- Prehistoric people were nomadic hunter-gatherers living in small groups.
- They had little understanding of causes or cures of illness.
- Instead, illness was explained by belief in the supernatural and evil spirits.
- Shamans, medicine men/women and witch doctors and magic rituals played a big part in prehistoric medicine.
- Because of belief in evil spirits, one 'cure' that was used was the trephining (aka trepanning) of skulls.
- However, evidence suggests that prehistoric medicine also involved the use of natural or practical common-sense cures.
- Trephining actually forms a link in this dual approach to medicine-evidence shows that the bone healed over after the operation, showing the 'patient' survived. Such as procedure is now known to help in some cases of head injuries and epilepsy.
- They also used herbal medicines, ointments, natural dressings for wounds (e.g moss) and knew how to set bones and carry out amputations.
- But, as there is no written evidence, historians also have to rely on archaeology, ethno-archaeology and anthropology to try and understand prehistoric medicine.
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Ancient Egyptian medicine
- The Ancient Egyptian civilisation along the fertile banks of the River Nile also had a dual approach to medicine.
- They believed evil spirits caused illness, and believed some gods (e.g Sekhmet, Thoth) helped bring about cures.
- prayers by priests, and the use of charms and amulets, were believed to help prevent illness.
- However, the Ancient Egyptians also had a wide range of natural or practical cures based on herbal ointments and potions, and natural drugs and antiseptics. They also performed simple operations and stressed the importance of a healthy diet.
- Their invention of writing allowed symptoms and treatments to be recorded.
- This led to continuity, and allowed the training of doctors, who had to follow strict rules.
- Their practice of mummification led to improved knowledge of human anatomy (although they were not allowed to examine the organs removed in more detail). In addition, the insistence of priests on cleanliness led to improved hygiene.
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Ancient Greek medicine
- Explanations of the causes and cures of illness continued in Ancient Greece. Particularly important was the cult surrounding Asclepios, the god of healing (and his daughters, Hygeia and Panacea).
- Asclepions (temples to Asclepios) were also used for treating the sick-usually done by priests who combined the use of ointments with prayers and rituals.
- However, some philosophers began to offer rational and natural explanations for the causes of illness.
- Particularly important was Hippocrates who based his work on earlier theories about the 4 elements, the need for balance and the importance of regimen.
- He stressed the importance of clinical observation of patients and symptoms, but he said little about treatment.
- His ideas were developed further by his followers in a collection of medical books known as the Hippocratic Corpus.
- Especially important was Aristotle who developed the theory of the four humours, and methods to restore balance.
- Further medical progress resulted from the founding of Alexandria, in which a large library containing many medical books was established and, for a time, human dissection was allowed.
- Greek doctors and their ideas spread across the ancient civilisations around the Mediterranean.
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- At first. after the Romans had conquered Ancient Greece, they rejected ,any of the Greek ideas about medicine.
- Later, an Asclepion was built in Rome and became a public hospital for the poor. Gradually, Greek doctors were allowed to practice, and they soon dominated medicine in the Roman empire.
- However, because there were few doctors, heads of households were supposed to treat their members-mainly using a mixture of common-sense practical cures and religious rituals.
- The Romans are particularly associated with practical achievements and developments in public health.
- This practical approach included the building of aqueducts, sewers, public baths and toilets, and the draining of swamps.
- Also, because of their desire for a strong army, attention was paid to treating ill or injured soldiers. This included clean drinking water, the safe disposal of sewage, hospitals for the wounded (valetudinaria), and special doctors and medical troops.
- Some of these were eventually extended to civilians.
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- The most famous doctor in Ancient Rome was Galen, who developed the ideas of Hippocrates, and based his cures on the theories of balance and treatment by opposites.
- He wrote of 100 books, which drew together the ideas of all the doctors of the ancient world, to form a single system. This influenced medicine through the Middle Ages and into the Renaissance.
- But, because human dissection was not allowed, Galen used dogs, pigs and apes-this led to some important mistakes about human anatomy.
- From about AD400. the Roman empire began to fall to northern tribes who destroyed books and libraries, so much of this medical knowledge was lost in Europe for a long time.
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- Although the fall of Rome led to regression in medicine in Europe, much of the medical knowledge and books of ancient civilisations were preserved in the East.
- Especially important in this was the new Islamic civilisation established in the Middle East.
- Although many Islamic doctors continued to believe that illness was cause by evil spirits, some based their work on the ideas of Hippocrates and Galen.
- Particularly important was Humaom ibn Ishaq (Johannitus) who became chief physician of Baghdad, the new capital of this Islamic empire.
- He travelled to Greece to collect medical texts, which he then translated into Arabic. This was in the ninth century, when much of this knowledge was still unknown in Europe.
- Islamic governments set up medical schools and, from 931, doctors had to pass exams to get a license to practice.
- The main cities had public health services-piped water, public baths and hospitals (care of the sick was a duty in the Quran).
- Eventually these ideas began to spread to Europe because of increased trade and the Christian Crusades.
- Also important were: Rhazes (al-Razi) who wrote the al-Hawi (The Comprehensive Book); and Ibn Sina (Avicenna) whose Canon of Medicine, based on Galen and his own observations, was later translated into Latin and became the main textbook in Europe until 1700.
- Arab alchemists also discovered new methods and techniques that helped prepare drugs for treating the sick.
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- In Europe, after the fall of Rome, there was a regression in medicine. Many books and libraries were destroyed, and the public health systems of the Romans collapsed.
- Although the Christian Church gradually re-established itself, this did not help progress in medicine at first, as the Church believed in supernatural causes and cures of illness.
- As a result, there was much emphasis on prayers to God and the saints, and on pilgrimages.
- However, increased trade and the Crusades led to the medical knowledge and books of Islamic doctors reaching Europe-many of the works of Hippocrates and Galen were translated into Arabic and Latin.
- During the eleventh century, the Church cam to accept the ideas of Hippocrates and Galen, but insisted these were the absolute truth. The Church also banned any human dissection.
- Many medieval doctors also saw astronomy and astrology as causing and/or curing diseases, and being useful for deciding diagnosis and treatment.
- Because doctors were few and expensive, most ordinary people relied on informal healers.
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- Then, towards the end of the eleventh century medicine became increasingly professional, and medical school were established.
- From about 1300, the Church also began to allow some public dissection of human corpses in universities, and even accepted some revisions to Galen.
- However, acceptance of new ideas was slow-for much of the time, medical knowledge in Europe was behind that in the Islamic world.
- A particular problem in the Middle Ages, as trade grew and towns expanded, was public health.
- After the collapse of Rome, central governments did not provide public health facilities. Instead, it was left to the corporations of each town.
- The problems of unclean drinking water and sewage disposal led to many outbreaks of disease.
- However, the monasteries did maintain some continuity, especially as regards water supply, toilets and care of the sick in hospitals.
- In 1348, the Black Death hit England, and brought public health issues to a head.
- In all, about a third of the population died, and it was worse in the towns. People had no idea about the disease;s causes, or how to cure it.
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- Around 1450, a more scientific approach began to develop in Europe-this period became known as the Renaissance.
- In medicine, this led to the recovery of more texts by Hippocrates and Galen, but there was also a greater emphasis on observation and science.
- Printing helped spread new ideas, while the Reformation weakened the hold of the Church over education.
- Particularly important was Vesalius who discovered errors in Galen's anatomical work, and criticised the method of bleeding. But Vesalius had little to say about the causes or cures of illness, and so had little impact on treatment.
- Further progress was made in the seventeenth century-particularly important were Fabricius and his student, Harvey.
- Harvey proved that Galen was wrong about the heart and the circulation of blood, but this discovery failed to lead to any real changes in medical treatment.
- The Scientific Revolution led to a new interest in science and experimentation. One important invention was the microscope by van Leeuwenhoek in 2693. In the early eighteenth century, thermometers were invented, and different gases discovered.
- Further improvements in medical knowledge were made by Boerhaave and van Haller.
- Despite this, before 1750, most ordinary people had to rely on 'informal healers'. Supernatural and magical 'cures' still continued.
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Medicine in the Industrial Revolution
- One effect of the Scientific Revolution was to increase respect for physicians and doctors, and to improve the training of surgeons.
- In the main, though, many old medical ideas continued in the first half of the eighteenth century.
- Also, despite the discoveries before 1750, doctors had little idea about the causes of disease. Knowledge of chemistry was limited, and microscopes weren't very powerful.
- However, from about 1750, Britain underwent important changes that created am industrial society.
- At first, this had a bad effect on public health in the large, overcrowded and dirty industrial towns. Governments continued to laissez-faire attitude and did nothing to intervene.
- Eventually, though, as a result of improved technology, there were better aids and chemicals for medicine, such as more powerful microscopes, new drugs and new machines.
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Medicine in the Industrial Revolution
- An important discovery was made by Jenner, who published the results of his successful vaccinations against small pox in 1798.
- Jenner could not explain why it worked, so there was much opposition at first to his method. Eventually, though, the government made vaccination compulsory in 1853.
- The next breakthrouhg came in 1857 whe Pasteur discovered the link between germs and disease (only in plants and animals).
- This idea was then taken up by Koch who, in the 1870's and 1880's (using newer technology), was able to link particular germs to particular diseases.
- Pasteur's team became the first to discover effective vaccines (against chicken cholera and then antharax). In 1882, they discovered a vaccine against rabies.
- But the important breakthrough regarding human disease was made by von Behring, who used anti-toxins to cure a child with diphtheria in 1891. Other anti-toxin soon followed.
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The drugs revolution
- In 1884, it was discovered that antibodies attacked specific germs. After 1900, Ehrlich (who had not had much success in extracting natural antibodies) began to look for synthetic chemical 'magic bullets' to cure disease.
- Using new dyes produced by the German chemical industry, he eventually made a breakthrough in 1909 when his team found a dye (Salvarsan 606) which attacked syphilis. It was first tried on a human in 1911.
- It was not until 1932 that a second 'magic bullet' (prontosil) was discovered by Domagk. In 1935, he used it to cure blood poisoning.
- A French scientist identified the active ingredient as a sulphonamide. This led to a range of new drugs, based on sulphonamide, to combat several diseases (although several had serious side-effects).
- The next breakthrough was made by Flemming in 1928 when, by chance, he discovered penicillin-this killed germs without harmful side-effects. But he was unable to find a way to produce pure 'mould juice'.
- Then in 1938, Florey and Chain developed a method based on freeze-drying, but they could only produce small amounts.
- However, once the ISA became involved in WW2, Florey and Chain were given money and equipment to mass produce penicillin.
- This led to the development of a whole range of antibiotics that wiped out many diseases.
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- The twentieth century saw the development of 'high-tech' surgery with many complex procedures, and great improvements in nursing. The discovery of DNA has led to the new science of genetics and genetic engineering.
- But there have also been problems- the side-effects of some drugs, the costs of providing new treatments, and also the question of ethics in some areas (for example, human embryo research and cloning).
- There have also been problems with some drugs companies bringing out drugs too early, before adequate research into side-effects, or dumping unsafe drugs on the poorer developing countries in Africa and Asia.
- Over-prescription of antibiotics has led to some germs becoming resistant- the 'super bugs'.
- During the twentieth century, Liberal and especially labour governments passed acts to set up welfare state. In 1948, Labour established the National Health Service.
- But problems over costs and staff shortages have led to problems, such as long waiting lists.
- This, and problems associated with high-tech medicine, have led to many people to turn/return to alternative methods, including herbal medicine, acupuncture and even supernatural 'cures'.
- Although some of these methods are now available from the NHS in some areas, the BMA remains doubtful about their effectiveness.
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- Before 1500, most people had to rely on informal healers. Many of these were women, who dealt with all aspects of medicine, as physicians, surgeons and midwives.
- In the civilisation of the ancient world, women were allowed to practice as doctors (especially as midwives). This was also true of the Islamic civilisation.
- At first, this was also true in medieval Europe but, as medicine became more professional and under control of the Church, women were increasingly excluded.
- However, as most people could not afford trained doctors, women continued to act as informal healers (for example, housewife-physicians, 'wise women' and midwives).
- The decline in women doctors continued during the Renaissance. The invention of the obstetric forceps even led to women being excluded from their role as midwives (although their informal role continued).
- The first signs of a return to women to formal medicine came in nursing, as a result of the work of Florence Nightingale in the Crimean War.
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- The Nightingale School of Nursing was established and other followed. In 1900, there were 64,000 trained nurses. After the establishment of entry qualifications in 1919, nursing became a respected medical profession.
- But there were still no women doctors. However after 850. attitudes began to change.
- Elizabeth Garrett tried to qualify as a doctor in Britain but no university would allow it. eventually she qualified in Paris in 1870. But in 1876, as a result of the efforts by those such as Sophia Jex-Blake, all medical qualifications were open to women.
- The move to greater equality was helped by the two world wars, which ked to an increased demand for doctors, and then by the establishment of the NHS. The Sex Discrimination Act, 1975, also helped to create more opportunities, but women are still under-represented in top medical jobs.
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- Public health developments in the ancient civilisations did not survive the fall of Rome.
- During the Middle Ages, governments were unwilling to provide public health facilities, and often lacked money or power to enforce such measure anyway.
- Corporations of individual towns rarely did anything, unless there was a serious outbreak of disease- the worst example being the Black Death (bubonic plague), which first hit Britain n 1348.
- Even after 1500, during the Renaissance, there was no real progress. In fact. the growth of trade and towns, and frequent wars, often made the situation even worse.
- As a result, epidemics and plagues continued to break out across Europe (e.g the Great Plague of London in 1665-6).
- The main problem was that people did not understand the causes of such diseases.
- However, with the Industrial Revolution, public health reached a crisis, with the filthy and overcrowded conditions in the large industrial towns. The result was a range of infectious diseases such as typhus and TB.
- Particularly important was the outbreak of a new disease in 1931 - cholera.
- This eventually persuaded the government to set up an enquiry under Edwin Chadwick. His report came out in 1842 and, after another outbreak in 1847, led to the passing of the first Public Health Act in 1848 (although it's measure weren't compulsory).
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- The work of Snow. and then the discoveries of Pasteur and Koch on germs, followed y another outbreak in 1865-6, led to the establishment of a Royal Sanitary Commission in 1869, and a new Public Health Act in 1875 (this was more effective as it made action compulsory).
- Further revelations about effectiveness of squalor on health (the Booth and Rowntree reports, and the Boer War, 1899-1902) led to further reforms by the Liberal government, 1906-18.
- Evacuation during WW2 revealed problems still existed and led to the Beveridge Report (1942) and the establishment of the NHS by the Labour government in 1948.
- However, problems remain concerning the impact of chemicals and fertilisers on drinking water and the air.
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- For most of the 5000 years until 1750, surgery's three main problems were pain, infection and bleeding.
- Although there was some improvement in knowledge and techniques in the ancient world, the collapse of Rome led to regressions in Europe. Even the advance made in the later Islamic civilisation had no impact on surgery in Europe.
- During the Middle Ages, surgery was often left to assistants or even untrained barber-surgeons.
- However, some discoveries were made by:Hugh and Theoderic of Lucca (wine as mild antiseptic); de Chauliac (his work based on Mondino's Anatomy of 1316); John of Arderne (early forms of anaesthetic).
- Generally, though, such new ideas had little impact, and were rejected by most doctors.
- Further progress (on treatment of wounds, amputations and bleeding) in the sixteenth century by Pare, who became the mot famous Renaissance surgeon, was also largely ignored at the time. In fact, as there were no antiseptics, Pare's use of threads actually increased the risk of infection.
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- The next important development was in relation to pain- with Davy identifying nitrous oxide as a possible anaesthetic in 1799.
- More important was the discovery of ether (1842) and chloroform (1847), but these had side effects too.
- Anther problem was that overcoming pain led to longer and more complex surgery, but the lack of antiseptics and blood transfusions led to increased death rates (the 'Black Period' of surgery, 1846-70).
- A breakthrough came with the work of Semmelweiss (1847); especially important was Lister (1867) who, using Pasteurs Germ theory, used carbolic acid to prevent infection.
- Though this led to greatly reduced death rate, there was opposition to his method at first.
- Then, in 1887, Neuber and Bergmann in Germany moved on from antiseptic to aseptic methods, so ensuring that germs did not even enter the wounds.
- however, bleeding continued to be a problem until 1901, when Landsteiner discovered different blood groups.
- Further discoveries during WWI by Hustin allowed blood to be stored more easily.
- The terrible injuries suffered by soldiers and civilians in the two world wars led to the development of plastic surgery (Gillies and McIndoe) and then heart surgery (Harken).
- Further inventions (X-rays, electrocardiographs, artificial kidney, heart and lung machines, and fibre optics) have led to transplants and key-hole surgery.
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