Medicine Through Time Revision/ PrehistoryBackground- Lived in tribes- Hunter gatherers who didn’t settle and

grow crops- wide ranging healthy diet- No reading or writing- Some info about them can be learnt

from studying tribes who lived in a similar way until recently e.g. Aborigines or Native Indians

Beliefs about the causes of illness- Supernatural forces/spirits were

blamed for causing illness- Evil spirits got inside you and

caused illness- Charms and bracelets were worn to

ward off these spirits

Treatments- A process called trephining was used. This involved

cutting a hole in people’s heads (through the skull) to let out evil spirits

- We know that people survived because their skeletons show the bone continued to grow afterwards

- Medicine Men would carry out the trephining- Women were in charge of looking after everyday

health and would make herbal remedies

Revision: Egyptian Medicine

Society and how it helped Medicine- Successful farming = spare food = people could

work as doctors, scholars rather than all farming. So could develop knowledge.

- Egyptians wrote on papyrus in hieroglyphics. This helped communicate and spread ideas.

- They traded on ships around the Mediterranean. Imported new herbs for medicines.

Causes of disease- Studied River Nile. When irrigation

channels got blocked, their crops didn’t grow. Therefore believed you had channels in your body, when these got blocked you got ill

- Also believed gods could cause disease (supernatural). Priests’ writings showed this.

Treating/preventing disease- Priests said spells as they believed gods

could also cure disease .- Priests also prescribed medicines using

drugs such as opium.- Egyptians also understood that a healthy

diet and good hygiene was important for preventing disease.

- Simple surgical procedures. Temple carvings are evidenc of this.

Mummification- Believed the body was needed in the afterlife. Preserved bodies through mummification.- Prepared bodies for mummification by

extracting soft organs such as the brain and the intestines, then drying what remained with salt.

- Body destroyed = no afterlife. So no dissection. Limited knowledge!

Greek MedicineFactors allowing progress

- Educated society. Alexandria was the centre of medical discovery where a massive library of medical knowledge was built. Dissection was also allowed in Alexandria (banned elswhere) so medics who learnt there were very advanced- Many great thinkers e.g. Hippocrates who

advanced the work of doctors through methods like clinical observation

- Wars with other states led to injuries, treating them built a knowledge of anatomy further

- Improvements in types of metal used (iron and brass) led to more advanced surgery

- Traded around the world e.g. India, China and learnt new medical techniques+ remedies

Causes of disease- Theory of the four humours- black bile,

yellow bile, blood and phlegm. Out of balance= you get ill and needed purging/vomiting/letting

- Supernatural causes also blamed

Treatments- Purging/vomiting/bloodletting- Some basic external surgery- Resetting broken/dislocated bones- Built Asclepions where you would go to

eat well, bathe exercise, and pray to the god Asclepios, the god of healing

- You would go to sleep in the Abaton(temple) where Ascpelios and his daughters (Panacea and Hygiea) would come to visit and heal you

Hippocrates ‘The father of modern medicine’- Encouraged doctors to look for natural (not

supernatural causes and cures - Developed the method of clinical observation-

observe, take notes, diagnose, make prognosis and treat

- Doctors still say the Hippocratic Oath in some countries today- to promise to do the best for their patients

Roman medicine. Factors allowing progress- Wealthy society which employed slaves-

people had more time to study and learn- Taxes were collected which allowed big

Government public health projects- Massive empire which built their

knowledge of medicine- Army needed to manage this empire

required doctors to be trained- Learnt from the Greeks, took some of their

doctors and took over their medical library at Alexandria

Galen- Army doctor who wrote 60 books-Discovered the brain, not the heart, controls the speech.- Believed in the 4 humours-Found that arteries, as well as veins, carry blood through the body.- However, because he studied animals he got some things wrong, for example, he believed the lower jaw was split in 2 and believed that blood passed from right side of the heart to the left.

Big idea- Public health- sewers, acqueducts, public toilets, water fountains. Rules about where to bury dead. Kept areas clean and people healthy

Causes of disease- Still believed in

gods/supernatural causes of disease

- Began to associate bad smells with illness (miasma)

- Carried on believing in the 4 humours

Treatments- Amputations- Basic surgery (not internal)- Herbal remedies (by women)- Opposites for 4 humours e.g.

phlegm linked to cold so treat with pepper

Medieval (Middle Ages) MedicineWhat happened after the Romans?- Wars destroyed Roman Public Health systems

and medical libraries.- Wars made travel dangerous, reducing

communication.- Rulers of small kingdoms across Europe built

armies rather than improved healthcareIt took a while for things to improve….- Eventually the church began training doctors- Town rulers ordered that they were cleaned up- Merchants began to travel again and spread ideas

Influence of the Church- Incredibly powerful. Controlled much of

education. Only Priests/Monks could read. Certain books banned.

- The Church supported Galen’s ideas and Doctors followed them. Galen referred to God as the ‘creator’ in his work. Doctors were bound to accept Galen as correct.

- Hospitals were set up at monasteries.- Monasteries were also some of the only places

with sewers and running water.

Causes of illness- 4 humours still believed- Some people began studying the stars and

planets (astrology) and blaming certain alignments for illness

- Christians believed that illness was a punishment from God.

- Some dissection was allowed in certain medical schools but little anatomical knowledge was gained as they constantly tried to link findings to the 4 humours

Treating illness- Simple surgery by barber-surgeons. Surgery was not a respected profession.- Flagellation/ pilgrimages to gain God’s

forgiveness and cure illness.- Opposites theory- Herbal remedies by housewives- Wine used as an antiseptic- Diagnosing by urine samples- still a valid

method today!

Medieval Arab Medicine- Not all Arabs were Muslim- some were Christian

Factors helping progress- A wide empire meant that Arab doctors collected

knowledge from Europe, India, China and Africa.- Libraries containing the works of Hippocrates and

Galen- Muslim faith encouraged care for the sick=

hospitals built- Culture of reading and writing. Ibn Sinna

(Avicenna) wrote a million-word medical textbook

Factors hindering progress- Islamic law forbade dissecting bodies- Doctors thought theory was more important that

practice- so didn’t concentrate on surgery- Many Muslims believed that the Koran already

held all important knowledge- so no point in making new discoveries

Treating eye problems was one area in which progress was made

Background- Swept across Europe in the 1340s- Hit Britain 1348, killing 1/3rd of people- Two forms- Bubonic Plague (affecting lymphatic (drainage) system) and Pneumonic Plague (affecting lungs)- Carried on fleas on rats- Symptoms- exhaustion, fever, swellings, difficulty breathing

CausesMany different things were blamed;- Punishment from God for sins- Alignment of the planets- Poisoned water (poisoned by Jews)- Bad smells/miasma (closest)- Humours out of balance

Cures- Flagellation- whipping/punishing themselves to ask for God's forgiveness- Praying- Sweet smelling herbs/flowers and lighting fires- Balancing the 4 humours- Germ theory not understood yet so unsurprisingly the plague did return

Medicine Revision: The Black Death

• 1500-1750 • Renaissance = rebirth• Rebirth of interest in old ideas e.g. 4 humours-

some which started to be questioned• Challenges to the church• Artists studied dissections of bodies- led to

better diagrams of anatomy• Leonardo da Vinci

Factors allowing progressPrinting Press – new ideas could spread more easily and rapidly now that books could be printed. Weakening Church – people did not necessarily have religious beliefs about the causes of diseases, meaning that people started to look for natural causes. Doctors could now dissect. Art– medical drawings could be drawn and shared among doctors through new anatomy books.Renewed Interest in Ancient Learning – people learnt to read and began to challenge old medical ideas (e.g. Galen holes in the septum).

The Great Plague of 1665• Return of the Black Death.

Killed 100,000 in London. • Efforts made to control the

spread. Households locked and red crosses painted on their doors with the words, “Lord have mercy upon us.”

• Carts organised by the authorities to collect corpses for mass burial in “plague pits”.

• People realised disease was contagious, but still didn’t understand about germs causing disease.

• Great Fire of London in 1666-sterilised large parts of London, killing the plague bacteria.

The Renaissance

1750-1900 (Massive topic)Areas covered;- Vaccination, Germ Theory and the fight

against disease- Improvements in nursing- Improvements in surgery- Developments in public health

Edward Jenner- Country doctor in England- Heard that milkmaids didn’t get smallpox- Jenner investigated and discovered people who had already had cowpox didn’t get smallpox.- 1796 he took a small boy and injected him

with pus from the sores of a milkmaid with cowpox. Jenner then injected James with smallpox. James didn’t catch the disease!

Opposition to the Smallpox vaccinationJenner could not scientifically explain how it worked.Many were worried about side effects; they worried about giving themselves a disease that from cows.Some doctors thought that if diseases were prevented they wouldn’t have a job!Some members of the Church believed that vaccination was not natural.

Pasteur and Germ theory

• Scientists thought microbes were caused by disease and appeared because of illness. This was the theory of spontaneous generation. Instead of blaming microbes, people looked for miasmas.

Until Louis Pasteur’s Germ Theory – 1857

• Louis Pasteur was employed in 1857 to find the explanation for the souring of sugar beet used in fermenting industrial alcohol. His answer was to blame germs in the air.

• He proved there are germs in the air by sterilising water and keeping it in a flask that didn’t allow airborne particles to enter. This stayed sterile – but sterilised water kept in an open flask bred microbes again.

Robert Koch

• Pasteur had proven that microbes cause disease and decay but couldn’t prove they caused disease in humans/animals. Koch (German) was determined to prove this.

• 1875- He injected mice with what he thought was the bacteria that caused the Anthrax disease

• Repeated the experiment with 20 generations of mice

• Bacteria at the end was exactly the same as what he injected in the first one linking this microbe to the disease and death of the mice

• Went to find bacteria causing Cholera and TB

• Used powerful microscopes and a dye to mark out the bacteria

Vaccinations round 2

• Hearing of Koch’s work, Pasteur came out of retirement. Big rivalry, fuelled by the ongoing French-German wars.

• Both he and Koch worked with large teams of scientists. Charles Chamberland was in Pasteur’s team.

• Chamberland was told to inject chickens with chicken cholera, but it was the day before his holiday and forgot. Left the germs on his desk and injected the chickens when he returned from holiday.

• The chickens survived, Pasteur and Chamberlain tried again with new germs, but the chickens survived.

• Cholera weakened by being left out, and made the chickens immune. Error = chance discovery.

• Pasteur’s team also produced weakened version of the anthrax spore that would make sheep immune to the disease. Demonstrated this in a public experiment.

Overcoming problems of surgery in the 1800sProblem of surgery

Pain Infection Bleeding

How was it overcome

• Initially surgeons would get patients drunk or give them opium.

• 1800 Humphry Davy discovered Nitrous Oxide (laughing gas) but the book it was in wasn’t widely published.

• 1847 Chloroform was discovered by James Simpson. It worked as an anaesthetic. Despite opposition (difficult to get correct dose, pain was ‘natural’ and worries about side effects), it was eventually accepted when Queen Victoria used it during childbirth.

• 1850s. Antisepticsintroduced, such as Carbolic spray, the idea of Joseph Lister. Uncomfortable on surgeon’s skin and not correctly done by some surgeons = disappointing results

• 1890s- Aseptic surgery- removal of all germs. Operating theatres cleaned, instruments sterilised and rubber gloves used.

• Not overcome in the 1800s

• No understanding ofblood groups

• No way of preventing blood from clotting.

Improvements in nursingFlorence Nightingale Mary Seacole

- Poor background in Jamaica. - Volunteers to help as nurse

in Crimean War, she rejected (possibly on racist grounds), goes anyway self-financing her journey.

- Nursed soldiers on the battlefields and built the ‘British Hotel’ where soldiers could go for treatment, rest and recuperation. Scandalous reputation.- Bankrupt when she returns to England but receives some support due to the press interest in her story and she writes an autobiography.

- Brought discipline and professionalism to job that had a bad reputation at the time.- From wealthy background, became a nurse despite family opposition.- Went to Crimean War to sort out nursing care in the English camp.- Made huge

improvements in the death rate, due to improvements in ward hygiene.- When she returns home,

she writes a book ‘Notes on Nursing’ and sets up a hospital in London.

https://www.youtube.com/watch?v=SBF3X2vkK7w

Final topic- 20th Century Medicine

Impacts of WW1- Way to stop blood clotting

discovered, allowed transfusions

- Solution later developed to allow blood to be stored outside of the body

- X-rays used on the frontline- Psychological health

considered with the shell-shock soldiers suffered from

First Magic Bullet - Developed by Paul Ehrlich- A compound that would target syphilis

germs specifically without harming the body in other ways.

- 606th compound experimented with- First used 1911

Penicillin• Penicillin is an antibiotic – kills bacteria• Before the development of penicillin,

many people suffered and died from bacterial infections that are no longer considered dangerous today.

Discovery• Looking through his microscope, Fleming noticed a dish in his

laboratory in which he had been growing bacteria. There was a mould in the dish and all around it the bacteria had stopped growing

• On investigation, Fleming found that penicillin fungus had got on to the dish, perhaps blown into his lab through an open window.

• It was killing the bacteria

• However, Fleming did not have the facilities or the support to develop and test his idea that penicillin could fight infection.

Production of Penicillin

• In the 1930s two Oxford scientists, Howard Florey and Ernst Chain, became interested in Fleming’s 1929 paper on penicillin.

• In 1939 they assembled a team of scientists, and three days after the outbreak of war Florey asked the British government for money to fund the team’s research into penicillin.

• British chemical firms were too busy making explosives to start mass production – so Florey went to US.

• USA had the funding and factories to mass produce it.

• America helped to mass produce penicillin. The casualties of the Second World War added to the urgency.

• By 1944 mass production was sufficient for the needs of the military medics. Fleming, Florey and Chain were awarded the Nobel Prize in 1945.

Howard Florey (left) and

Ernst Chain.

The NHS

How did WW2 push the foundation of the NHS?

• WW2 broke down social distinctions and brought people together.

• The raising of armies made powerful people take notice of the health problems of the poor.

• Evacuation of children increased awareness of how disadvantaged many people were.

• After the Second World War people looked for improvements in society. Such feelings led to the 1945 victory for the Labour Party.

Key characters involvedSir William Beveridge published his famous Beveridge Report in 1942. In it he called for the state provision of social security “from the cradle to the grave”.

Bevan was the Labour Minister for Health who introduced the National Health Service in 1948. Hospitals taken under Govt. control, new health centres built + new salaries for Doctors.

Making it workNational Insurance was introduced to pay for the NHS. Doctors and dentists were attracted with a fixed payment for each patient. They were also allowed to continue treating private fee-paying patients.

Helping medical progress Hindering medical progress

Government

Chance

Technology

Religion

War

Communication