Medicine through time (From Erin)

Hippocrates

Hippocrates

Developed ideas of 4 Humours

4H blood was associated with

spring, air, hot

Galen developed idea of

Theory of Opposites

Reasons for little progress in medieval times

Nature of work (90% of people worked on farms, children expected to help out from early age), Church controlled education, people told not to challenge old ideas

Where did Hip. and Galen believe miasma came from?

swamps, corpses, rotting matter

Medieval methods of purifying air (m)

sweet-smelling herbs and flowers, lighting fires, ringing bells, allowing birds to fly through house

Religious actions to protect self from illness (m)

pilgrimage, attending Church, living life free from sin, self-flagellation

Treatment methods in medieval time (give specific facts about each one)

praying for forgiveness (especially in hospitals), bloodletting and purging (cupping, leeches, laxatives), herbal remedies (50% worked, theriaca - contained up to 70+ herbs and was used as poison antidote)

Physicians training period (m)

7-10 years

Doctor’s diagnosis techniques (m)

looking at urine samples, symptoms, faeces

How many hospitals were there in the country by 1500?

1100

How many hospitals were in monasteries? (m)

30%

How many hospitals were funded by endowment? (m)

70%

How many hospitals actually treated the sick? (m)

10%

Conditions in hospitals (m)

Some were cramped with patients having to share beds, others were more hygienic with regularly changed linens etc.

Evidence for poor public health in middle ages

Water supplies were dirty and contaminated, cesspits leaked into water supplies, people used the streets as latrines and would also butcher animals in the street

Public health solutions middle ages

Exeter brought in aquaducts to improve cleanliness of water, regulations were introduced for cesspits to maintain standards, public latrines were built in Norwich

Black Death years

1348-49

Believed causes of the Black Death

Punishment from God (most prominent), astrology (in 1345 there had been an unusual alignment of Saturn, Jupiter and Mars), miasma from earthquakes and volcanoes

Religious attempts at prevention for Black Death

self-flagellation, praying for help, activities that might anger God were banned (e.g., in Suffolk, wrestling matches in church courtyards were stopped)

Preventing miasma in Black Death

lighting fires, boiling vinegar, holding flowers and fragrant herbs to faces, avoided bathing as they believed it would open up their pores

Avoidance as a prevention technique during the Black Death

local governments created quarantine laws with some places requiring new people to isolate for 40 days (very ineffective, people did as they please - especially the rich)

Religious remedies for Black Death

praying for forgiveness, confession

Herbal remedies for Black Death

theriaca was prescribed, strong herbs like myrrh were used as they were believed to have cleansing properties, apothecaries starting selling Black Death treatments

Treatment of buboes during Black Death

They were burst and/or had shaved chicken bottoms applied

New ideas in Renaissance in causes

Punishment from God was less believed, astronomy (came from Galileo inventing telescope), iatrochemistry

Continuity in causes in Renaissance

Four Humours still used by physicians, miasma (cemented by Fracastoro’s “seeds”)

Fracastoro’s work

Published “On Contagion” in 1546, theorizing disease was caused by “seeds” in the air

How did Thomas Sydenham group illness?

Grouped illnesses based on symptoms, observations and progression of illness

Thomas Sydenham’s new ideas

Was Humanist, relied on his own observations as opposed to textbooks, believed different diseases should be treated in different ways (e.g. iron to treat anemia)

Sydenham’s book

“Observations Medicae”, 1676

When did the printing press come to England?

1476

When was the Royal Society founded?

1660

Who set up the Royal Society?

Charles II

What language did the Royal Society encourage their scientists to write in and what else did they fund?

English, not Latin - plus they funded the translation of texts

Why was the power of the Church reduced in Renaissance period?

Dissolution of the monasteries

How were hospitals in Renaissance times different to the Middle Ages?

Were now secular, focused more on treating the sick, were secular due to dissolution of the monasteries, centered around care by physicians

What was used to treat dysentery? (R)

ipecac

Example of new herbal remedy from America and its use (R)

tobacco - chewed to treat a wide range of conditions

Continuity in prevention and treatment in Renaissance

herbal remedies, cleanliness and healthy living, bleeding and purging

Changes in prevention and treatment in Renaissance

More of a focus on cleaning streets to get rid of miasma, new herbal remedies (e.g. tobacco), transference, alchemy

Change in training of apothecaries

Got better training through guild systems (started off as apprentices then went all the way up to masters), required licenses to sell remedies

Vesalius’ new ideas about dissection

Carried out lots of human dissections to learn, believed dissections should be performed in public and done by lecturers and doctors, wanted students to see dissections close up

Vesalius’ book and details about it

Fabric of the Human Body, 1543, dedicated to Charles V, illustrations down by renowned artist Titan, published after extensive dissection

Discoveries that Vesalius made to disprove Galen

the lower jaw is one bone not two, the heart has no holes in its septum

Who was William Harvey a physician to?

James I

How did Harvey discover the system of blood circulation?

Researched Galen’s idea that blood flowed towards the heart , proved blood couldn’t be produced by the liver (disproving Galen), believed that the heart behaved like the new mechanical water pumps, discovered the arteries and veins were part of one big system

Why was Harvey initially unpopular?

Went against ideas of purging, would put barber surgeons out of business, disproved the religious idea that the soul was carried round the body in the blood

Harvey’s books + deeets

“An Anatomical Study of the Motion of the Heart and of the Blood in Animals”, 1628. Included detailed diagrams.

Year of the Great Plague

1665

What % of London’s population was killed by the Great Plague?

15%

What % of England was killed by the Black Death?

40%

Beliefs about cause of Great Plague that were the same as Black Death

miasma. minority groups like Jews

Beliefs about cause of Great Plague that were different to Black Death

Transference from person to person

Treatments of Great Plague

Applying boiling onions filled with herbs, posies, transferring illness to animals (especially birds), sweating illness out

Government action to prevent spread of GP

They created mandatory “plague orders” - theatres were closed, large gatherings were banned, barrels of tar were burnt, days of fasting and public prayer were ordered, dogs and cats were killed

Methods of warding off miasma in Great Plague

posies, strong-smelling herbs over doorways

Methods of avoiding transference in GP

avoiding contact with others, soaking coins in vinegar

Change in causes of illness in Industrial period

Spontaneous generation (animacules/seeds in the air were produced when something decayed, which created miasma), germ theory

Continuation in ideas of illness in industrial

Miasma (although slightly less prominent)

How did microscopes improve knowledge of causes of illness in the Industrial period?

By 1700, microscopes were able to capture blurry outlines of what would later be known as bacteria. By 1850, they had the ability to see tiny images with high resolution

Reasons for new ideas on causes of illness in Industrial period

Improved microscopes, changing attitudes

When did Louis Pasteur publish “Germ Theory”?

1861

Who was the scientist that fought against Pasteur?

Henry Bastian

Which diseases did Pasteur develop vaccines for?

Chicken cholera and rabies

What was the first disease that Koch identified the bacteria for?

Anthrax

What dye did Koch develop and what was it used for?

Methyl violet dye, used to identify smaller pathogens

When did Koch find the bacteria for tuberculosis?

May 1882

How many different bacteria had been identified using Koch’s techniques by 1900?

21

Which military hospital did Nightingale first work at in Crimea?

Constantinople

By what proportion was Nightingale able to reduce death rates at Constantinople?

2/3

What changes did Nightingale make to Constantinople?

Emphasised hygiene and fresh air, set up a laundry service and a library, made sure nurses had good training and supplies

What did Nightingale do that helped to spread her ideas?

She published several books and set up the Florence Nightingale School of Nursing

What kind of hospital became more prominent in the Industrial period?

Specialist hospitals

When was laughing gas first used and for what purposes?

1844, dentistry in the USA

What substances were used as anaesthetics before 1800?

Alcohol and opium

When was ether first used and what were its issues? (2)

1846, irritated the lungs so made patients cough, was stored in heavy metal canisters that were difficult to carry around

When was chloroform first used and who by?

1847 by James Simpson

What were the pros (2) and cons (1) of chloroform?

Was highly successful with little side effects, given to Queen Victoria during childbirth, was tricky to get the right dosage so many patients were killed (e.g. one girl died due to too much chloroform during an operation on an ingrown toenail)

When did Lister first use carbolic acid and what did he do with it?

1865, soaked bandages with it to prevent post-op infection

What did Lister do with carbolic acid after his initial success? (2)

used it to sterlise equipment and wounds, created a spray to kill germs

What did Lister achieve in his wards through carbolic acid?

He made his wards entirely sepsis-free

Support for anaesthetics in Industrial (3)

allowed pain-free procedures, allowed surgeons to attempt more complex surgeries, increased success rate

Opposition to anaesthetics (I) (3)

In 1848, a girl died during an ingrown toenail operation due to a chloroform overdose, people believed God sent pain as punishment, no-one knew how chloroform worked

Support for antiseptics (I) (2)

surgery was eventually able to become aseptic, the death rate from infection decreased

Opposition to antiseptics (I) (2.5)

Made surgery more expensive and time-consuming, took a while for Germ Theory to be accepted so some surgeons didn’t see the point

Who published “The Sanitary Conditions of the Labouring Population” in 1842?

Edwin Chadwick

When was the first public health act passed?

1848

When was the second public health act passed?

1875

What were 2 things set out in the 1848 Public Health Act?

A National Board of Health was set up, councils were encouraged to provide sewers and clean water

What were 3 things set out in the 1875 Public Health Act?

Councils were required to improve sewers and waste disposal, provide clean water for their area and appoint their own medical officer who would inspect public health facilities

Who brought inoculation to England and where from?

Lady Wortley, brough it from Turkey

What were 2 issues with inoculation?

Could be fatal, expensive

Who did Pasteur first infect with cowpox?

James Phipps

When were vaccinations made free for the poor? (I)

1840

When were vaccines made compulsory? (I)

1853

Why was their opposition to Jenner’s work? (3)

He couldn’t prove why it worked, people believed it went against God’s will, it would put inoculators out of business

When did Snow publish his ideas?

1855

Which was the pump that Snow focussed his work around?

Broad Street pump

When were electron microscopes created?

1931