H Medicine in Britain

Medieval - Causes

• The church controlled what people thought about causes by removing those who challenged ideas and (the church) kept control of universities

• Hippocrates theory of the four humours claimed an imbalance of blood, phlegm, black bile and yellow bile caused disease

• Miasma was the idea disease was transferred by bad smelling air, indicating sin

• Some though the alignment of the planets caused disease (astrology)

• Most thought disease was a punishment or test from God

Medieval - Preventions

• Air was purified to remove miasma and sweet smelling herbs were worn

• The Church claimed that avoiding sin would prevent disease

• Physicians worked together to create 'Regimen Sanitatis', which told people to exercise, wash regularly, and eat appropriate amounts of food to keep disease away

• Christians would often carry lucky charms to ward off bad spirits

• People often bathed in clean water, but poor had to do so in dirty rivers

Medieval - Treatments

• Greek doctor Galen came up with the theory of opposites, which said the way to treat an excess humour was to use its opposite (e.g. a dry and hot humour excess would be treated with a wet and cold remedy)

• Bloodletting meant bleeding a patient to remove excess blood and was done by barber surgeons

• Purging meant making a patient asphyxiate or defecate to remove excess humours, often initiated by a apothecary or wise woman

• The Church advised pilgrimages, prayer, or fasts, but did not give patients treatments in hospital, just made them comfortable and prayed

Medieval - Black Death (1348-1349)

• Symptoms: Buboes, fever, headache, diarrhoea, vomiting

• Causes believed: Position of Mars+Jupiter+Saturn was odd at the time, punishment for sin, imbalance of humours, miasma

• Preventions: Praying and fasting, cleaning away rubbish, carrying herbs and spices, lighting a fire and ringing bells, blocking outsiders

• Treatments: Praying and holding charms, cutting buboes, transferring to bread or chickens, taking cold baths

Renaissance - Causes and communication

• Decline in church power after 1536 DOTM meant ability to shift to a more scientific approach

• Astrology and urine charts stopped being used to diagnose

• Miasma continued to be believed, especially during epidemics

• Four humours believed but only a few left by 1700

• Gutenberg made printing press in 1440 and by 1500 new theories could spread quickly

• Royal society granted a royal charter and made a platform for scientists to discuss theories

Renaissance - Preventions and people

• Pest houses held people with infectious diseases to stop them spreading

• People practised being clean and changed their clothes more often

• Andreas Vesalius published The Fabric of the Human Body in 1543, which challenged many prominent medical theories at the time

• William Harvey proved Galen's theories were wrong and that blood flowed through the heart like Vesalius had said

• Thomas Sydenham wrote Observations Medicae in 1676, which told Doctors to treat the disease of the patient rather than the individual symptoms and not to listen to old books but rather note down the symptoms

Renaissance - Treatments

• By 1500, focus had changed from helping travellers and pilgrims and more for people who were actually sick, and had apothecaries that would come and visit to mix medicines

• Due to the DOTM, there were barely any hospitals left

• Apothecaries and surgeons were now required to have a sufficient education to practises

Renaissance - The Great Plague (1665)

• Causes: Miasma was most common belief, far fewer believed it was four humours, communicable nature was now known, other beliefs stayed the same

• Prevention: Aligned with new beliefs, plague doctors wore beak masks with herbs to protect themselves, government intervened by closing social spaces+cleaning streets+ collecting bodies+ ordering fasts and prayers+ 40 day isolation+burning tar

• Treatments: Theory of transference meant people tried to transfer it to something else, thought to be able to sweat out so covered in blankets and put by fire

Industrial Revolution: Causes

• Louis Pasteur developed Germ theory in 1861, which showed that disease was caused by harmful microorganisms (built on by Koch)

• John Snow investigated and found out that cholera was a water borne disease and was often caused by cesspit leakages

• Some still believe theory of spontaneous decay but this was much less popular than in earlier years

Industrial Revolution: Preventions

• Edward Jenner developed first vaccine (for smallpox) which used a dead strain of cowpox to create immunity from smallpox, but was initially rejected due to fears of turning into cows

• Florence Nightingale created the Pavillion Plan which created cleaner hospitals for patients to recover in and made the death rate go from 60% to 2%, and wrote a book + founded a school to teach others

• The 1875 Public Health Act made it mandatory to: provided clean water, have proper street lighting, provide public parks for exercise, check food quality, provide public health officers to conduct inspections

Industrial Revolution: Surgery

• James Simpson discovered in 1847 that chloroform could be used as an anaesthetic to stop patients from dying in shock from the pain, later used by QV in childbirth, but wrong dosage could kill as it did to a little girl

• Joseph Lister developed Carbolic Acid to be used as an antiseptic during surgery so that wounds did not get infected, but it made surgeons hands sticky

• Surgeries were often performed in a theatre so others could watch but this practise was abolished to make sure the room was as sterile as possible

Industrial Revolution - Cholera in London (1854)

• Effect: Made the afflicted dehydrated and so their skin turned blue, mostly affected poorer slums but did affect some wealthier parts, caused severe diarrhoea and vomiting

• Treatment: None

• Prevention: 1848 PHA advised clean water supplies and clean streets but was not enforced, Snow removed the broad Street pump and cases dropped dramatically

Modern - Causes and diagnosis

• Mendel showed how disease can be passed down through generations via DNA, creating understanding of genetic conditions

• Smoking linked high blood pressure, heart disease, and cancers

• Drinking linked to liver disease, kidney disease, and cancers

• Poor diet linked to heart disease and cancers

• X-rays, scanning machines, and endoscopes can observe inside the body to see what's wr

Modern - Preventions

• NHS launched healthy lifestyle campaigns promoting good diet and sufficient exercise

• Laws implaced banning cigarette advertisement and smoking in public places

• Proper waste disposal systems set up

• Health officers inspecting food outlets

• Free and compulsory vaccine programs

• NHS warning signs recommending medical advice at early warning signs

Modern - Treatments

• Magic bullets developed to attack and kill the microbe of a specific disease

• Keyhole and microsurgery allows small cuts to be made into large wounds, decreasing recovery time

• Surgeries can be done remotely via robots

• Alexander Fleming discovered Penicillin, Florey and Chain developed it as an antibiotic and after proving effectiveness, was made in large quantities by US drug companies from 1942 to give to soldiers

• Radiotherapy and chemotherapy shrinks tumours to reduce their growth

Western Front - Trenches

• Frontline - Direct line of action where troops attacked

• Support - Where troops would retreat to if necessary

• Reserve - Where troops could be stationed for a counter attack

• Made in a zig-zag pattern

• Linked by communication trenches

Western Front - Key battles

• Second Battle of Ypres - First use of Chlorine gas (by Germans)

• The Somme July-November 1916 - Deadliest battle in British military history, first use of tanks (by British)

• Arras (April-May 1917) - Underground tunnels used to expand movement and to shelter

• Cambrai (November-December 1917) - First large scale use of tanks, First blood bank

Western Front - Injuries and Illnesses (and remedies)

• Gas attacks - Urine soaked pads

• Head injuries from flying shrapnel - Brodie helmets

• Shellshock (PTSD) - Most accused of cowardice and shot

• Trench fever (flu-like symptoms) - Mass delousing

• Trench foot from standing in waterlogged trenches - Duckboards, oil, spare socks, pumps, amputation

Western Front - Chain of evacuation

1. Stretcher bearers take casualties from the field

2. Regimental Aid Post gave triage status and did immediate first aid where possible

3. Dressing stations were staffed by medical officers and could look after men for about a week and were a mile back from the front line

4. Casualty Clearing Stations prioritised treating life threatening injuries to those who had a chance of survival and helped reduce risk of infection and were several miles from the front

5. Base hospitals were near the coast and held specialised doctors who could treat patients for quite some time

6. Sent on a hospital bat to be treated back home

Western Front - Medical support groups

• RAMC - Royal Army Medical Corps took notes of everything and were in charge of directly treating soldiers

• FANY - First Aid Nursing Yeomanry drove ambulances and cooked and cleaned

Western Front - Transport issues

• Motor ambulances were expensive so limited to 512

• Terrain meant stretcher bearers would have difficulty and mud may infect wounds

• Roads and railways lines had been destroyed

• Constant attack made recovery difficult

• Ambulances could not fit into the front lines

Western Front - Medical advancements

• Carrel-Dakin method in 1917 meant tubes of sterilised salt solution could be used to prevent infection

• Blood was refrigerated and citrate glucose was added to keep the blood lasting longer for any transfusions

• Thomas Splint kept the leg rigid reducing blood loss and death from broken limbs went from 80% to less than 20%

• Plastic surgery was developed by Harold Gilles to repair facial injuries

• Mobile X-ray units meant shrapnel could be located before any operation