Medicine

• The Church had a duty of care
• Robert Grosseteste was a leading advocate for scientific theory, and his work led to the invention of spectacles
• Roger Bacon was arrested, for going against Galen and trying to do his own research (example of the Church actively hindering medical progression)

• Survival rate of over 50% when removing growths from inside a patient's anus - this was exceptionally high for the time
• Made his own painkilling ointment, with hemlock, opium and henbane (probably would have done more harm than good)
• Sometimes used wine for painrelief - this is bad, as wine thins the blood, making the patient bleed more
• 'Practice of Surgery' - published 1350
• Urged doctors not to rely on Galen
• Good bedside manner

• 1348
• Towns and ports were most affected (most people travelling through them)
• over 20 million people died
• There were many beliefs about the causes, including God, Jews, and miasma
• The king ordered the streets to be cleared
• Flagellants whipped themselves (and others) to cleanse themselves of sins, believing God caused the Black Death as a punishment for sins

Avicenna

• Wrote over 450 books
• Followed the approach of Hippocrates and Galen
• Listed medical properties of over 760 different drugs

Averroes

• Argued against those who said philosophy went against Islam
• Medical encyclopedia
• First described pulmonary circulation of the blood, and disputed Galen's theory about blood passing through the septum (which Vesalius later realised)

Rhazes

• Followed Galen, but built on his work
• Described the first known case of smallpox
• Stressed the need for observation, and recording a patient's symptoms

Abulcasis

• Arab surgeon
• Wrote a surgical textbook, with diagrams and explanations
• Surgeons should plan carefully before operating, and have a clear idea of what they are doing
• Very knowledgeable on surgery

Like in Christianity, Islam didn't allow dissections, and followed Galen's teachings. Both religions also wrote books and manuals.

Islam encouraged people to find new ideas, even if it meant proving Galen wrong, Christianity actively discouraged this (eg. Roger Bacon).

Islamic hospitals have medical treatment, while Christian hospitals didn't.

People had many beliefs regarding the causes of disease, few of which would be seen as accurate today.

• Four Humours - people still followed Hippocrates' ideas about the four humours, and would treat people based on these ideas
• Astrology and the Zodiac - people would often consult the stars when making a diagnosis, and believed the position of the stars could cause disease. The zodiac related sar signs to body parts, and people often believed you would be unable to operate on certain body parts at certain times of year
• Urine chart - physicians often looked at a urine chart, and linked this to the four humours
• God - many people believed God caused disease as a punishment for sins
• Miasma - people believed dirty air could cause disease

Apothecaries

• Trained for 7 years
• Sold herbs and spices (medicinal)
• Cheaper than going to see a doctor
• Remedies often varied from apothecary to apothecary

Wise women

• Passed down knowledge
• Often acted as midwives

Barber surgeons

• Found in large towns and cities
• Performed basic surgery and minor operations, eg. setting bones, or pulling out teeth
• Lower form of a physician
• Often travelled around
• Bloody apron and workshop was symbollic of having more experience (in reality, this would increase the number of germs and likelihood of infection)

• People were more willing to experiment
• After the Black Death, people were wealthier
• Greater wealth led to more travel and education
• People became more willing to challenge Galen
• People started to move away from the Church
• The microscope and printing press were invented
• The printing press allowed more books to be published, faster, which meant knowledge could be shared more easily
• Still followed Galen's ideas about the four humours, and the importance of diet and hygiene
• Herbal remedies and astrology were still used to treat the sick
• Some people were still reluctant to move away from Galen
• Lots of people were stilll very superstitious

• 1665
• People began to link dirt and disease
• Thought it was caused by God, the movement of the planets, or miasma
• Infected houses were marked with a red cross
• Assemblies were prohibited, in an attempt to limit the spread of disease
• The streets were cleaned, and animals and humans were separated
• Infected houses were watched - to stop people going in or out
• Bodies were buried at night, six feet under ground
• The government was more involved

Similarities

• Didn't know what caused it - believed it was miasma, or a punishment for sins from God, or to do with astrology (however, during the Plague they began to link dirt and disease)
• Lots of cures, that probably did nothing, eg. attaching a live pigeon to your foot during the Black Death
• Lots of praying to God, in an attempt to get Him to stop the disease
• Bloodletting was used in both times, despite this probably doing more harm than good
• Herbs and posies were carried - people thought that miasma caused the disease

Differences

• During the Plague, the government was far more involved - the most that was done during the Black Death was the king ordered the streets to be cleaned

Compare treatments of the Black Death in the Middle Ages and the Plague in the Renaissance.

In what ways were they similar?                                                          [8 marks]

Andreas Vesalius

• Did dissections himself - this was unusual, as people normally got an assistant to do it for them
• Discovered that the human bone is only one bone, not two - proved Galen wrong
• Discovered that blood doesn't go through the spetum - proved Galen wrong, though this had already been discovered by Islamic doctors
• Realised that Galen had looked at animals rather than humans, which caused a lot of his mistakes
• 'Fabric of the Human Body' - published 1543
• This was widely read, and was used in Universities - this was helped by the invention of the printing press
• It had very detailed images, of the sort the Ancient Greek drew
• Vesalius studied at Padua University

William Harvey

• Discovered that blood travels in one direction around the body, and isn't used up - proved Galen wrong
• Based his ideas on dissections, rather than other people's books and ideas
• 'On the Circulation of the Blood' - published 1628
• Studied at Padua University

Ambroise Pare

• Army surgeon
• Used a mixture of oil of roses, egg yolks, and turpentine to seal wounds, instead of boiling oil - worked a lot better, and was far less painful. He discovered this while healing people on the battlefield
• Used ligatures, instead of a red hot iron - led to a tourniquet

Leonardo Da Vinci

• Encouraged art students to do dissections, to improve their understanding of the human body, so they could draw more accurately
• Drew very detailed images, of the sort in Vesalius' 'Fabric of the Human Body'

• Challenged Galen
• Promoted the scientific method
• Told people to make observations of patients
• Distrusted those who based their knowledge off of book learning, instead telling them to make their own observations and work things out for themselves
• Didn't think doctors should do anything unnecessarily

• 'The Anatomy of Melancholy' - study of mental illness, published 1621
• Blamed lack of exercise, idleness, excessive pleaseure and too much studying for mental illness
• Recommended fresh air, exercise, music and laughter as a treatment

• 'An Essay on Health and Long Life' - 1724
• Said that nervous disorders and obesity could be either hereditary, or caused by poor lifestyle
• Said that people should take responsibility for their own health, rather than relying on doctors to treat them when they get ill

• Found a cure for scurvy (lime juice, and fresh fruit) in 1753
• Scurvy killed more British soldiers than war

• 'The Midwife Book' - published 1671
• Said that midwifery should be reserved for women

• 'A Treatise on Asthma' - published 1698
• First person to recognise the causes, and offer treatment
• His treatment included clean air and diet

John Hunter

• Did lots of dissections (was later arrested because of this) - shows progression from Medieval times, as this would not have been allowed
• Believed in leaving as much to nature as possible
• Army surgeon
• Learnt a lot about STIs
• Found a new way of treating an aneurysm (a bulge in a blood vessel), which stopped it needing to be amputated

William Chesleden

• Could remove a bladder stone in under a minute - shows the improvements in surgery, as this would not be possible in Medieval times

Nicholas Culpeper

• 'Complete Herbal' - published 1653 (still in print today)
• Written in English, rather than Latin, which made it more accessible to people

• No-one could practice surgery within seven miles of London without being examined by the college
• 1811 - to be a surgeon, you had to attend at least one course in anatomy and one in surgery
• 1813 - to be a surgeon, you had to have at least one year's experience in a hospital

This showed the improvement from Medieval times, as more regulations were introduced. This meant surgery would have improved, and surgeons would have been more educated and had more imrovements - meaning survival rates would have gone up.

Lady Johanna St John

• Made herbal remedies, and sent them to London

• Came up with vaccinations
• Published his findings in 1798
• Repeated his experiment 23 times - scientific method
• Parliament gave him a £30, 000 grant to set up a vaccination clinic in London
• Thomas Jefferson, president of the US, endorsed the vaccination
• 1805 - Napoleon had all of his soldiers vaccinated
• Initially, there was lots of opposition to vaccinations
• People thought it was unnatural, and potentially dangerous
• Anti-Vaccinaton League was set up
• Because of vaccinations, smallpox was eradicated
• 1796 - 35,000 people died from smallpox (before the vaccine)
• 1853 - vaccines were made cumpolsary for infants
• 1887 - vaccinations were no longer cumpolsary, because of the Anti-Vaccination League
• His work led to other vaccinations being made

Louis Pasteur

• Government asked him to look into what was causing wine to turn sour
• Published 'Germ Theory' in 1866
• Proved that the miasma theory was wrong
• His discoveries led to pasteurisation
• Accidentally found a cure for chicken cholera (exposure to air weakened the disease)

Robert Koch

• Identified the bacteria causing lots of diseases - Cholera (1883), septicaemia (1878), tuberculosis (1882), anthrax (1876)
• Tuberculosis affected 15% of the population in the 19th century
• Other people used his methods, increasing his long-term significance, eg. Edwin Klebs discovered the diphtheria germ in 1883
• Promoted scientific method
• 1881 - Pasteur came up with a vaccine for anthrax, that he demonstrated on sheep - this was only possible because of Koch's discovery of the germ causing anthrax (and Jenner's work on vaccination)

How significant was Robert Koch to the development of medicine?                          [8 marks]

Paul Ehrlich

• Discovered the first magic bullet, Salvarsan 606, in 1909
• Scientific method - tried 606 different compounds before finding one that worked
• Others were able to use his research and ideas to come up with new magic bullets, that worked for other things

John Snow

• 1854 - John Snow proved that there was a link between cholera and water supply
• Used meticulous research and observation
• Died three years before Pasteur's Germ Theory was published
• Major cholera epidemics occured in 1832, 1848, 1854 and 1866
• The 1848 epidemic killed 53,000 people
• Discoveries helped bring about more changes to public health

1848 Pucblic Health Act

• Governement only approved it after the second major cholera epidemic (1848 epidemic killed 53,000) people
• Encouraged local authorities to improve conditions, but wasn't cumpolsary
• Only a few local authorities actually did anything
• By 1872, only 50 councils had appointed Medical Officers of Health - one of Chadwick's main proposals

1875 Public Health Act causes

• Germ Theory
• 1867 - working class men got the vote
• Laissez-faire weakened
• Improved education
• More cholera epidemics
• Farr - statistics that prompted the government to act

1875 Public Health Act

• Laid down all duties expected of a local council - towns were forced to perform these
• Included provision of clean water, proper drainage and seage, and the appointment of a Medical Officer of Health
• New houses had to have piped water and proper toitlets, drains and sewers

• 1802 - Factory Acts - improved working conditions
• 1848 Public Health Act
• 1852 - vaccinations made cumpolsary
• 1858 - regulations of doctors' qualifications were introduced
• 1870 onwards - education improved - health education taught at many schools, improved literacy meant more people could read pamphlets produced by Medical Officers, ...
• 1875 Public Health Act
• 1876 - laws against the pollution of rivers
• 1876 - food regulations - improved quality of food sold in shops
• 1889 - isolations hospitals for infectious diseases

Edwin Chadwick

• 1842 - published a report on poverty and health
• Suggested that the government should pass laws for proper drainage and sewage systems, funded by local taxes
• Prompted the 1848 Public Health Act

Farr

• Cumpolsary registration of births, marriages and deaths

Southwood Smith

• Published papers on public health, supporting Chadiwck's work

Bazalgette

• 1859 - appointed by the governent to build a new sewer system
• This was prompted by the Great Stink (1858)
• 1300 miles of sewers were built
• Sewers were opened in 1865
• Bazalgette's design was used for most of the cities in Western Europe

Dr Barnado

• 1867 - set up a ragged school in the East End
• 1870 - first Barnado's shelter
• By his death in 1905, he had opened 96 homes, caring for 8500 children

Sir Humphrey Davy

• Nitrous Oxide (laughing gas)
• Difficult to control dosage
• Relieves pain
• Not widely used, initially

Robert Liston

• Ether
• Very flammable
• Precise dosage needed - sometimes killed patients, sometimes patients woke up in the middle of the operation

James Simpson

• Chloroform
• Reduced pain in childbirth
• Induces dizziness, sleepiness and unconsciousness
• Could kill if too much was gived
• God made childbirth painful
• Queen Victoria used it in 1853, and publicly praised it

All anaethetics initially faced a lot of criticism, as they weren't natural, and God had made things painful. This wasn't helped by the difficulty in controlling the dosage which often caused death

Lister

• Carbolic spray - antiseptic
• When sprayed over the wound as a thin mist, it reduced infection
• 1887 - all instruments had to be steam sterilised
• Operating theatres and hospitals were rigorously cleaned
• 1894 - sterilised rubber gloves
• 1892 - Pasteur and Lister given awards

Semmelweis

• Realised importance of washing hands
• Regarded as a fanatic, thought to be mentally unstable
• From 15th May 1847, any doctor or student going from the postmortem room must thoroughly wash their hands in chlorinated water before entering the maternity wards

Florence Nightingale

• Crimean War
• Improved hygiene in hospitals
• Mortality rates went from 40% to 2%
• 1859 - 'Notes on Nursing'
• Britain's first nurse training school, at St Thomas' Hospital
• 1863 - 'Notes on Hospitals'

Elizabeth Garret Anderson

• One of the first women to be medically trained and accepted as a doctor
• Set up her own hospital
• Increased equality in medicine

Sofia Jex-Blake

• One of very few women to open a surgery

Surgery

• 14,000 doctors were taken from their normal work
• Gave doctors opportuniteis to discuss, practice and experiment

Blood Transfusion

• cells could be bottled and stored in ice
• Karl Landsteiner discovered blood groups in 1901
• October 1915 - first blood band set up on the Western Front
• 1921 - British Red Cross set up the first voluntar blood donor scheme, which was copied across the world
• 1938 - as preparation for WW2, the government set up the Army Blood Supply Depot in Bristol

X-rays

• Invented in 1895 by Wilhelm Roentgen, but not used much until WW1
• 1918 - George Eastman invented X-ray film
• Very useful during the war for locating bullets
• After the war, they were used more than they had been before the war - people realized how useful they were

• New techniques to heal broken bones were found
• War sped up the development of plastic surgery and skin grafting
• People had already started working on skin grafting, which helped plastic surgery
• Harold Gillies worked on plastic surgery
• Improved ear, eye, nose and mouth surgery
• Successfully attempted brain surgery
• Sir Harold Ridley found that perspex splinters weren't always rejected by the eye - this led to cataract surgery
• Mepacine - anti-malaria tablets
• Gas masks
• MASH - mobile army surgical hospitals - established during the Korean war

• 1918 to 1919
• Strain of flu
• Estimated that 20-40 million people died worldwide as a result of the flu
• Infected 20% of the world's population
• Mass troop movements due to the end of the war increased the spread
• 7 million deaths in Spain
• In only a few months, 280,000 died in the UK
• Killed more people than WW1
• Treatments were less focused on God - improvement from Plague and Black Death
• Boiled handkerchiefs, stayed in bed away from people, gargled salt water

• Penicillin was initially found by Fleming, but due to a lack of funding, he didn't take the work any further
• Florey, Chain and Heatley were able to purify the mould and extract penicillin from it, turning it into a drug
• In December 1941, the US governement began to give out grants to businesses that manufactured penicillin
• By 1943, British businesses also started producing it
• The development of penicillin was sped up by WW2
• After the war, the cost fell, making it more accessible for general use
• Penicillin saved many lives during WW2
• Today, penicillin is used to treat a range of bacterial infections and skin infections
• Because of penicillin, other antibiotics were discovered after 1945
• Penicillin was first used in the Normandy landings
• In WW1, more people died from infection than direct fire - penicillin reduced this problem
• Extraction of penicillin from the mould penicillium was a technique that could be used with other antibiotics
• However, we now have the problem of antibiotic resistance

Explain the significance of penicillin in the development of medicine.                     [8 marks]

• The liberal party won by a landslide victory in 1906
• They wanted to provide support 'from the cradle to the grave'
• Prompted by National Efficiency and the Boer War - 77% of people failed the health test to fight in the Boer War
• Booth published 'Life and Labour of the People' in 1889
• 35% of London's population was living in abject poverty
• Rowntree published 'Poverty: A Study of Life in Towns' in 1901
• The 'Poverty Line' was the minimum amount of money needed to survive - a lot of people earnt less
• Beveridge Report - 1942
• December 1952 - 'Killer Smog' caused Clean Air Acts (1968)
• New towns were created
• 1906 - Workmen's Compensation Act - granted compensation for injuries at work
• 1906 - Education (Provision of Meals) Act - introduced free school meals
• 1907 - Education (Administrative Provisions) Act - created school medical inspections
• 1911 - National Insurance Act - sick and unemployment pay introduced if you paid contributions into the scheme
• The above are just some of the many Liberal Reforms
• This improved public health

• Set up 4th July 1948
• More people needed it than expected
• There was initially a lot of oppostition
• Many conservatives opposed the NHS because they thought it would be too expensive
• Doctors saw themselves as independent professionals, and didn't want to be controlled by the government. They also thought they would lose a lot of income
• Many doctors threatened to go on strike, in protest against the NHS
• 1950 - the budget was under pressure
• 1952 - end of the completely free NHS - there was a charge for spectacles, prescriptions cost 1 shilling, dental treatment cost £1
• Now, the NHS is still under pressure, due to not enough doctors and not enough money
• Obesity is a major problem
• 150,000 people have a stroke every year

Compare the Liberal Reforms of the 1900s and the National Health Service of the 1940s.

In what ways were they different?                                                             [8 marks]