributions and free for all to be created - doctors and nurses would be paid for by the government - everyone in work would pay National Insurance out of their wages, which would help fund benefits etc.
• Anuerin Bevan - he was a minister of health who made inspirational speeches in favour of the NHS, winning many people over. He compromised with doctors by allowing them to continue treating patients privately and charging them fees.

Blood Transfusions:

• developed to treat patients with blood disorders or who had lost a lot of blood (technology for storing blood was developed in ww1 when it was not practical)

X-Rays:

• discovered by Rontgen in 1895 - used in hospitals to help diagnose broken bones and diseases. Useful in ww1 when the government funded x-ray machines for every hospital on the western front.

Radiotherapy:

• developed by Marie Curie from x-rays. She discovered radium, which was developed to help treat cancer.

Cost:

• Equipment can be very expensive(especially if advanced)
• Treatments eg. IVF are expensive

Inequality:

• Wealthier people can seek private care and so dont have to wait as long

Side Effects:

• New drugs often have unexpected side effects
• New rigourous testing of drugs to prevent a repeat of the thalidomide incident

Ethical Objections:

• Lots of opposition to genetic research
• Stem cell research can damage or kill the embryos providing the cells

Brought in to help the poor

• Free school meals - offered to children with poor backgrounds 1906
• School medical service and health visitor - organised to check on childrens health 1907
• Old age pension - offered to people over 70 who couldnt support themselves 1908
• Back-to-back housing was banned - new housing regulations introduced 1909
• The national insurance act - contributions from workers, which entitles workers to free medical treatment and sick pay 1911