Medicine Through Time

Revision Booklet.

Medicine Through Time Timeline

3000 BC Pre-History – understanding is based on spirits and gods. No real medical care. People die very young, normally by the age of 30-35 for men, but only 15-25 for women due to the dangers of childbirth. Most people suffered osteoarthritis (painful swelling of the joints).

2000 BC Egyptian Empire – development of papyrus, trade and a greater understanding of the body (based on irrigation channels from the River Nile). They believed the body had 42 blood channels and that illness was caused by undigested food blocking these channels.

1500 – 300 BC

Greek Empire – Medicine still based on religion – Temple of Asclepius. Here, patients would get better, but mainly through the standard of rest, relaxation and exercise (like a Greek health spa)

400 BC Hippocrates – founder of the Four Humours theory. This theory stated that there were four main elements in the body – blood, yellow bile, black bile and phlegm. Illness was caused by having too much of one of these humours inside of you. He also wrote the Hippocratic Collection, more than 60 books detailing symptoms and treatments of many diseases.

400 BC – 500 AD

Roman Empire – The Romans were renowned for excellent public health facilities. The Romans introduced aqueducts, public baths, sewers and drains, etc. In the city of Rome, water commissioners were appointed to ensure good supplies of clean water.

162 AD Galen – continues the four humours theory but extends it to have the humours in opposition to each other. This meant that an illness could be treated in one of two ways, either removing the “excess” humour or by adding more to its opposite. Galen also proves the brain is important in the body (operation on the pig). Galen’s books would become the foundation of medical treatment in Europe for the next 1500 years.

Dark Ages Britain and Europe return almost back to pre-historic times under Saxons & Vikings

1066 Battle of Hastings – Normans invade Britain

1100s – 1200s

When Europeans went on crusades to the Holy Land in the 12th and 13th centuries, their doctors gained first-hand knowledge of Arab medicine, which was advanced by Western standards.

1347-1348 Black Death – across Europe more than 25 million people die. Two main types of plague

1. Bubonic – 50-75% chance of death. Carried by fleas on rats. Death usually within 8 days

2. Pneumonic – airborne disease. 90-95% chance of death within only 2-3 days

People had no idea how to stop the plague. People thought it was caused by various factors, i.e. the Jews, the Planets, the Gods, etc. etc. etc.

1455 The Printing Press was invented by Johannes Gutenberg. This allowed for the massive reproduction of works without using the Church as a medium.

1517 Martin Luther posted his “Ninety-Five Theses” on the door of a Catholic Church in Germany. This began the Protestant Reformation.

1540s Andreus Vesalius – proved Galen wrong regarding the jawbone and that blood flows through the septum in the heart. He published “The Fabric of the Body” in

1543. His work encouraged other to question Galen’s theories.

1570s Ambroise Paré – developed ligatures to stop bleeding during and after surgery. This reduced the risk of infection. He also developed an ointment to use instead of cauterising wounds.

1620s William Harvey – proved that blood flows around the body, is carried away from the heart by the arteries and is returned through the veins. He proved that the heart acts as a pump re-circulating the blood and that blood does not “burn up”.

1665 The Great Plague – little improvement since 1348 – still have no idea what is causing it and still no understanding of how to control or prevent it. In London, almost 69,000 people died that year.

1668 Antony van Leeuwenhoek creates a superior microscope that magnifies up to 200 times. This is a huge improvement on Robert Hooke’s original microscope.

1721 Inoculation first used in Europe, brought over from Turkey by Lady Montague.

1796 Edward Jenner – discovered vaccinations using cowpox to treat smallpox. Jenner published his findings in 1798. The impact was slow and sporadic. In 1805 Napoleon had all his soldiers vaccinated. However, vaccination was not made compulsory in Britain until 1852.

1799 Humphrey Davy discovers the pain-killing attributes of Nitrous Oxide (Laughing Gas). It would become the main anaesthetic used in Dentistry. Horace Wells would try and get the gas international recognition. He committed suicide the day before it got the recognition it deserved.

1830s Industrial Revolution. This had a dramatic effect on public health. As more and more families moved into town and cities, the standards of public health declined. Families often shared housing, and living and working conditions were poor. People worked 15 hour days and had very little money.

1831 Cholera Epidemic. People infected with cholera suffered muscle cramps, diarrhoea, dehydration and a fever. The patient would most likely be killed by dehydration. Cholera returned regularly throughout the century, with major outbreaks in 1848 and 1854.

1842 Edwin Chadwick reports on the state of health of the people in cities, towns and villages to the Poor Law Commission (fore-runner to the Public Health Reforms). He highlights the differences in life expectancy caused by living and working conditions. He proposes that simple changes could extend the lives of the working class by an average of 13 years.

1846 First successful use of Ether as an anaesthetic in surgery. The anaesthetic had some very severe drawbacks. In particular, it irritated the lungs and was highly inflammable.

1847 James Simpson discovers Chloroform during an after dinner sampling session with friends. He struggles to get the medical world to accept the drug above Ether. Doctors were wary of how much to give patients. Only 11 weeks after its first use by Simpson, a patient died under chloroform in Newcastle. The patient was only having an in-growing toenail removed (non-life threatening). It took the backing of Queen Victoria for chloroform and Simpson to gain worldwide

publicity.

1847 Ignaz Semmelweiss orders his students to wash their hands before surgery (but only after they had been in the morgue).

1847 Elizabeth Blackwell becomes the first woman doctor in USA

1848 First Public Health Act in Britain – It allowed local authorities to make improvements if they wanted to & if ratepayers gave them their support. It enabled local authorities to borrow money to pay for the improvements. It was largely ineffective, as it was not made compulsory for Councils to enforce it. This was an element of the “Laissez-Faire” style of government.

1854 Crimean War – Florence Nightingale and Mary Seacole contribute majorly to the improvements in Hospitals.

1854 John Snow proves the link between the cholera epidemic and the water pump in Broad Street, London. Unfortunately, he was unable to convince the government to make any substantial reforms.

1857 Queen Victoria publicly advocates use of Chloroform after birth of her eighth child.

1858 Doctors’ Qualifications had to be regulated through the General Medical Council.

1861 Germ Theory developed by Louis Pasteur whilst he was working on a method to keep beer and wine fresh – changed the whole understanding of how illnesses are caused.

1865 Elizabeth Garrett-Anderson – first female doctor in the UK

1867 Joseph Lister begins using Carbolic Spray during surgery to fight infection. It reduces the casualty rate of his operations from 45.7% of deaths to just 15.0 % dying.

1875 Second Public Health Act – now made compulsory. Major requirement is that sewers must be moved away from housing and that houses must be a certain distance apart.

1876 Public Health improvements – in the UK, the government introduced new laws against the pollution of rivers, the sale of poor quality food and new building regulations were enforced.

1881 Robert Koch discovers the bacterium that causes anthrax. He establishes a new method of staining bacteria. Using Koch’s methods, the causes of many diseases were identified quickly:

1880 – Typhus

1882 – Tuberculosis

1883 – Cholera

1884 – Tetanus

1886 – Pneumonia

1887 – Meningitis

1894 – Plague

1898 – Dysentery

1889 Isolation Hospitals were set up to treat patients with highly infectious diseases.

1895 William Röntgen discovers X-Rays. Though it is an important discovery, it is only WW1 and the treatment of soldiers that propels it into the medical spotlight.

1895 Marie Curie discovers radioactive elements radium and polonium

1901 Scientists discover that there are different blood groups- this leads to the first 100% successful blood transfusions.

1905 Paul Ehrlich discovers first “magic bullet” – Salvarsan 606 to treat Syphilis. The problem was it was based on arsenic and so could kill the patient too easily.

1911 National Health Insurance introduced in Britain

1914-1918 World War One – development of skin grafts to treat victims of shelling

1928 Alexander Fleming – discovers Penicillin. The mould had grown on a petri dish that was accidentally left out. Fleming writes articles about the properties of Penicillin, but was unable to properly develop the mould into a drug.

1932 Gerhardt Domagk discovers Prontosil (the second magic bullet). Slight problem is that it turns the patient red.

1937-45 Florey, Chain & Heatley work on producing penicillin as a drug. Their success will make the drug the second most funded project by the USA in WW2. They fund it to the tune of $800 million and every soldier landing on D-Day in 1944 has Penicillin as part of his medical kit.

1939 Emergency hospital scheme introduced – Funded and run by Government

1942 William Beveridge publishes the Beveridge Report. The report was the blueprint for the NHS

1946 National Health Service Act – provides for a free and comprehensive health service. Aneurin Bevan convinces 90% of the private doctors to enrol.

1948 First day of the NHS. Hospitals were nationalised, health centres were set up and doctors were more evenly distributed around the country. However, the popularity and costs of the NHS would rapidly spiral out of control. The £2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks. The government had estimated that the NHS would cost £140 million a year by 1950. In fact, by 1950 the NHS was costing £358 million.

1950 William Bigelow (Canadian) performed the first open-heart surgery to repair a 'hole' in a baby's heart, using hypothermia.

1952 First kidney transplant (America)

1952 Charges introduced in NHS - 1s for a prescription

1953 Description of the structure of DNA

1961 Contraceptive pill introduced

1967 Christiaan Barnard (South Africa) performed the first heart transplant - the patient lived for 18 days

1978 First test tube baby

1990s Increasing use of keyhole surgery, using endoscopes and ultrasound scanning, allowed minimally invasive surgery.

1994 National Organ Donor register created

Ancient medicine:The period before ancient civilizations is known as PREHISTORY. Medicine was very primitive in this time and was centred on spiritual beliefs. The role of spirits and the medicine man were very important. We think people in prehistoric times worm charms and amulets to ward off evil spirits and bad health. However, it is very hard to be 100% sure about prehistoric medicine because there is very little remaining evidence from the time. Egyptian Medicine:Egypt was the first civilization due to nomadic people settling around the River Nile. This allowed the people to TRADE and made the civilization very WEALTHY and so they could improve medicine. The Egyptians also developed a sophisticated way of writing and medical ideas and religious beliefs were written down.

The GODS controlled the world of the Egyptians and many of these Gods controlled aspects of illness and medicine. Sekhmet was the goddess of war and also had the power to cure epidemics. Thoth gave doctors the ability to cure people. Imhotep was the God of healing. Doctors in Egyptian times were RESPECTED people.

Mummification : The Egyptian people believed that the body would be needed in the next life after a person had died. This led to successful preservation of bodies. Egyptians would extract soft organs such as the brain and the intestines and dry the rest of the body with salt. This led to some limited knowledge of anatomy. The Egyptians believed that illness could be caused by a blockage of channels in the body. This theory was linked to the River Nile. They believed that all channels in the

body led to the heart. This theory of blockages would lead to the practice of purging to remove blockages through vomiting, laxatives or bleeding. But not everyone in Egyptian times believed this some were reliant on religious beliefs.The Egyptians kept themselves clean and the climate in Egypt meant they would change their clothes and wash regularly. Priests would shave their body hair and wash before ceremonies.

Ancient Greek medicine:

This is when medicine develops into two branches, religious medicine and rationale medicine. The Greek empire was vast and included those that lived like the Greeks outside of Greece, these people are known as “Culturally Greek”.

Religious Medicine: The Cult of Asclepius - faith healing:Asclepius was the Greek god of healing. Temples built in his honour were known as Ascelpions. People went to stay in them when they were ill. Visitors were expected to wash, make a sacrifice to the gods and then sleep in an abaton. The abaton was a narrow building with no walls so the Gods could visit you whilst you were sleeping. Priests would visit patients on the wards and use snakes as part of the healing process. Asclepious’ daughters were also involved in the healing process, they were called Panacea and Hygiena both of these words we use in our language today Hygiene and Panacea is a cure for ailments. Women were allowed to be doctors in Greek times.

Rationale Medicine:Philosophers such as Hippocrates first developed these ideas and they believed that religion had nothing to do with healing and illness but instead they looked for every day causes and cures for illness.Greek thinkers believed that there were 4 important liquids in the body:

Phlegm Yellow bile Black bile Blood

If these humours stayed in balance then the person was well if they became imbalanced they would become ill. This idea built on the early work of Aristotle and the 4 elements of wind, earth, fire and water. Each season was linked with an element and a humour.

Hippocrates: Developed the theory of the 4 humours and wrote many of his ideas down in a collection of books called the “Hippocratic Corpus”. He also developed a code of practice for doctors that is still in use today. All doctors have to take the Hippocratic oath. Hippocrates developed a system of diagnosis used by doctors.

Diagnosis: Where the symptoms of an illness are studiedPrognosis: When the doctor considers and predictsObservation: Observe note and compareTreatment: Treat with confidence.

Hippocrates suggested that no action should be taken until a reliable diagnosis could be made.Hippocrates also came up with a “Regimen” This was a list of rules and instructions on how to lead a healthy lifestyle. These included regular exercise, hygiene and stress management.

The Importance of Alexandria:Was a city in Egypt and it became an important centre for medical knowledge. It had a very important library that attempted to amass the knowledge of the world. It made copies of books from other libraries, however, many of them were destroyed by fire.Dissection was allowed in Alexandria this was different to the rest of the empire so this became an important centre for training medics and surgeons. Doctors that had trained in Alexandria went to work all over the world and spread their ideas and training when they went.

Roman Medicine:The Roman Empire took over from the Greek Empire and many of the Greek ideas the Roman followed and copied this included medical beliefs and practices. There are many links between Roman medicine and Greek medicine: The first doctors in Rome were Greek doctors that were captured as prisoners of war, Greek doctors flocked to Rome as they could demand high wages, Rome took over Alexandria and its library and universities, The main medical books in Early Rome were those written by Greek such as Hippocrates.

The importance of the Roman Army: The success of the Roman Empire lay with the strength of its army and they knew that their army had to be strong and healthy if their empire was to be strong. So often the best doctors were deployed to work in the army. This meant that they got to see lots of injures and their knowledge of human anatomy improved. The Romans had an advance society with a strong public health system paid for by taxes so ensure the population and the armies were healthy.

PUBLIC HEALTH FROM THE ROMANS TO 1350:The Romans conquered Britain bringing their culture and ideas with them, but they did not entirely change medicine they still used HERBAL CURES AND BELIEVED THAT GODS CAUSED ILLNESS.HIPPOCRATES. He believed in NATURAL CAUSES for illness (the FOUR HUMOURS being out of balance). He also believed in CLINICAL OBSERVATION and taking careful notes on the progress of a disease.GALEN DEVELOPS HIPPOCRATES ideas of the four humours with the THEORY OF OPPOSITES. GALEN did dissections on ANIMALS and WROTE 62 BOOKS ON MEDICINE, these books were used for HUNDREDS of YEARS.ROMANS saw the cause of disease as SUPERNATURAL; BAD AIR in swampy or dirty places and an in balance of the humours.

Roman TREATMENTS were sometimes SUPERNATURAL (like OFFERINGS TO GODS LIKE SALUS), NATURAL REMEDIES LIKE HERBS OR REALTED TO THE HUMOURS (purging or blood letting)The ROMAN ARMY had hospitals to care for the sick and wounded. These hospitals had SURGEONS and GENERAL DOCTORS, but they did not treat ORDINARY PEOPLE.ROMAN PUBLIC BATHS charged a fee. Romans did not use SOAP they used oil then scrapped off the oil and dirt with a STRIGIL (a metal scrapper)ROMAN TOWNS HAD PUBLIC TOILETS (LATRINES) with running water, which ran away into sewers. They also had FRESH WATER BROUGHT IN BY AQUADUCTS; the people could drink water from FOUNTAINS.After the Romans public health DECLINED.

The Work of Galen:Galen was a Greek doctor who trained in Alexandria and worked at a Gladiator school when first qualified, this allow him to see many injuries and he had been allowed to dissect in Alexandria.

Galen made a number of important medical discoveries: The brain was the most important organ in the human body not the heart,

as the Egyptians had believed. He proved this with a famous operation on a pig.

But he also got many things wrong due to his research being reliant on animals once outside of Alexandria. His theory about the liver and the human jawbone were wrong, he also believed that the liver made blood and that blood was consumed by the body each night rather than being circulated.His work and books had great influence on medicine in the Middle Ages in England and his work was influential to Arabic doctors also.

The Middle Ages:Beliefs on causes of disease people did not understand the true cause of disease, germs. Therefore had natural and supernatural beliefs on causes. Still believed in 4 humours as they did not have the technology to find an alternative. Did like the Romans link dirt and disease but could not enforce measures to control dirt.

Believed god and sin could cause disease

Imbalance of the 4 humours

Bad air

Dirt

Jews

Planets and their alignment

Prevention/treatment (Did not understand true cause of disease. Did try to take public health measures see below. Still had natural and supernatural. Some herbal

remedies, which were based on practice over generations, were effective. Could not cure diseases like the Black Death so often reverted to supernatural ideas)

Prayers

Pilgrimage

Flagellants

Balancing the humours by e.g. bleeding, purging, exercise, diet, and hygiene.

Burning fires in the street (to get rid of bad smell causing disease)

Cleaning the streets e.g. rakers

Consult astrologers

Herbal medicines e.g. honey to prevent infection.

Surgery. Simple surgery carried out by barber surgeons who would, cut hair, pull teeth and carry out amputations of limbs and lance boils.

Hospitals Hospitals/infirmaries in convents and monasteries

Almshouses to provide care for the deserving poor including some old and poor people.

Leper houses. Lepers had to ring a bell so people could avoid them. Some were taken into leper houses there was no treatment just care

Black death 1348This was an epidemic. People did not know the true cause of the disease that fleas from rats were infecting people with the diseases. One third of the population died in Britain.Beliefs on causes, as above. Treatments many as above.

The influence of the Christian church:Christian church helped the development of medicine.

Powerful across Europe so helped to spread ideas across Europe.

Had libraries including the writings of Hippocrates and Galen. Monks copied texts (no printing until Renaissance)

Ran universities where doctors could train.

Hospitals or infirmaries in convents and monasteries took care of the sick and old people.

Promoted the ideas of Hippocrates and Galen, which were correct e.g. brain controlled the body, observation and recording.

The Christian Church hindered the development of medicine:

Powerful across Europe so stopped challenges to ideas believed by the Church e.g. God all powerful could cause and cure disease

Did not allow challenges to Galen’s idea and he had got some things wrong as he had to dissect animals. E.g. jaw had 2 bones like a dogs when a human has one jawbone.

Hospital in convents and monasteries did not cure people just took care of old and sick. Often prayed for them and fed them. Very small often only room for 12 patients like the 12 apostles.

Would not allow human dissect so stopped the development of knowledge on anatomy and physiology.

Public health in the Middle Ages (Public health= Government action to keep population healthy)On the one hand towns and cities in the Middle ages were dirty and led to disease

Water was dirty and most people drank ale instead of water. Even water from water sellers could be dirty.

People built latrines over rivers and rubbish was emptied into rivers. These rivers were used by many for their water supply.

Animal and human excrement (waste) was emptied onto the streets was not always removed

Rubbish was emptied onto the streets and was not always removed.

Rats were common as they lived on the rubbish on the streets

People would go to the toilet in the streets.

Butchers slaughtered animals in the streets and left the remains in the street.

Little organized provision of water and sanitation by councils or government.

Laws were passed especially in times of epidemics but were difficult to enforce as the amount of rubbish and excrement on the streets every day was difficult to clear.

Councils found it difficult to enforce laws as they had limited wealth to spend on public health and did not have the army or officials enforcing their laws which they often passed again and again as they had not worked.

On the other hand town councils did understand the importance of public health, they like the Romans understood the link between dirt and disease but did not know why

There were public toilets in some towns and cities

Laws were passed against people emptying rubbish and excrement onto the streets

Councils employed rakers to clean the streets

Toilets or latrines were to be built away from wells.

Some cities like London, Exeter had fresh water running through pipes to some parts of the city.

Large baths known as stewes where people bathed together in large wooden tubs.

Rich and poor Rich would bathe regularly. They would have their own latrine. They had a

variety of food and plenty of food. Their homes would be heated by large fires in the winter. They would supervise peasants who worked for them. They could afford clothing, which was suitable for the weather conditions. They would also sometimes have a water supply piped into their homes and some had stone sewers. They could afford to consult a physician and buy medicines from the apothecary. Women in the families would also administer herbal medicines.

Poor people or peasants would have to work hard in all weathers often outdoors. They shared their homes with animals. They had limited food supplies and if the harvest failed could starve. Their homes were draughty and they would have one fire to provide warmth and to cook on. They rarely washed and would therefore have lice and parasites on them, which could lead to disease. They would have limited clothing for different types of weather especially the winter. Women would act as midwives and administer herbal medicine, which had been passed down through the ages from mother to daughter.

Medical training for physicians in the Middle Ages Most still read the works of Hippocrates and Galen to learn what they were

to do as doctors

Some were educated by experienced doctors. Barber surgeons would train with an experienced surgeon for about 7 years.

Some doctors trained at church universities but this could take 10 years and few doctors trained this way.

There was no organization to check up on poor doctors

By 12th century there was an Arts of Medicine course at universities

By 13th century towns would not allow a doctor to set up a medical practice unless he could prove he had studied for a number of years.

The church controlled education and students were taught by following Galen’s ideas and were not to challenge his ideas, as he was correct. (The church supported his ideas because he believed that a superior being created

the body a god, as it was so perfect. This fitted with the church’s idea that God had created man)

Physicians were male very few women physicians.

Consults astrology charts

Diagnoses illness with urine

Have to pay for his services per visit

Will send you to an apothecary for medicine

ApothecaryMixes medicines. No formal qualifications. Male. HousewifeTraditional remedies. Local wise woman. Broken bones, childbirth. Used herbs, charms and spells. Some ladies of the manors would treat family and servants.

THE CHRISTIAN CHURCH became increasingly POWERFUL in the MIDDLE AGES when the Romans LEFT. The church encouraged the idea that disease was a PUNISHMENT from GOD and PRAYER would bring about a CURE. The church would not allow DISSECTION and approved the work of GALEN. However, it did encourage the MONKS and NUNS to care for the SICK.ROMAN DOCTORS DID NOT HAVE TO BE TRAINED, but many of them had come from GREECE where they had trained in ALEXANDRIA (in Egypt where dissection was allowed) Most Roman DOCTORRS LEARNT by reading GALEN’s books.In the EARLY MIDDLE AGES DOCTORS DID NOT HAVE TO TRAIN but some MONASTERIES had important collections of medical books. Some of these DEVELOPED INTO UNIVERSITIES.By the 12th CENTURY there WERE MEDICAL SCHOOLS TRAINING doctors. Much of this training was based on reading BOOKS some by MUSLIM authors.MEDIEVAL cities were DIRTY; people threw rubbish and sewage into the streets and rivers, where their drinking water came from. THERE WAS NO CENTRALISED GOVERNMENT LIKE THERE HAD BEEN IN ROMAN TIMES SO LAWS WERE OFTEN ONLY PASSED TO CLEAN UP WHEN DISEASES BROKE OUT (LIKE THE PLAGUE) but they were not properly enforced.Some middle age towns had STEWES; large wooden bathes that people shared.MONKS and NUNS gave medical care in the MIDDLE AGES; this care was only really SPIRITUAL.There were over 1,000 HOSPITALS in BRITAIN BY THE END OF THE MIDDLE AGES, such as ST BARTHOLOMEWS in London 1123 funded by DONATIONS, there were also ALMSHOUSES FOR THE POOR and specialist homes for people such as LEPERS.

The Medical Renaissance 1450-1700:

This is a time of many discoveries and advances in medicine, this was because the church had begun to lose its power and people were starting to question the world

around them and starting to think scientifically. The Royal Society, Britain’s most prestigious scientific body was founded in 1660 during the Renaissance. The return of the works of the classical authors, Galen and Hippocrates through Arabic translations led to a renewed faith in the four humours and treatments of opposites.

Andreas Vesalius:He importantly showed that the heavily relied on works of Galen were wrong in a number of ways. He made accurate drawings of the human body and human anatomy from his studies of the human body (he often used stolen corpses to draw) He published a famous book “ The Fabric of the Human Body” in 1543 which due to the development of the printing press could be copied many times and used by doctors and surgeons world wide. He said it was vital for doctors to dissect human bodies and to find out how the structure exactly worked. He said people needed to test Galen’s ideas rather then accept them uncritically.

Ambroise Pare:A French barber- surgeon who later became a surgeon in Paris. He became an army surgeon and this allowed him to see many injuries these were worse with the development of gunpowder and gun shot wounds.He developed a new cauterizing oil to use after surgery rather than pouring boiling oil onto a wound to cauterize it he used a mixture of his own using egg whites, turpentine and rose water. This along with using ligatures of silk to seal a wound was a far better way of stopping bleeding and infection after an amputation. In 1575 he published a book on the “Works on Surgery”, which was written in French not in Latin and it was soon translated into many other languages and his ideas were quick to spread all over Europe.

William Harvey:Studied medicine at Cambridge and Padua in Italy and was a lecturer in anatomy in London. He published a book in 1628 on the motion and circulation of blood in the body. He proved that Galen’s idea that blood was constantly manufactured by the liver and consumed every night to be wrong. He proved that blood circulated around the body and was pumped around the body by the heart and that the body carried blood away from the heart in arteries and back to the heart in veins.

Factors that allowed medicine to advance in the Renaissance:

Experiment: People started to think scientifically and question the church. Wealth: Since the Black Death of 1348 people had become richer and could

spend money on luxuries such as education. Machinery: Improvements in clocks, pumps, watches, presses etc. Art: Skillful artists such as Leonardo da Vinci observed the human form

closely. Wars: The improvement in weapons led to a need for medicine to improve

alongside it.

The King’s Evil:

Some people believed that the King had healing powers and this belief that if the king touched you, you would be cured of illness. Between 1660-1682 King Charles II touched 92,000 people. The Age of Enlightenment:

The 17th Century onwards saw an increase in PREVENTATIVE medicine.

Inoculation and Vaccination:Smallpox was a greatly feared disease as it often left many victims scarred, blind or disfigured. Lady Mary Wortley Montague leant of inoculation whilst abroad with her husband in Turkey. Inoculation is when a small amount of pus from a smallpox sore is put into the open wound of a healthy person, in order to give them a mild case of the illness. This is dangerous though because they may develop a full-blown outbreak of the disease and the amount of pus transferred could not be measured. Many doctors became very rich charging for inoculations.

Edward Jenner and Vaccinations:Jenner was a doctor from Gloucestershire, England and he had noticed that milkmaids did not appear to get the deadly smallpox but instead suffered from a milder disease cowpox. He came up with the theory that by giving someone cowpox they would become resistant to contracting smallpox. He tested this theory on a small boy James Phipps using the pus of a cowpox sore from Sarah Nelmes. He then injected the boy with smallpox to prove his theory and he was correct James did not contract smallpox. This was the first vaccination. (Vacca is Latin for cow) The government gave Jenner £30,000 to develop his vaccinations and in 1853 smallpox vaccinations became compulsory for children.Jenner faced opposition:People were worried they would turn into cows if given cowpoxDoctors that had made money from inoculation feared they would lose money.

Nursing: Seacole and Nightingale:

The Crimean war brought the work of two nurses Mary Seacole and Florence Nightingale into importance.

Florence Nightingale: Prior to her work at the Scutari hospital in Turkey conditions in army hospitals were very poor and nursing was not a respectable job. Nightingale went against the wishes of her middle class family to become a nurse and she trained in Germany. She was invited to send a team of 38 trained nurses to Scutari where infection and disease were killing many of the soldiers sent to the military hospital not the wounds they had sustained in battle. She did a number of things to improve conditions: She fed the soldiers a healthy diet and cleaned wards and gave each patient their own bed. She came up against opposition from the male doctors that

thought a woman had no place in medicine. But she successfully decreased the death rate from 42% in 1854 to 2 % in 1858. The soldiers fondly knew her as the “Lady with the lamp” She built two hospitals in England on her return (St Thomas’ in London was one) and she wrote books on how nurses should train. However, like many of her time she did not believe in germs and followed the belief that miasma caused illness.

Mary Seacole:

Was a volunteer and she used her own money to set up a private hospital for soldiers in the Crimean. She helped soldiers but due to racist attitudes of the Victorians her story is not as well known as Nightingale’s.

The fight against germs:For centuries people knew that there was a connection between dirt and disease, but there was no explanation of what the link could be. A popular belief was miasma or bad air, another theory was spontaneous generation.

Louis Pasteur and his Germ Theory of 1861:Louis Pasteur was a chemist who had been employed by a wine manufacturer to discover why their wine went bad when brewing. Pasteur proved that it was micro organisms (germs) in the wine that made it go bad. He said in his germ theory: “If wine and beer are changed by germs, then the same can and must happen sometimes in men and animals”> he published his book “Germ Theory” in 1861.Pasteur proved that by heating substances these microorganisms would be killed. This led to the process we now call Pasteurization. Pasteur was a chemist and it was the work of his rival Robert Koch that led to this theory being used to discover the causes of human illnesses and diseases. Pasteur did develop a vaccine for chicken cholera in 1879, in 1881 he developed a vaccine for Anthrax a disease that killed many cattle and sheep and could also be contracted by humans and in 1882 he developed a rabies vaccination.

Robert Koch:Was a German doctor, he had become interested in the earlier work of Pasteur. France and Germany were bitter rivals at the time and Koch and Pasteur raced each other to discover the bacteria that caused different diseases so they could make a vaccine for the many diseases in order to instill national pride in their respective countries.In 1882 Koch developed a vaccine for TB and in 1883 for cholera two of the biggest killers at the time.

Emil von Behring: In the 1890’s Behring would take these ideas one step further and develop the idea that animals produced anti toxins to fight harmful bacteria. He used animal blood and removed the clotting agents and then gave this blood to humans in order to help to cure diseases like diphtheria.

Paul Ehrlich: Developed a chemical that could do the job of killing bacteria but not poisoning the rest of the human body. He found that some dyes stained only bacteria, so he looked for a dye that would kills bacteria. After years of research he discovered SALVERSAN 606 in 1911, the first magic bullet, based on a compound of arsenic.

Fleming and Penicillin:This is a great example of CHANCE playing a part in medical advances. Penicillin is made from a mould called penicillium and it was first discovered in the early 19th

century, Joseph Lister had noted it as early as the 1880’s but scientist were unable to get sufficient quantities of the mould to discover a way to apply it to patients.It was in 1928, in London when Alexander Fleming rediscovered the properties of penicillin. Fleming was a messy research chemist and had been surrounded by dirty petri dishes on which he had been growing mould cultures. He noticed that penicillin (that had probably blown in from an open window) was killing staphylococci (bacteria). But Fleming was unable to take his study further because he could not produce enough of the penicillin to administer it as a medicine . That would not happen until WW2 with the work of two Oxford Scientists Florey and Chain and with the help of the Americans to fund it. (The US government gave drug companies $80 million in 1942 to start the production of penicillin) It was first used in the D-day landings. By 1945 the US army was administering 2 million doses a month! Soon after WW2 the drug became available to civilians and known as an antibiotic.

Dangers of Surgery:Pain: There was no real way to control the amount of pain a patient felt during surgery and this reduced the number of patients willing to undergo the surgeons knife. Before the discovery of anesthetics patients could be “Knocked out” or a surgeon could get their patient drunk before operating but these did not stop the patient wriggling or moving during an operation.

Some early discoveries of anaesthetics were scientists that discovered the effects of certain chemicals on the body. Humphrey Davy: 1799: Discovered Nitrous Oxide (laughing gas) but he was not a medical doctor and had used this as a recreational drug so it was frowned upon by the medical profession,Michael Faraday: A student of Davy’s discovered Ether. But this had many drawbacks it caused the patient to cough during surgery and it was a highly flammable liquid.

James Simpson: Chloroform: He was a professor of Midwifery in Edinburgh and in 1847 he discovered the anesthetic properties of the liquid CHLOROFORM. He soon started to use it to assist women in childbirth, to relieve labour pains. But like many new ideas it came up against opposition. It was difficult to give an exact dose too much could kill a patient, there were also those that opposed it on religious grounds, child birth was meant to be painful as a punishment for Eve’s sin in the Garden of Eden. A final breakthrough came for Simpson in 1857 when Queen

Victoria used chloroform for the birth of her 8th child. She publically praised chloroform and many now approved as it has the royal seal of approval.

Infection:Until the acceptance of the Germ Theory in the 1860’s surgeons did not take any precautions to protect wounds from infection. The surgeons themselves were often a major cause of infection, they would reuse bandages, not wash their hands between patients and they did not sterilize their equipment.

Joseph Lister:He was surgeon and he had read the work of Louis Pasteur. He had seen carbolic acid used to treat sewage, and in 1867 he developed a pump that would spray a fine mist of carbolic acid into the operating theatre. He would then bandage the wounds with bandages that had been soaked in carbolic acid to avoid a patient getting gangrene. This method of antiseptic surgery was successful and few of his patients died of gangrene. But his CARBOLIC ACID SPRAY had a number of drawbacks: It made surgeons cough so they would often open the windows letting polluted air in and it caused the surgeons hands to go numb. His work led to ASEPTIC SURGERY from 1887 where, operating theatres were cleaned rigorously, all surgical instruments were steam sterilized, from 1894 surgeons wore rubber gloves.

Bleeding:A surgeon had 3 minutes to operate before a patient went into clinical shock and the heart stopped due to blood loss. This was not solved until 1901 when Karl Landsteiner discovered blood groups. Blood transfusions were not widely used until WW1

Public Health:

Towns grew in the MIDDLE AGES and SEWAGE and rubbish disposal problems GREW. Some people saw a connection between DIRT and DISEASE, but many people still dumped rubbish and sewage in the street or the river that they took their drinking water from.TOWN COUNCILS PASSED LAWS about cleaning streets, but in most places people had to PAY for rubbish collection and CESSPIT CLEARANCE. NOONE EXPECTED THE GOVERNMENT TO DO THIS. Only a few towns had baths and or toilets.CLEAN WATER WAS PIPED TO LONDON FROM ABOUT 1300, from the river TYBURN. Over the years more pipes were added. Water carriers sold fresh water DOOR TO DOOR.The government tried to stop the PLAGUE in 1665, THEATRES WERE CLOSED, Barrels of TAR burnt in the streets and houses were SHUT UP and RED CROSSES PAINTED ON DOORS, they also collected dead bodies in carts each morning.THE GOVERNMENT PASSED PUBLIC HEALTH LAWS although ENFORCEMENT was a PROBLEM; in 1750 they raised the price of GIN and in 1852 made VACCINATIONS FOR SMALLPOX COMPULSARY.CHOLERA killed THOUSANDS in 1832, it was new to Britain and SPREAD IN DIRTY WATER, IT SPREAD EASILY where the POOR LIVED IN OVERCROWDED CONDITIONS.

EDWIN CHADWICK was a member of the poor law commission. In 1842 HE WROTE A REPORT CALLED “THE SANITARY CONDITIONS OF THE LABOURING CLASSES”. In this he investigated CHOLERA outbreaks. His report said that people needed CLEAN WATER and that the LOCAL GOVERNMENTS SHOULD COLLECT TAXES TO PAY FOR THE REMOVAL OF SEWAGE AND RUBBISH.CHADWICK’S report was not POPULAR with some people, some people believed in LASSAIZ FAIRE, the WATER COMPANIES thought they would lose money; the rich did not want to pay more taxes to help the poor.1848 PUBLIC HEALTH ACT: was passed after a really bad outbreak of CHOLERA. Towns could BUT DID NOT HAVE TO (because it was PERMISSIVE) set up a Board of health and raise taxes to pay for the collection of rubbish and removal of sewage.JOHN SNOW liked water to the cause of CHOLERA in 1854 when he plotted the death of his patients in BROAD STREET in LONDON. He proved his idea by REMOVING THE HANDLE ON A WATER PUMP.The work of JOHN SNOW AND LOUIS PASTEUR and government studies all showed that TOWNS and CITIES had higher DEATH RATES than the countryside. This caused government to act. They began making plans for SEWERS.THE GREAT STINK 1858. This was the year that the RIVER THAMES smelt so bad that they had to shut parliament. This made the RICH realise how bad things were and they quickly paid for JOHN BAZALGETTE to draw up plans for SEWERS all over LONDON. They took SEVEN years to complete. By 1865 there were 1,300 miles of SEWERS, many of which are still in use in LONDON TODAY.SANITARY ACT of 1866 this followed another outbreak of cholera; local councils were made to appoint inspectors to INSPECT water supplies.1875 ARTISAN’S DWELLING ACT gave town councils the right to buy up slum housing, to knock it down and build better housing. Town councils HAD TO PROVIDE CLEAN WATER, PAVED STREETS, SEWERS AND RUBBISH REMOVAL. This act was STATUTORY so the rich had NO CHOICE.The WELFARE STATE began in the 1900’s when the government ABANDONED laissez faire, and started to make provisions for the POOR, THE OLD and UNEMPLOYED.1911 NATIONAL INSURANCE this is where employers, employees and the government all paid into a fund that paid the worker sick benefits if they could not work. UNFORTUNATLEY the cover DID NOT EXTEND TO THE WORKERS FAMILY.The MINISTRY OF HEALTH 1919: provided healthcare in emergencies (such as the FLU EPIDEMIC that year), It also set up vaccine clinics, provided cheap baby food and brought hospitals under local government control. By 1931 life expectancy had gone up to 58 for men and 62 for women. THE NHS (1948) was set up by the MINISTER OF HEALTH ANEURIN BEVAN despite resistance from DOCTORS who feared they would LOSE MONEY. The NHS provided FREE HEALTH CARE FOR EVERYONE FROM CRADLE TO GRAVE, including DENTISTRY and EYE CARE, but from 1951 they had to charge for PRESCRIPTIONS.Preventative measures from 1949: Included POLIO VACCINES 1952, CERVICAL CANCER 2008 and policies like CLEAN AIR ACT 1956 and anti smoking campaigns from the 1960’s.

Modern medicine:Crick and Watson and DNA:The structure of DNA was first discovered in 1953 by Francis Crick and James Watson. They relied heavily on the electro photography of Rosalind Franklin. Crick and Watson found that DNA had a double helix structure and that DNA forms a

coded message about our genetic makeup. The Human Genome project has identified all of the genes in human DNA and specific genes can now be singles out that cause illnesses or disabilities and doctors can scan for faulty genes.

Medicine Blockbusters

What A…

Is a collection of pus caused by an infection?

Abscess What B….

Was a disease that hit England in 1348 that killed 1/3 of the population?

Black Death

Is a building you slept in an Asclepion?

Abaton Is a treatment to bring the humours back into balance?

Bleeding

Is the God of Healing in Greek times?

Asclepius What C…

Is a way of sealing a wound in surgery?

Cauterization

Is a word for an illness that is not serious?

Ailment Is an early anaesthetic developed by Simpson?

Chloroform

Is the removal of a limb in surgery?

Amputation Are thread like structures that contain our genetic information?

Chromosomes

Is when a drug is applied to control the pain felt in surgery?

Anaesthetic Is another name for TB?

Consumption

Is a substance that kills bacteria?

Antiseptic Is another word for spreading disease from one person to another by touch or contact?

Contagion

Is the study of the human body?

Anantomy Is the name of a person who wrote a report on sanitary conditions in

Chadwick

Victorian times

What C..

Is a disease that arrives in England in 1832 for the first time, it is transmitted in dirty drinking water?

Cholera.

Is a charm worn by the Egyptians or prehistoric people to ward off evil spirits?

amulet What D…

Is the word for looking inside a dead body?

Dissection

Is a group of drugs that are used to treat infections?

Antibiotics Is the structure discovered by Crick and Watson in 1953?

DNA

Is where you would go to get a mixture of herbs for a remedy?

Apothecary Is a disease caused by dirty drinking water?

Dysentery

Is the belief that illness is caused by the planets?

Astrology Is a symptom of many diseases including cholera which involves frequent fluid bowel movements

Diarrhoea

Were proved by Harvey to carry blood from the heart?

Arteries What E….

Developed the first “magic Bullet”

Ehrlich

What B…

Is another word for a germ?

Bacterium Was the first microscope that used electrons rather than light?

Electro microscope

What F…

Discovered Ether? Faraday (Michael)

What I….

Is another name for a hospital?

Infirmary

What G..

Is an infection of dead tissue?

gangrene Is the name of a cut made in surgery?

Incision

Is a microorganism that causes disease?

germ Is a word to mean you are protected against a disease?

Immune

Was a book written by Pasteur in 1861?

Germ Theory

Is the formation of disease causing germs?

Infection

Is a famous doctor of Roman times?

Galen Is a hormone produced by the pancreas?

Insulin

Is an event in London 1858 that closed parliament?

Great Stink What J… Discovered a vaccine against smallpox?

Jenner (Edward)

The first female doctor to qualify from University?

Garrett (Elizabeth)

What K.. Developed vaccines for many human diseases using the identification of specific bacteria?

Koch (Robert)

Were the civilisation after the Egyptians?

Greeks Is the idea that the touch of a king could cure you?

King’s evil

What H…

Was an English surgeon that proved blood circulated around the body?

Harvey(William)

What L… Means “leave it alone” in French and describes the government attitude to public Health for much of the 19th

Century?

Laissez Faire

Was the organ Egyptians thought was the most important in the body?

heart Developed carbolic acid spray?

Lister (Joseph)

Was a Greek philosopher that came up with the

Hippocrates What L…

4-humour theory?Is a promise that doctor’s make?

Hippocratic Oath

Were built after 1948 as a part of the NHS

hospitals

Is the name of Asclepius’ daughter?

Hygiena

What I..

Is a way of stopping someone get a disease?

Inoculation