Medicine Through Time - Key Individuals

460BC - 370BC

Disease and Infection

• The Hippocratic Oath - makes clear that doctors are not magicians and must keep up high standards of care for their patients not for the benefit of wealth.
• Encouraged doctors to look for natural causes of diseases etc
• Believed in observation and recording symptoms and development of disease and treatment
• THE FOUR HUMOURS - Blood, Phlegm, Yellow Bile and Black Bile
• theory that the body is made up of four humours or liquid that when balanced a person is healthy but when a person is sick the humours are unbalanced (there is too much or too little of a specific humour)
• The Humours are linked with the seasons - (e.g.) when its winter a person will get a runny nose and will sneeze etc (a cold) which are cold moist symptoms linked with the cold moist season of winter

384BC - 322BC

Surgery and Anatomy

• One of the greatest Greek Pilosophers
• An interest in biology led him to dissect animals and plants
• Believed in carefull methodical observation was the basis of all learning (similar belief to Hippocrates)
• Later admired by William Harvey
• Although he did not dissect human bodies (due to religious reasons) Aristotles studies led him to suggest that the heart and brain are the most important organs in the body
• Suggested that the heart provides the body's heat and the brain cools it down, noth organs working together to control the body.

Born - AD129

Surgery and Anatomy

• Wrote hundreds of books - Galen became the basis for medical teaching for the next 1500 years
• Belief in the FOUR HUMOURS and OBSERVATION
• Followed Hippocrates and based medical advice for patients on a healthy diet and exercise.
• Developed the idea of OPPOSITES - used to balance the humours which involved treating illnesses acociated with each season with specific treatments that focussed on opposites - hot with cold (e.g.) a common cold or flu would be treated with a slight change in diet by giving the patient chillies or advising them to take as many hot baths as possible
• Believed that dissection should be done as much as possible (preferably using human bodies) to observe and develop a keen knowledge in Anatomy

• Discoveries of the NERVOUS SYSTEM - he dissected a pig, as the pig squealed on the table Galen cut into its neck, finding the nerves. As Galen cut two nerves he announced that the pig would keep squealing, he then said as he cut the third nerve that the pig would consequently stop squealing as he did this it fell silent.
• Galen discovered that the brain, not the heart, controlled speach and that the arteries not just the veins carried blood around the body - however he did make mistakes as he would often have to dissect the bodies of animals (in particular apes)

1514 - 1564

Surgery and Anatomy

• BACKGROUND (ANATOMY SO FAR) - Doctors believed Galen had given a fully correct description of the human body. Dissection was carried out to show Galen was right, not to check or challenge him.
• WORK OF VESALIUS: - Repeated Galens work but proved that sometimes he could be wrong
• PROVED THAT:
• the human jaw bone was made from one bone not two (as Galen had said)
• the breastbone has three parts not seven (asd Galen had said)
• blood does not flow into the heart through invisible holes in he septum - such holes he proved, do not exist
• Showed that doctors could learn more about Anatomy and had to carry out human (not animal) dissection to learn more

1578 - 1657

Surgery and Anatomy

• BACKGROUND (BLOOD) GALEN HAD SAID:
• new blood was constantly manufactured in the liver to replace blood burned up in the body just like wood is burnt by a fire
• blood passed from one side of the heart to the other through invisable holes in the septum. This had been challenged by Ibn al-Nafis (1210-1288) and Vesalius but neither could provide an alternative explanation

• HARVEY'S ACHIEVEMENTS - he proved that the heart acts as a pump, pumping blood around the body. He did this by:
• dissecting live cold-blooded animals whose hearts beat slowly so he could see the movement of each muscle in the heart
• dissecting human bodies to build up a detailed knowledge of the heart
• proving that the body has a one-way system for the blood - he tried to pump liquid past the valves in the veins but could not do so
• calculating that the amount of blood going into the arteries each hour was three times the weight of a man. This showed that the same blood was being pumped round the body by the heart

1510 - 1590

Surgery and Anatomy

• BACKGROUND (SURGERY SO FAR):
• Wartime practice helped surgeons make minor improvements to treatments/techniques but no major breakthroughs were made.
• Gunpowder was believed to be poisonous so boiling oil was poured onto bullet wounds for treatment or an oil-soacked cloth was placed on the wound which was then bound. Both methods were very painful
• A red-hot iron called a cautery was used to close open wounds and amputations - used to seal blood vessels. CAUTERISING was very painful
• PARE'S ACHIEVEMENTS:
• Pare replaced the current treatment of gunshot wounds with the use his own mixture made up of egg yolks, oil of roses and turpentine.
• Pare used LIGATURES to stop bleeding (silk threads tied around individual blood vessels) - replaced cauterising - 'the old and too cruel way of healing'
• He designed and arranged the making of false limbs for wounded soldiers and included drawings of them in his books to spread the idea.

1493 - 1541

Disease and Infection

• Original name was 'Philippus Aureolus Theophrastus Bombastus von Hohenheim' - later changed to Paracelsus meaning 'better than Celsus'. Celsus was a renowned Roman doctor - changing his name to this shows his views about ancient medical teachings and practices.
• He believed that no doctor should study ancient medical practices and also that Galen was a 'liar' and a 'fake' - the patient is what a doctor should learn from not ancient books. He also said that the Four Humours was wrong.

• PARACELSUS - PRACTICES:
• Said illness was caused by chemicals in the body so treatments should be based on the use of chemicals - experimented with Salt, Mercury and Sulphur
• Believed God sent secret messages about how the world works (called 'signatures') - 'signatures' included plants that resembled a body part/illness (e.g. the plant 'eyebright', shaped like an eye, he used to treat eye problems. Sexualy transmitted diseases he treated with Orchids shaped like a testicle
• Argued that the body was a CHEMICAL SYSTEM that had to be balanced not only internally, but which also had to be in harmony with its environment.
• Believed that metals were the key elements which made up the universe - they were subject to control by God, the ‘great magician’ who created nature.

1749 - 1823

Disease and Infection

• SMALLPOX (THE STORY SO FAR):
• smallpox was a highly dangerous disease in the 1700's that would often kill or leave terrible scars and disfigurement on peoples skin
• INOCULATION was used to prevent people from catching the disease - this involved spreading the pus from a smallpox pustule into a cut in the skin of a healthy person. This was risky, if the person was lucky they would get a mild dose of smallpox and would then be immune to the disease. If the person was unlucky, they would get a bad case of smallpox and die.
• This was expensive, dangerous and the disease could also be passed on through this process to others.

• JENNER'S ACHIEVEMENTS:
• Jenner leanred a lot from the surgeon John Hunterwho told his students to observe their patients carefully and also experiment to test ideas.
• Jenner had long known the story that milkmaids who caught COWPOX never seemed to get SMALLPOX - he then thought about how to test the idea.
• 1790's - Jenner selected a milkmaid 'Sarah Nelmes' who was infected with cowpox from her masters cows, he then selected a young boy about 8 years old and inserted some of the matter from a cowpox postule on the milkmaids hand inot two insisions made in the young boys skin. The boy then fell ill with cowpox. After recovery he was inoculated with smallpox matter but didnt fall ill. This was then repeated and again the boy did not fall ill
• In 1798 Jenner published his book describing VACCINATION and presenting his evidence, describing 23 different cases of the experiment.

1822 - 1895

Disease and Infection + Public Health

• Created and developed the process of PASTEURISATION - gently heating liquids to kill organisms or bacteria that have made or will make the liquid turn sour (e.g. commonly used in wine and milk industries)
• As a result of his work with liquids and organisms or bacteria he was convinced that it was GERMS in the air that were causing the liquid to go sour and perhaps causing disease (the government paid for a new lab and better materials for Pasteur to test and develop this theory and any other ideas)
• 1864 - he carried out a series of experiments that convinced scientists that his GERM THEORY was correct and that SPONTANEOUS GENERATION was wrong - he showed that bacteria were causing decay not being caused by decay

• 1865 - he proved that disease can be spread by germs in the air. This was the first time it was proved that germs were causig disease in animals
• PASTEUR'S WORK 1879 - 1881:
• Pasteur had built up a research team to work on theories and test and develop new ideas
• In an experiment (working with Cholerah in chickens and immunisation) Pasteur descovered how Jenner had managed to create the VACCINE to Smallpox - with this information he could then create and develop more vaccines.

1843 - 1910

Disease and Infection

• Investigated Anthrax, a disease infecting animals and people and discovered the specific bacterium that caused the disease - the first time the specific germ causing a disease had been identified
• Developed a method to determine which particular bacterium was causing a disease - could then be used by other scientists
• Improved methods of studying bacteria - developed ways of staining bacteria so they could be photographed using a new high quality photographic lens
• Discovered how to grow bacteria on potatoes - a lot easier than growing bacteria in a liquid
• 1881 - 1882:
• Koch set to work on finding the specific bacterium that causes other diseases suuch as Tuberculosis - he did this by using the method of staining the bacteria

1881 - 1955

Disease and Infection

• Studied soldiers' wounds that were infected during WW1
• 1928 - working at St Mary's Hospital (London), going on holiday he left a pile of petri dishes containing bacteria on his laboratory bench. When he returned he found that there was mould in one of the dishes, the bacteria around the mould had disappeared
• Fleming carried out experiments with the PENICILLIN mould on living cells and made a list of the germs it killed - it did not seem to work on deeper infections

1938 - Florey and Chain's Research Trials

Disease and Infection

• Researched how germs could be killed
• Began growing Penecillin in anything that was usefull such as bedpans (there were not enough funds for drug companies to grow penecillin)
• 1941 - there was enough penecillin to test it on one person - a volunteer who was suffering from Septicaemia (Albert Alexander) was the test subject for the drug. Chemical drugs had not cured the infection - Florey and Chain requested permission to try their new PURIFIED PENECILLIN and the injections began and Alexander began to recover - but it ran out and Alexander died
• 1941 - America was attacked by the Japanese at Pearl Harbour and entered the war. The American government realised the potential of penicillin for treating wounded soldiers - made interes-free loans to US companies to buy the expensive equipment for making penecillin - soon British firms were also mass producing penecillin (enough to treat the allied wounded on D-Day 1944)

1800 - 1890

Public Health

• 1842 - Chadwick published his 'REPORT ON THE SANITARY CONDITIONS OF THE LABOURING POPULATION'
• 1 - the poor live in dirty, overcrowded conditions
• 2 - this causes a hug amount of disease
• 3 - many people are too sick to work and so become poorer still
• 4 - therefore other people have to pay higher taxes to help the poor
• Solution to REFORM PUBLIC HEALTH Report 1842:
• 1 - improving drainage and sewers
• 2 - removing refuse from streets and houses
• 3 - providing clean water supplies
• 4 - appointing medical officers in each area to check on the reforms
• This was not done straight away

• The PUBLIC HEALTH ACT 1848:
• National board of health set up
• Public health primarily improved in towns where the death rate was high (clean water supply etc)
• Local councils encouraged to make public health improvements
• Councils allowed to appoint medical officers of health and local boards of health to oversee public health

1813 - 1858

Public Health ( + Surgery and Anatomy + Disease and Infection)

• 1849 - published a book saying that Cholera spread through water not 'bad air' - his theory was mocked
• 1854 - Cholera outbrake gave him a chance to prove his theory- he wrote reports and evidence on the deaths of Broad Street to the disease of Cholera - his evidence was so strong that the Broad Street water pump was removed
• Snow had proved that clean water was essential for the prevention of the spreading of diseases (in particular Cholera)
• However, even this evidence did not lead to a public health act, and many scientists stuck with the 'bad air' theory

1838 - 1912

Public Health

• Governments were reluctant to pass laws forcing improvements in Public Health - but individuals showed that public health standards could be increased
• CAMPAIGNER of Public Health
• Started teaching poor children when at 14 and was appalled by their homes
• 1865 - she bought 3 SLUM HOUSES and cleaned them up to show how to provide healthy homes for the poor (and stop overcrowding)
• Over time she took over 2000 HOUSES -improving them to a much higher standard of cleanliness
• Similar schemes were set up elsewhere - she campaigned for laws inforcing the improvement of housing
• 1875 - ARISTANS' DWELLING ACT was passed giving councils the power to knock down slums - her influence helped to persuade and inforce and act like this

1871 - 1954

Punblic Health

• Investigated POVERTY and LIVING CONDITIONS in York
• 1901 - he published 'POVERTY: A STUDY OF TOWN LIFE'  - providing detailed evidence that more than a quarter of people in York  were living in poverty even though they were in work + poverty was having a serious impact on health
• This led him to increase his workers' wages and continue his research recording changes in conditions
• 1941 - he published a new report - 'PROGRESS AND POVERTY' which showed a 50% reduction in poverty since 1901 - showed that poverty in the 1030's was mostly a result of unemployment

1840 - 1916

Public Health

• Believed in improving conditions for the poor
• Thought that campaigners were exaggerating about the statistic 25% of people in London are living in poverty - he then set to work finding evidence to prove or disprove that statistic
• He spent weeks living in the East End of London renting rooms in a common lodging house - the result was an extremely detailed description of living conditions and poverty with coloured maps identifying the extent of poverty
• He descovered that the percentage of people living in London in poverty was 35% - far more than had been claimed
• Booth continued building up evidence of poverty and ill-health - he argued that the government had to take more responsibilty in caring for the poor
• A suggestion made by him was an old-age pension

1863 - 1945

Public Health

• One of the most inspirational politicians in British history
• A brilliant, persuasive speaker - determined to improve the lives of ordinary people
• 1890 - became a LIBERAL MP + was a chancellor of the EXCHEQUER in the Liberal Government
• Insisted on raising taxes on the well-off to pay for old-age pensions and the National Insurance Act of 1911
• 1916 - Became priminister

• THE IMPACT OF THE LIBERAL GOVERNMENT 1906 - 1914:
• 1902 - Compulsory training for midwives
• 1908 - Old age pensions paid to people over 70 who did not have enough money to live on
• 1909 - Back - to - back housing banned. New regulations enforced higher standards of house building
• 1911 - National Insurance Act provided help for the sick
• 1912 - Clinics held in schools to give children free medical treatment

1879 - 1963

Public Health

• National Coalition Government asked a leading civil servant, Sir William Beveridge to write a report on what should be done to improve peoples lives
• Played a key part in organising the 1911 National Insurance scheme
• The REPORT RECOMMENDED:
• Setting up a NATIONAL HEALTH SERVICE - free to everyone and paid for from taxes. Doctors, Nurses etc would become government employees instead of charging the public for diagnosis etc
• Everyone in work would pay NATIONAL HEALTH INSURANCE out of their wages - would pay benefits (sick-pay, old-age pensions, unemployment pay)
• The BEVERIDGE REPORT was popular with many people - people qued outside shops to buy copies 600,000 were sold

1897 - 1960

Public Health

• MINISTER FOR HEALTH in the LABOUR GOVERNMENT (which introduced the NHS)
• Son of a welsh coal miner and started working underground himself at 13 - his background and work for the miners' union gave him first hand experience with poverty and sickness
• Inspired to make a change he became an MP for Ebbw Vale in 1929 - was an inspiring speaker and an idealist determined to make life better for working people
• Speeches in favour of the NHS won support - reassured oposition (particularly doctors) about the NHS programme
• Ensured thhat doctors could still keep working for private patients who would pay them as well as working for the government with the NHS programme

1811 -1870

Surgery and Anatomy

• PROFESSER OF MIDWIFERY at Edinburgh University
• Used ETHER but was searching for a better ANAESTHETIC
• 1847 - he and several colleagues sat around a table experimenting with different chemicals to see what anaesthetic effects they had.
• SIMPSON WROTE:
• 'I poured some of the CHLOROFORM fluid into tumblers infront of my assistants and myself. Before sitting down to supper we all inhalde the fluid, and were all under the table in a minute or two to my wifes consternation and alarm'
• Realised he had discovered an effective anaesthetic - started using it to help women in childbirth and in other operations
•  Chloroform was a dangerous substance - could kill if not used correctly (too little ot too much could harm the patient) Doctors were unfamiliar + cautious
• Religious belief that God had meant for us to suffer and feel pain - many opposed the anaesthetic as you would be going 'against' Gods wishes 

1827 - 1912

Disease and Infection ( + Surgery and Anatomy)

• CARBOLIC ACID used on sewage pipes and prevented all odour from the lands covered by sewage and destroyed the parasites that usually infest cattle feeding on such land
• Lister then got the idea of using CARBOLIC ACID first to prevent infection and stop bacteria on patients with open fractures
• 1867 LISTER PUBLISHED HIS RESULTS, showing the value of using carbolic acid:
• 1 - HANDWASHING WITH CARBOLIC before operations to prevent infections in wounds
• 2 - CARBOLIC SPRAY used to kill germs in the air around an operating table
• 3 - ANTISEPTIC LIGATURE to tie up blood vessels and prevent blood loss
• 1877 - moved to London to train young surgeons, Listers work had opposition but it still marked a key turning point in surgery

ASEPTIC SURGERY:

Lister's antiseptic methods (killing germs on the wound) developed into ASEPTIC SURGERY (removing all possible germs from the operating theatre):

• Operating theatres and hospitals were rigorously cleaned
• From 1887 all instruments were STEAM-STERILISED
• Surgeons abandoned operating in their ordinary clothes and wore SURGICAL GOWNS and FACE MASKS
• 1894 - STERILISED RUBBER GLOVES were used for the first time - as however well surgeons' hands were scrubbed, they could still hold bacteria in the folds of skin and under nails

1922 - 2001

Surgery and Anatomy

• South African Heart Surgeon
• 1967 - carried out the FIRST HEART TRANSPLANT
• Barnard headed a team of highly  skilled + experienced doctors, nurses and scientists
• Patient died after18 days - much was learned + many heart transplants have been successful since then
• Other organs gad been transplanted before the heart (kidneys in 1954 - liver in 1963)
• Transplants could not be done untill scientists had discovered drugs to stop the body from rejecting transplanted organs - 'tissue typing' matched organs to suitable recipients (like blood groups)

1820 - 1910

Disease and Infection ( + Public Health)

• Trained as a nurse (from a wealthy background) - became Superintendent of Nurses in a London hospital
• 1854 - CRIMEAN WAR - arranged for herself and 38 to go to work in the Crimea
• Army hospital of Scutari - Florence appalled by the terrible conditions + concentrated on cleaning the hospital and patients
• Not described as a hands-on nurse - focussed on improving conditions in hospitals and training nurses for the good of the patient
• 1859 - wrote 'Notes on Nursing'   1863 - wrote 'Notes on Hospitals'
• Continued to associate disease with dirt +  concentrated on improving:
• SANITATION in HOSPITALS - clean water, good drains and sewers, toilet facilities, total cleanliness
• good VENTILATION in hospitals - making sure patients got fresh, clean air to breathe
• FOOD supplies, CLOTHING and WASHING facilities for patients

1821 - 1910

Elizabeth Blackwell was a female doctor. This was an unusual and bold thing in her time as men were considered the ones who should work etc. Certain jobs were considered to be 'man' jobs and certain jobs were considered to be for 'women'. This time was very sexist.

• Born in Bristol - had to go to the USA to qualify as a doctor
• Qualified in 1849
• Later set up work in the NEW YORK INFIRMARY for POOR WOMEN and CHILDREN - staffed completely by women
• Also travelled back to Britian to encourage other women wanting to become doctors - including Elizabeth Garrett

1836 - 1917

The first woman in Britian to qualify as a doctor

• Colleges of Surgeons and Physicians refused to allow women members which stopped Garret working as a doctor
• Had to take the COLLEGE of APOTHECARIES to court before it accepted her as a member  -  after that it changed its rules so that women could not become members
• Male students at the Middlesex Hospital protested that Elizabeth Garret shouldn't be allowed to attend lectures
• (For five years after) 1876, ROYAL COLLEGE of SURGEONS refused to allow anyone to take exams in midwifery - a way of preventing women from learning alongside men
• Edinburgh University said it could only give medical degrees to men - women had to complete their degrees in Dublin or Switzerland

1805 - 1881

Mary Seacole is not as celebrated as Florence Nightingale but her work and dedicated spirit definatley matches that of Florence if not exeeds it. She showed to have a different more hands-on approach towards treating patients compared that of Florence Nightingale.

• Born in Jamaca (daughter of a local healer) - became a knowledgeable healer and midwife
• Gained more experience in Panama where - showed people how to deal with a cholera outbreak - isolating patients and cleaning out dirt
• 1854 - heard about the CRIMEAN WAR - travelled to Britian to volunteer her services - but nobody would see her -  She then paid her own way to Crimea
• Mary set up her 'BRITISH HOTEL' - providing food and drink to the soldiers
• Treated sickness + tended to the wounded on the battlefield - her bravery in helping the wounded while fighting made her increasingly popular among the soldiers

980 - 1037

• known in Europe as 'Avicenna'
• His MEDICAL ENCYLOPAEDIA 'The Canon' - was used to teach European physicians untill the 1600s
• Included the work of the Greeks and his own methods and was known as the 'GALEN OF ISLAM'
• Arab hospitals at this time were famous for the care they gave patients
• The first hospital was founded in Baghdad around 805 - by the 1100s every large town had a hospital

c860 - 925

• known in Europe as Rhazes
• He wrote over 200 books
• Including his own ideas but also believed:
• 'he who studies the works of the Ancients, gains the experience of their labour as if he had himself lived thousands of years'
• Islamic Doctors wrote multi-volume medical encyclopaedias which organised medical knowledge with great thoroughness - including their own ideas and the work og Galen and other Greek medical writers
• These books were later translated from Arabic into Latin and were used in Europe so that European physicians could learn more about the work of Galen and Arab doctors

1852 - 1922

Surgery and Anatomy

• 1889 - Caroline Hampton, an operating theatre nurse in America developed a skin infection from the chemicals used to disinfect hands before operations
• She showed her hands to the chief surgeon, William Halsted, and he arranged for the Goodyear Rubber Company to make a pair of thin rubber gloves to protect Caroline's hands
• Within a year the nurse and the surgeon were married and Halsted spread the idea of wearing rubber gloves during operations
• He went on to become one of America's most famous surgeons, responsible for many new developments

1854 - 1915

Disease and Infection

• 1909 Paul Ehrilch (who had been part of Koch's research team) developed the first chemical cure for a disease
• This was SALVARSAN 606, he called 'magic bullet' - it homed in on and destroyed the harmful bacteria that cause syphilis
• 1930s - Gerhard Domagk developed PRONTOSIL the second 'magic bullet' - scientists then discovered the important chemical in both drugs - SULPHONAMIDE
• Drug companies could then develop more cures for diseases using this chemical
• Called SULPHONAMIDE DRUGS

(1916 - 2004)  and  (1736 - 1819)

Surgery and Anatomy

• Discovered DNA - genetic make-up of the body - were able to base treatments on this knowledge
• 1953 - Francis Crick and James Watson discovered the STRUCTURE of HUMAN DNA - and how its passed from parents to children
• They had the latest and best equipment - using new technoogies (e.g. x-rays)
• Built up knowledge in other types of science - GENETICS + BIOCHEMISTRY
• Had a team of highly skilled and experienced scientists working on a team which they headed

1900 - 1960

Surgery and Anatomy

• New Zealander, studied at home then America - came to England in 1930
• Was encouraged to work in PLASTIC SURGERY by his cousin Sir Harold Gillies
• 1938 - became consultant in Plastic Surgery to the Royal Airforce + was ready well-placed to help the many airmen who suffered terrible burns during WW2
• Used SKIN GRAFTS to RECONSTRUCT faces + HELPED PATIENTS PSYCHOLOGICALLY - to deal with great changes in their appearance + horrors they had been through
• helped some of his patients financially to start life again
• Patients devoted to him setting up 'The Guinea Pig Club' for all those he treated