Surgery & Anatomy ~ Prehistoric Societies
- Prehistoric Societies performed extremely basic surgeries, research shows they did these surgeries for superstitous reasons like ridding of 'evil spirits'.
- They set broken limbs, by covering the broken bone in mud & baking it, forming a sling.
- They performed a surgery known as 'trephining' which is cutting a hole in the skull to remove chunks of bone. They did this to 'release evil spirits'.
- Evidence for trephining is anthropological. From skulls which have been discovered with the surgery performed.
Surgery & Anatomy ~ Ancient Egypt
- The ancient Egyptians sill didn't know huge amounts about anatomy. They learnt a small amount indirectly through embalming. Embalming was performed for religious reasons.
- They had specialised (metal) surgical instruments.
- They also had basic surgery knowledge (e.g. Treating a broken nose).
- Doctors now knew what the heart, lungs & liver were, but not what they did. Religion forbade them from dissecting bodies.
- They knew that blood was essential for life.
Surgery & Anatomy ~ Ancient Rome
- Many of the Greek ideas were absorbedby the romans (Four humours, Alexandria). Because the Romans conquered the Greeks.
- Opium was used as an anaesthetic.
- They used the same surgical instruments as the Greeks.
- The Roman army had specific doctors and orderlies.
- The main Individual for Rome was Galen, who was successful in the field of Anatomy.
- Galen was a Roman doctor to the Emperor and had studied anatomy and dissection in Alexandria.
- He was a doctor who encouraged students to go to Alexandria and dissect animal or human bodies.
- Proved that the brain controlled different parts of the body and not the heart, through public dissections.
- He wrote 60 books on medicine which were used for the next 1500 years, and the church did not mind Galen because his work complimented God as a designer.
Surgery & Anatomy ~ Ancient Greece
- Generally 'outside' operations ~ Setting bones, amputations, remvoing arrow heads from war.
- However, they could successfully perform the internal operation of draining fluid from the lungs (to cure pneumonia).
- They also performed alot of bleeding.
- The use of steel & iron improved surgical instruments.
- Alexandria was extremely important to the Greeks as it was the only city where dissection was allowed, so it became a huge learning place for surgeons and doctors.
- Two important doctors of anatomy;
- Herophilus: Discovered that the brain controlled the body.
- Erasistratus: Discovered the heart could act as a pump. (But people did not accept this at the time because it disagreed with the theory of the four humours).
Surgery & Anatomy ~ The Middle Ages
The impact of faith on Surgery & Anatomy
- Some universities run by the church allowed to work of Galen to be read as it agreed with their theory of God as a designer. Some also allowed dissection to take place but the students were only allowed to watch.
- This dissection was done to confirm Galen's theories.
- The church stopped people questioning Galen's work, which meant ideas became 'fossilized'
- The Muslim faith, forbade dissection of the bodies too, for religious reasons.
- Muslims also respected Galen and did not question his work. (Ibn Nafis who did was not well respected)
Overall Surgery & Anatomy in the middle ages
- Surgery was not universally trained, and people usually became one through an apprentice.
- Women could become surgeons, but were not allowed to attend university.
- Old procedeurs such as bleeding were continued, aswell as new procedures like rectal operations.
Surgery & Anatomy ~ Renaissance
- Pare was a very important individual in renaissance s&a.
- Pare was an army surgeon, who (maybe due to chance) discovered a new way of treating wounds (particularly gunshot) and stopping them getting infected on the battlefield.
- The old way was using boiling oil to treat the gunshot wounds, one night that ran out and more wounded were still being brought in, Pare was desperate so mixed an ointment of his own, containing: Egg yolks, oil of roses & turpentine. It soon became clear that the soldiers whom had been treated with Pare's mixture were healthier and in much less pain than those treated with oil.
- The other thing Pare was particularly famous for was ligatures.
- A problem was trying to stop bleeding after an amputation, in the old traetment, a red hot iron (called a cautery) would be pressed against the stump of a limb
Surgery & Anatomy ~ Renaissance
- Vesailus studied medicine in Paris & Italy. This is where he met artists who sutdied skeletons & dissected bodies.
- Became professor of surgery at Padua in Italy.
- He wrote 'the fabric of the human body' in 1543. Which was a book on the human anatomy, combined with detailed illustrations to aid his descroptions, the illustartions done by the artists he had previously met.
- The importance of this book was that it proved some of Galen's ideas wrong, which were idea's that had been followed foe hundreds of years.
- He encouraged the dissection of bodies and the testing of ideas that were currently followed.
Surgery & Anatomy ~ Renaissance
- Famous for developing the 'theory of circulation'
- By this theory Harvey showed that the blood flows around the body, is carried away from the heart by arteries and back into the heart via veins. By this he proved that the heart acts as a pump, recirculating the blood.
- This theory disproved Galen's idea that new blood was constantly being manufactured in the liver.
- Harvey proved his theory through dissection of both animals (with slow beating hearts) and humans.
- However, Harvey could not prove that tiny blood vessels called capillaries carried blood as they were to small to see and were only proven in the late 1600's when microscopes were developed.
Surgery & Anatomy ~ 19th century
Surgery & Anatomy ~ 19th Century
- Pain was another large problem to 19th century surgery.
- Ether was the first major anaesthetic used in an operation, by Liston in 1842, for a leg amputation.
- Ether was then used by dentist, William Morton in 1846.
- Chloroform was discovered in 1831 but only first used in 1847.
- Ether had it's own drawbacks however, as it irritated the lungs, causing the paitent to cough during the operation, it was also flammable.
- There was alot of opposisiton to anaesthetics
Surgery & Anatomy ~ 20th Century
Impact of the world wars & Technology
- The first world war did hinder medcial progress in a way, by taking 14,000 doctors to cope with battlefield casualites
- Altohugh the war did help more than it hindered as the ocnditions in which the suregones had to work, forced them to develop new techniques that had an impact on civillian hospitals after the war.
- One of the biggest improvements was x-rays, which were first discovered in 1895 by Rontgen, a German scientist. Within the year of its discovery X rays were being installed in hospitals but their true importance was not realised until the first world war when they were being used to locate bullets in gunshot wounds.
- In 1901 blood groups were discovered which meant that Blood Transfusion was finally made practical. This led doctors to the further discovery that the plasma could be seperated from the tiny particles in the blood and the cells could be frozen until they needed to be used.
- Other improvements included, succesful attempts at brain surgery, and improved methods of skin grafting, making a basis for plastic surgery.
Disease & Infection ~ Prehistoric Societies
- There was a large focus on 'medicine men', and they were normally the person you would visit if you were sick.
- Medicine men knew how to 'rid you of evil spirits' and usually did so via a chant or trance.
- Prehistoric people also wore charms in a pre-emptive attempt to 'ward off evil sprits'.
Disease & Infection ~ Ancient Egypt
- There were specialist doctors and healing priests (employed by the rich, like the pahroah) who spent their lives improving their medical knowledge.
- Some Egyptian doctors kept records of their medical knowledge.
- The Egyptians used both natural & supernatural methods to treat illness.
- Natural methods included the uses of herbs & minerals to cure ailments such as a diseased eye.
- Supernatural methods included the use of charms made from foul smellin gherbs to ward off evil spirits, and bathing in sanctified water, in the sanatorium, in the hope God would make you dream your cure.
- There was also some preventative techniques used, such as purging yourself, or wearing a mosquito net.
Disease & Infection - Ancient Greece
- The Greeks were a civillisation that still placed emphasis on spritual explanations for disease, with the god Asclepius being the main God of healing for the people.
- Paitents would visit the Asclepion temple with offerings for the God, and the belief was that at night, Asclepion would visit with his snakes and in the morning the paitent would be cured. It would seem likely that healing priests performed the surgical procedures and gave treatments overnight.
Disease & Infection ~ Ancient Greece
Hippocrates & The Four Humours
- Greek thinkers were people who, looked for more rational explanations for disease, and were the first to carefully observe and record symptoms of their paitents.
- These thinkers believed that the body contained four important liquids (Phlegm, Blood, Black Bile, Yellow BIle), they called these four liquids, the four humours.
- It was believed that if these humours stayed in balance, then a person would stay healthy.
- This theory was so important because, it was the first logically thought up explanation of disease and illness, and also linked with the beliefs of four seasons and four elements.
- The idea of the four humours worked well, because it led the Greeks to do everything in moderation (not eating too much, not excersing too much, etc).
- Hippocrates was the most important doctor in the Greek period, and arguably in the entire ancient world.
- He was important for being a strong encourager of observation and symptom recording in paitents and also writing the 'Hippocratic collection', a list of medical books that were used by doctors for centuries.
- His Greatest accomplishment though was developing and pushing forward the theory of the four humours, so it was used by many doctors for centuries to come.
Disease & Infection ~ Ancient Rome
- The Romans conquered the Greek empire, meaning they were highly influenced by Greek emdicine (four humours, Asclepius).
- They were less theoretical than the Greeks, and looked for more Practical solutions to preventing illness.
- Some continued to believe in Gods curing & causing illness, and the Romans adapted the Asclepius (evidence found on altars).
- Training to become a doctor was still not compulsory, but many did based on the Hippocrates book or being apprenticed by another doctor.
- The Roman Army now had specific doctors & orderlies for the army.
- There were many female doctors and mid wives.
- Galen, did develop the theory 'of opposites' which was treatment based on the idea of the four humours. He thought that if one of the humours was out of balance, it should be balanced out by another humour.
- Galen also had an idea about disease being spread through 'seeds in the air' but never developed it.
- Stressed the ideas of regular excerise and a healthy diet.
Disease & Infection ~ The Middle Ages
The impact of Faith on medevial medicine
- Religion was a very important factor in Medevial medicine, with the Christian Church both hindering and helping medical progress in different ways (but probably hindering more).
- When it came to developing new medical ideas, The church hindered progress as it only protected and taught ideas by Galen (because his ideas agreed with the Church's belief of God as a designer). It put people (such as individual priest Roger Bacon) in prison for heresy if they tried to bring in new theories about medicine.
- Church's did set up universities to train doctors, however in these universities they were taught to only accept past findings like Galen's.
- The priest for each villiage instructed people on life choices, however their explanations for medical problems relied on supernatural explanation (sin).
- The monastries were responsible for the controlling of books & texts and banned books that didn't agree with the christian doctrine.
- Women could act as midwives and surgeons, but were not allowed to go to the universities and therefore couldn't train to become physicans.
- The muslim faith had similar ideals to the christian in that they respected and preserved Galen's ideas.
Disease & Infection ~ Middle Ages
- Islamic doctors were more interested in theoretical medicine than practical and harboured some influential doctors.
- Rhazes: formualted the first accurate descriptions of measles and smallpox.
- Ibn Sinna (Avicenna): Wrote a million word textbook 'The book of healing' covering all aspects of medicine.
- Ibn Nafis: He dared to disagree with Galen's theory of how blood flows around the body, because of his theory of 'pulmonary circulation'. Because of this he was not taken seriously.
Disease & Infection ~ Middle Ages
What a medieval doctor knew
- Their explanations about disease generally revolved around the four humours.
- Surgeries also had moon & urine charts.
- Doctors & Wise Women, still were heavily reliant on herbs & potions for their treatments.
- Many recipes of potions were recorded in 'Bald's leechbook'
Disease & Infection ~ Renaissance
- Who you went too for treatment. For treatment you could see a number of people. Licensed healers were Physicans (all male, still), an apothecary (which sold and mixed potions), A surgeon, or a midwife.
- Unlicensed healers, would be family (normally a woman), the wise women of the village or the 'lady of the manor'.
Improvement in health via renaissance medicine.
- Lady Grace Mildmay was born in 1552. She was a lady from a wealthy family who read widely to accquire her knowledge of herbs & minerals.
- She became well known for her complex mixture of potions (most famously her 'precious balm') which treated a wide range of illnesses including, Jaundice, Smallpox & Ulcers.
- Paracelsus was a physician and chemist born around 1483 who disagreed with Galen on the belief that diseases were caused by an imbalance of humours.Paracelsus believed that disease attacks from outside the body, adn devised mineral remedies to help the body defend itself.
- Thanks to his disagreement, Paracelsus helped medical thinking onto a more scientific course.
- The great plague in 1665 was not treated much differently from the black plague back in 1348.
- The government still placed an emphasis on shutting up victims and focusing on air.
- However, the level of precise deatil in laws is improved, With a clear team of examiners and precise timing and depth of burial.
Disease & Infection ~ 18th Century
Lady Mary Wortley Montague & Inoculation
- The first major method of smallpox prevention was Inoculation.
- Inoculation was an idea that started in China, where it had been used for centuries, in which a mild form of the smallpox disease was put onto an open wound. This would give the person infected with the dose, a mild case of smallpox, but would protect them from the full force of a severe attack.
- This method was observed by Lady Mary Wortley Montague whilst she was in Turkey. She had suffered smallpox herself and didn't want her children to have to iswell, so she got them inocualted.
- Being an influential woman with many doctor friends, Montague's idea soon caught on (when people saw they could make money from it).
- Results do show that mass inocualtion did work well and when used, less people died from an epidemic.
- However, even inocualtion was a high risk procedure with some of the people being inoculated dying from their mild dose of smallpox, or spreading it to others.
Disease & Infection ~ 18th/19th Century
Edward Jenner & Vaccination
- Edward Jenner was a doctor in Gloucestershire, who was offering people inocualtions against smallpox. He was shocked to disocver many people turning it down however.
- He learned from local farmers that people did not belive they would catch smallpox if they had already had a mild disease called Cowpox.
- Jenner then discovered that some dairy maids, who caught cowpox were less likely to catch smallpox.
- Jenner then tried an experiment of infecting someone with the cowpox disease, then after they recovered, trying to infect them with smallpox disease to see if they caught it. He did this experiment to 23 people, including a healthy 8 year old boy and a milk maid called Sarah Nelmes.
- He concluded that after having cowpox you are better protected from the infection of smallpox.
- Jenner wrote up his findings and submitted them to the royal society in 1798, however there was much opposition to vaccination because Jenner did not have any logical explanation as to why vaccination worked, and also doctors did not want to lose out on money they were making through inoculations. So the Royal Society rejected it.
- After having it rejected, Jenner decided to publish his findings himself, and Parliament thought Jenner';s work was very significant and gave him a £30,000 grant to opena vaccination clinic in London.
- Slowly many people including Thomas Jefferson & Napoleon (who had his army vaccinated in 1805) began to support the idea, and in 1852 vaccination became compulsory in Britian.
- However people were outraged at this and saw it as an attack on their personal liberty, so after much protesting, in 1887 the opposistion sucedded and parents could refuse to have their children vaccinated.
Disease & Infection ~ 19th century
Miasma, Germ Theory & It's Impact.
- In the early 1800's the popular theory to explain disease was miasma. Miasmatists believed that posionous fumes were given off by rubbish and decaying matter, and those bad smells, spread in the air/wind carried disease.
- Florence Nightingale who was famous for her hospital work in the Crimean war was a big believer in it. This is why she wanted all hospitals to be clean and well ventilated.
- Although the Miasma theory was wrong, it was closer to the truth than the four humours theory, and the clearing away of rubbish and decaying matter certainly did help prevent disease.
- Back in the late 1600's Van Leeuwenhoek made some of the earliest microscopes, with distorted quality, however, in these microscopes, he could see tiny organisms (which he called animalcules) in food, excretement and animal intestines.
- Leeuwenhoek prestend his findings in 200 papers to the royal society, this caught the interest of other scientists, however microscopes were not advanceed enough at the time, to pursue the idea.
- In 1830 however, Joseph Lister, developed a microscope that magnified 1000 times without distortion.
- In the 1850's Louis Pasteur became interested in Micro-organisms when a brewing company asked him to help discover why their alcohol was going bad.
- Pasteur discovered that a micro-organism was growing vigourously in the liquid, he developed a theory that this micro-organism (which he called a germ) was the cause of the problem.
- Pasteur solved the problem, showing him he could killl the the germs by boiling the liquid.
- After solving this problem, Pasteur became well known in France and helped other industries with similar problems.
- in 1860 he got an oppourtunity to spread his theories further when the french academy of science launched a competition to prove or disprove the theory of 'spontaneous generation'.
- Pasteur proved his theories correct, through a series of ingenious experiments and in 1861 published his 'Germ Theory'
- Pasteur was now also convinced that disease was caused by the same process as material decaying, but he was no doctor, it was Robert Koch, a German doctor, who applied Pasteur's ideas to human diseases.
Disease & Infection ~ 19th Century
Robert Koch & Louis pasteur
Disease & Infection ~ 20th Century
Disease & Infection ~ 20th Century
- Penicillin itself is made from a mould called Penicillium.
- This was first discovered in the early 19th century by John Sanderson who found very ittle grew near it.
- In the 1880's Lister noted these observations and sucessfully tried using penicillin to treat a young nurse's wound. However he did not leave notes on this case and stopped using the mould.
- Penicillin was really re-dsicovered in 1928 by Fleming in the laboratory of St Mary's hospital.
- Although the story of how Fleming discovered the mould is never entirely clear, due to his varying stories, the important thing was he did and realised it's importance. That Penicillin could be injected into areas with penicillin sensitive microbes. The problem was FLeming did not have the facilities or support to develop the idea that Penicillin could fight infection.
- In the 1930's two oxford scientist, Florey & Chain, became interested in the 1929 paper Fleming had published on Penicillin.
- In 1939 they gathered together a skilled research team and three days after the outbreak of WW2 asked the british government for funding for research into penicillin.
- In 1940, Penicillin was tested on animals for the first time (mice), and the results of the test were successful.
- In 1941, they finally had enough penicillin to test on a human, a man from oxford. Although this paitent ended up dying, because a lack of pure enough penicillin, the trial confirmed that the penicillin could fight infection.
- It was only in 1942 that the U.S. Government gave $80 million to drug compaines to mass priduce penicllin. And by june 1944 there was enough penicillin produced to treat all the D-Day causalties.
- This is an example of how the world war acted as a catalyst for penicillin.