Medicine Through Time (SWHS)

Connections in Greek and Roman Medicine

• Greek doctors, they were unpopular because they were foreign and some were jealous of their skills
• The main medical books in Rome were written by Hippocrates and his followers who were all Greek
• The Romans took over universities and libraries at Alexandria, it was the centre of medical learning.

Background information

• Romans were very wealthy 
• People of the Roman Empire were taxed 
• It was a slave owning society

Public Health

• noticed that bad smells, unclean water, sewage, swamps and dirt made people become ill
• they built aqueducts to carry clean water into cities 
• they also built public baths, toilets and sewers to remove waste
• ideas about pulic health spread around their huge empire

Claudius Galen- he wrote 60 medical books!

• Galen was a Greek physician. Like Hippocrates, he believed that illness was caused by imbalances of the humours. Just as Hippocrates did, he told doctors to observe patients carefully and record symptons
• he developed the idea of opposite humours for counter - valancing the body's humours
• Galen discovered that the brain, not the heart, controls the speech
• he found that the arteries, as well as veins, carry blood through the body
• proved that animal's anatomy is different from humans

However...

• Galen made mistakes ecause he had to use only animals
• he said there were holes in the septum of the heart which would let the blood pass right to the left side
• Galen also believe that the blood was consumed rather than circulated

Beliefs and Treatments

• Romans were not as interested as the Greeks in developing theories about the causes of disease
• doctors recommanded more exercise, changes in diet or prescribed herbal medicines as opposites
• doctors were too expnsive for most people. The head of the family was expected to look after their household. They would used herbal remedies and common sense methods.

Summery of Roman Medicine

Changes:

• good harvests, better houses, more food
• rained doctors in the army and towns
• wider rnge of herbal medicines
• fresh water supplies, sewers and baths

Continuities:

• Diseases could not be stopped from spreading 
• women treated most leath problems, often using herbal remedies and common sense
• the poor didn't benefit from the new public health schemes

Influence of the Christian Church

• the Christian Church frew stronger in the Middle Ages
• Monasteries controlled education, priets and monks were the only people who could read. The Church opened medical schools where the ideas of Galen were taught
• the only libraries were in monasteries, church sometimes banned books they did not want people to read
• Monasteries made an effort to provide clean running watre and toilets

Medieval Hospitals

•  Medical care for the poor came from hospitals set up by monasteries, and run by monks and nuns.
• They provided “hospitality” for visitors.
•  Genuinely ill people were often turned away due to fear of disease spreading

The Four Humours Theory 

• Medieval doctors believed illness was caused by an imbalance of the four humours.
•  The theory developed into a more complex system, based on the position of the stars.
•  Although human dissection was carried out in medical schools, findings were interpreted as the theory of the four humours – although some later doctors began to challenge traditional understandings.

New Developments in Medieval Medicine 

• More schools sprang up and human dissection was allowed. There were some doubts about classical texts. 
• New techniques included diagnosis by urine sample. This is a good aid to diagnosis, which is done today! 
• Doctors also believed the stars caused disease and relied on astrology when deciding on treatments 
• Trained doctors were very expensive. Medicine practised amongst the  most was provided by monasteries and housewife-physicians, using traditional cures and their experience.

Supernatural Beliefs and Treatments 

• The church believed that illness was a punishment for sins – they prayed to god if they became ill.
•  Some believed that pilgrimages to holy shrines could cure illness.
•  Doctors had superstitious beliefs, saying magical words when treating patients and consulting stars

Background to the Renaissance

•  Renaissance means rebirth. It began with close study of classic texts and was critical of old translations
•  There was a greater interest in how the human body worked based on observation and dissection.
•  Artists attended dissections of human corpses and did wonderful illustrations for medical books.
•  Return of classical texts led to a renewed faith in the four humours theory and treatment by opposites. 

Andreas Vesalius – Anatomy 

• Studied anatomy, became professor of surgery and anatomy at Padua. He was allowed to do dissections. 
• Did his own dissections and wrote books based on his observations using accurate diagrams to illustrate his work. His most famous book was ‘On The Fabric of the Human Body’ written in 1543.
•  He was able to point out some of Galen’s mistakes. Vesalius said there were no holes in the septum of the heart and that the jaw bone is not made up of two bones.
•  Vesalius encouraged doctors to dissect and look for themselves.

William Harvey – Circulation of the Blood 

• Discovers the circulation of the blood, disproving Galen’s ideas.
•  Identifies the difference between arteries and veins.
•  Becomes doctor the King, his ideas are very influential.
•  To spread his ideas he writes “An Anatomical Account of the Motion of the Heart and Blood”.
•  However, bleeding operations still continue after Harvey as people are unsure of what else to do.
•  Blood groups are discovered in 1901, which makes blood transfusions successful. 

Public Health 

• There were many wars during the renaissance. Warfare gobbled up resources.
•  Populations were beginning to increase in the towns and cities, placing more strain on the available clean water supplies and sewage disposal systems

What factors affected progress in medicine during the renaissance? 

• The Printing Press – new ideas could spread more easily and rapidly now that books could be printed.
•  The Weakening Power of the Church – people did not have religious beliefs about the causes of diseases, meaning that people started to look for natural causes. Doctors could now dissect.
•  Artists Drawing from Life – medical drawings could be drawn and shared among doctors through medical books, new anatomy books were produced.
•  Renewed Interest in Ancient Learning – people wanted to learn how to read, they began to challenge old medical ideas (e.g. Galen holes in the septum)

Backgroud information

Why Had They Stopped Reading Galen in the Nineteenth Century? 

• New understanding of the body and Galen’s descriptions were incomplete and sometimes wrong.
• The invention of the proved that Harvey’s ideas were right.
•  Theory of the four humours no longer accepted. People initially thought that miasma, caused disease.
•  Doctors carried out dissections and used microscopes. Galen’s books were no longer important. 

Smallpox and Edward Jenner

Inoculation:

•  In the 18th century, smallpox was a big killer. Lady Mary Wortley Montagu brought inoculation to Britain.
•  She discovered that a health person could be immunised against smallpox using pus from the sores of a sufferer with a mild form of the disease.
•  However, inoculation sometimes led to smallpox and death.

 Edward Jenner 

• Jenner was a country doctor. He heard that milkmaids didn’t get smallpox, but instead a milder cowpox.
•  Jenner investigated and discovered people who had already had cowpox didn’t get smallpox.
•  In 1796 he took a small boy and injected him with pus from the sores of a milkmaid with cowpox. Jenner then injected James with smallpox. James didn’t catch the disease!

Opposition to the Smallpox Vaccination

• Jenner could not scientifically explain how it worked.
•  Inoculators were afraid of losing money.
•  Many were worried about side effects; they worried about giving themselves a disease that from cows.
•  Some members of the Church believed that vaccination was not natural.

Developments in Nursing

Florence Nightingale 

• Nightingale brought discipline and professionalism to a job that had a bad reputation at the time.
•  From a wealthy background, she became a nurse despite the opposition of her family.
•  Went out to the Crimean War to sort out nursing care in the English camp.
•  She made huge improvements in the death rate, due to improvements in ward hygiene.
•  When she returns home, she writes a book ‘Notes on Nursing’ and sets up a hospital in London

Louis Pasteur’s Germ Theory – 1857

•  Scientists thought microbes were caused by disease and appeared because of illness. This was the theory of spontaneous generation. Instead of blaming microbes, people looked for miasmas.
•  Louis Pasteur was employed in 1857 to find the explanation for the souring of sugar beet used in fermenting industrial alcohol. His answer was to blame germs in the air.
•  He proved there are germs in the air by sterilising water and keeping it in a flask that didn’t allow airborne particles to enter. This stayed sterile – but sterilised water kept in an open flask bred microbes again. 

Robert Koch 

• German scientist. He began linking diseases to the microbe that caused that specific disease.
•  Koch developed a solid medium to grow cultures, and dyeing techniques to colour microbes, which he viewed through high-powered microscopes. 
• He identified anthrax spores and the bacteria that cause septicaemia, tuberculosis and cholera. 

Louis Pasteur – Chicken Cholera Vaccine 

• Hearing of Koch’s, Pasteur came out of retirement and competed to find new microbes and combat them.
•  Pasteur looked for cures to anthrax and chicken cholera. Both he and Koch worked with large teams of scientists. Charles Chamberland was in Pasteur’s team.
•  Chamberland was told to inject chickens with chicken cholera, but it was the day before his holiday and he forgot. He left the germs on his desk and injected the chickens when he returned from his holiday.
•  The chickens survived, Pasteur and Chamberlain tried again with new germs, but the chickens survived.
•  The cholera had been weakened by being left out, and the weakened cholera made the chickens immune. Chamberland’s error had produced a chance discovery. 

Edwin Chadwick 

• In 1842 he was asked by the government to report on the living conditions and health of the poor.
•  Chadwick concluded that poverty was caused by ill health which was caused by the terrible conditions in which people lived.
•  He said that ratepayers can cut their taxes and save money in the long-term by looking after the poor and to spend money improving their health.
•  In his “Report on the Sanitary Conditions of the Labouring Population” he said industrial towns should:
•  Organise drainage and refuse collection
•  Provide a pure water supply
•  Appoint a Medical Officer of Health

For over 30 years an argument went on about the need for town councils or the government to take action. Towns such as Liverpool and Manchester did start to build sewage and water-supply systems. 

1853 John Snow

•  In 1854 John Snow proved that there was a link between cholera and water supply. He used research, observation and door-to-door interviews to build a detailed map of a cholera epidemic in Broad Street.
•  Nearly all the deaths had taken place within a short distance of the water pump.
•  Near to the pump, there was a brewery and none of the people there had cholera. The brewery had its own water pump, and the men had been given free beer. They didn’t use the Broad Street Pump at all.
•  After collecting evidence, John Snow removed the handle from the Broad Street pump.
•  There were no more deaths. It later came to light that a cesspool near to the pump had a cracked lining which allowed the contents to contaminate the drinking water.
•  Snow put pressure on water companies to clean up their water supplies.  

1858 Great Stink

•  For years human waste made its way from the latrines in London into the River Thames.
•  In 1858 the hot weather caused a ‘great stink’. The putrid smell was right under Parliament’s nose.
•  Parliament considered moving and had to coat their curtains with a deodorant to get rid of the smell.
•  The Great Stink prompted Parliament to sort out London’s sewage and drainage system and to clean up the River Thames.
•  Within a year Sir Joseph Bazalgette had begun to build an extensive system of sewers and drains that are still in operation today. 

What Medical Progress Did the First World War Bring About? 

• Surgeons had the opportunity to experiment with new techniques. Surgeons developed techniques to repair broken bones, and perform skin grafts – plastic surgery.
•  Soldiers promised good housing when they returned. This helped to get rid of unhealthy slum housing.
•  Surgery of the eye, ear, nose and throat all improved rapidly. Brain surgery also advanced.

The Development of X-rays 

• X-rays were first discovered 20 years before the war.
•  Hospitals installed X-ray machines, but it was the First World War which confirmed their importance.
•  More were manufactured to meet demand and they were installed in hospitals along the Western Front.
•  X-rays immediately improved the success rate of surgeons in removing deeply lodged bullets and shrapnel which would otherwise have caused fatal infections.

Blood Transfusions 

• In the renaissance, Harvey proved blood circulates and this encouraged experiment with transfusions.
•  It sometimes worked and sometimes failed. Scientists didn’t know about different blood groups.
•  Blood groups were discovered in 1901 by Karl Landsteiner. The discovery made transfusions successful.
•  During the First World War vast amounts of blood was needed. On-the-spot donors were impractical. Many soldiers bled to death in the trenches before blood could get to them.
•  The search began for a better method of storage and transfusion. Doctors discovered how blood can be bottled, packed in ice and stored where it was needed. This discovery helped to save many lives.

The Discovery and Development of Penicillin

1 Fleming discovered mould killed germs. Writes articles but publishes them in book with an obscure name.

2 Chain and Florey begin research in Oxford after reading an article by Fleming. They experiment with mice.

3 Penicillin is first tested on a human being in Oxford.

4 U.S. and Britain fund production of penicillin.

5 Enough penicillin is produced to treat all the allied forces wounded in the D-Day invasion of Europe

How Was Penicillin Discovered? 

• The discovery of penicillin is a great example of a chance finding helping science.
•  One day in 1928 Fleming came to clean up some old culture dishes he had been growing bacteria for his experiments on. By chance, a fungal spore had landed and grown on one of the dishes.
•  He noticed that colonies of bacteria around the mould had stopped growing. The fungus was identified and the substance given the name penicillin. It produced a substance that killed bacteria.
•  Fleming was unable to take his work further. The industrial production of penicillin still needed work.

How Was Penicillin Developed? 

• In the 1930s two Oxford scientists, Florey and Chain, became interested in Fleming’s 1929 paper.
•  In 1939 they gathered a skilled research team and three days after the outbreak of the Second World War Florey asked the British Government to fund the team’s research into penicillin.
•  British chemical firms were too busy making explosives to start mass production – so Florey went to US.
•  America helped to mass produce penicillin, the casualties of the Second World War added to the urgency.
•  By 1944 mass production was sufficient for the needs of the military medics. Fleming, Florey and Chain were awarded the Nobel Prize in 1945. 

Factors Leading to the Development of Penicillin 

• Government – British government funded Florey’s research, U.S. government funded mass production.
• Technology – microscopes and bacteria growing mediums.
•  Scientific experiment – testing on mice.
•  Individuals – Florey and Chain were skilled scientists supported by a skilled team of researchers.
•  War – the growing casualties of World War Two added to the urgency to mass produce penicillin.
•  Chance – Alexander Fleming discovered penicillin by chance in 1928.

Impact of the Second World War 

• Blood transfusion –blood could be stored for longer, civilians donated blood.
•  Diet – rationing improved some people’s diet, government encouraged healthy eating. 
• Drugs – penicillin was developed as the first antibiotic.
•  Poverty – evacuation took children out of urban areas. Highlighted contrast between rich and poor.
•  Surgery – developments in the use of skin grafts and treatment of burns.
•  Hygiene – government posters education people about health and hygiene.

National Health Service Influence of WW2 

• WW2 broke down social distinctions and brought people together.
•  The raising of armies made powerful people take notice of the health problems of the poor.
•  Evacuation of children increased awareness of how disadvantaged many people were.
•  After the Second World War people looked for improvements in society. Such feelings led to the 1945 victory for the Labour Party.

Introduction of the NHS 

• Sir William Beveridge published his famous Beveridge Report in 1942. In it he called for the state provision of social security “from the cradle to the grave”. The report became a bestseller.
•  Aneurin Bevan was the Labour Minister for Health who introduced the National Health Service.
•  National Insurance was introduced to pay for the NHS. Doctors and dentists were wooed with a fixed payment for each patient. They were also allowed to continue treating private fee-paying patients.

The NHS Still Has A Few Problems…  

• Governments have reduced how much of the NHS is free – charging for prescriptions and dental health.
•  Long waiting lists and doubts about the quality of treatment have led to paying for treatment outside NHS.
•  Longer life expectancies have meant more need for care of the elderly and increased costs for the NHS.