History GCSE medicine through time

What are the factors?

* Religion
* War
* Individuals
* Government
* Technology
* Science
* Communication
* Luck

What year does our course start?

AD 1000 but medicine in this time was based of ancient Gree, Hippocrates and Ancient Roman, Galen

What was Hippocrates known as?

The father of modern medicine

Who came up with the Theory of the Four Humours?

Greek Philosopher Aristotle

What did Hippocrates do?

Developed the theory of the four humours further

Hippocratic oath

Believed you should observe your patients as you treat them

What were the four humours?

* Blood
* Phlegm
* Yellow bile
* Black Bile

What did they believe the four humours had to do with illness?

When the humours were all balanced you weren’t I'll, when they were unbalanced, you were ill

What seasons and elements were each of the four humours related to?

Blood:

* Spring
* Air

Yellow bile:

* Summer
* Fire

Black bile:

* Autumn
* Earth

Phlegm:

* Winter
* Water

Why did they believe that the four humours were linked to seasons?

Greek doctors noted that patients’ symptoms varied with the seasons – heat rashes in summer, wet runny noses in winter

In the Ancient World how did war effect medicine?

The Roman armies spread knowledge through the countries they conquered (including Britain)

In the Ancient World how did individuals effect medicine?

* Hippocrates
* Galen

In the Ancient World how did religion effect medicine?

* In all times religion banned dissection
* Believed gods made you sick and made you better

In the Ancient World how did education effect medicine?

The Greeks were great thinkers , they encouraged logical thinking and natural solutions to causes of illness

In the Ancient World how did trade and communication effect medicine?

As trade increased, there was an exchange of ideas

In the Ancient World how did the government effect medicine?

The Romans introduced public health into the towns

What is the Hippocratic oath?

A promise made by doctors to obey rules of behaviour in their professional lives, a version of this is still used today

What did Galen do?

Theory of opposites

Incorporated miasma theory into the four humours

Believed you should observe patients as you treat them

Dissected animals to learn about the human anatomy

What is the miasma theory?

That bad air causes disease when someone breaths it in

During the middle ages what was believed to cause disease?

Punishment from God

Astrology (the movement of the planets and stars had effect on the Earth and people)

Star signs were thought to affect different parts of the body

Evil beings like witches and demons

Evil spirits living inside you

Miasma

Unbalanced four humours

During the middle ages how was disease treated?

Praying (punishment from God)

Flagellants (punishment from God)

Pilgrimages to holy shrines (punishment from God)

Bloodletting and purging (four humours)

Purifying or cleaning the air (miasma theory)

Physicians carried posies or oranges (miasma theory)

During the black death juniper,myrrh and incense were burned (miasma theory)

Remedies

Urine Charts

Why was bloodletting and purging dangerous ways to treat disease?

People died due to lose of blood

Patients were given laxatives to make them throw up

Who made remedies to treat disease?

Apothecary

Wise Women

Made at home

Give examples of the remedies or ingredients used to make them that were used to treat disease?

Herbs

Spices

Animal parts

Minerals

Lucky charms (powdered unicorns horn)

How were these remedies passed on?

Through books called Herbals

What happened after the fall of the Roman empire?

Much of their progress in medicine and public health was lost in the West

Known as dark ages

How did Muslim writers help in the dark ages?

Muslim writers saved much of this knowledge, translating manuscripts into Arabic, which eventually passed on to western Europe

In the AD900s onwards what were Islamic hospitals used for?

They were sites of medical education and healing

Name some places where there were famous Islamic hospitals and why were they famous?

Baghdad

Damascus

Cairo hospital AD1283, patients given money when they left so didn’t have to go straight back to work

They had lecture rooms, pharmacies, and libraries

What are some important things to know about Islamic medicine?

Schools and universities

Many students received practical training and observed patients

Cleanliness was encouraged

Hospitals often centred around fountains, and cooling breezes circulated around the wards

Public baths

No dissection – religious rules

Thought diseases could be sent by Allah

Islamic texts told Muslim doctors to try and cure patients “Oh servant of Allah, use medicine. Allah has not created pain without a remedy for it.”

Charity and caring = important in Islam

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Name the medical practitioners and what they did in the middle ages?

Barber surgeon:

* Minor operations, set broken bones, pull teeth
* They served an apprenticeship before qualifying
* Mostly in towns and cities but some travelled in the countryside and visiting fairs

Apothecary:

* Sell medicines, herbs, and spices
* Apprenticeship for seven years
* Simples = medicine of one herb or plant
* Compounds = combination

Wise woman:

* Wisdom and skills handed down
* Reasonably priced
* Usually knew the patient
* Also acted as midwife

‘Lady of the house’:

* Provided medical care for the family and labourers

Trained doctors:

* Hugely expensive
* University trained and licensed

How were urine charts used to treat patients?

Doctors would use urine charts to diagnose patients, they test the colour, smell and even taste of the urine

How were zodiac charts used to treat patients?

Parts of the body linked to astrological sign, so what would be needed to cure a patient

E.g. some things work for an Aries but not a Pisces

It might also tell the physician the best time to treat, and even when to pick the herbs

How was the theory of opposites (Galen) used to treat patients?

They still believed in the theory of opposites and so would use methods such as bleeding to balance the humours

John Arderne

* Born 1307
* Trained as a surgeon and practised in London
* Famous for his success rate E.g. removing growths from inside an anus had a survival rate of over 50% - massive for medieval times
* Worked as a surgeon on the battlefield
* Pain killing ointment – hemlock, opium, and henbane Speedy amputation skills
* Book – the Practice of Surgery, 1350
* Advocated good bedside manner
* Told doctors to trust own judgement
* Charged the rich as much as he could but treated the poor for free

How did the church help in the middle ages?

* Set up 160 hospitals in 12th and 13th centuries
* Set up university schools of medicine
* Preserved knowledge by copying books
* Monks and friars acted as doctors
* Treated the poor for free

How did the church hinder in the middle ages?

* Dissection limited if not forbidden
* Insistence on using Galen
* Emphasised prayer and pilgrimage over scientific treatment Tried to control knowledge – arrest people spreading anti-Church ideas

Medieval hospitals and public health:

Monasteries

* Own water and drainage supplies
* Dirty water used to clear toilets
* Water for drinking was purified many times
* Monks emphasised hygiene
* One monk would be in charge of clean towels and sheets

Medieval hospitals and public health:

Towns

* Crowded and dirty


* Water came from river but this had rubbish and sewage in it Cesspits emptied into river
* Some passed law to stop people throwing rubbish and sewage but this was hard to enforce
* Animals everywhere
* Most drank beer rather than water

Medieval hospitals and public health:

Hospitals

* Set up for different reasons e.g. poor, pregnant women (St Bartholomew's in London) or ‘poor and silly persons’ (St Mary’s)
* Leper houses
* Catered to poor
* Most were care homes rather than treatment

How was medieval medicine effected by war?

Armies took trained doctors to war so they gained experience on the battlefield

However war also made travel dangerous and caused the collapse of the public health system

How was medieval medicine effected by religion?

The Christian church set up universities for doctors to train in. It also built hospitals

They also housed books in the monasteries

However, the universities did not teach the doctors to look for new ideas as they said Galen’s ideas were correct

How was medieval medicine effected by communication?

The Crusades led to an exchange of ideas with Arab doctors

How was medieval medicine effected by the government?

There were some laws to force towns and cities to clean up However, these were not enforced and the King had not money to pay for improvements

When did the black death arrive in England?

1348

What were the two types of plague during the black death, how did they spread and what were the symptoms?

Bubonic:

* Spread by the bites of fleas from rats
* Headaches
* High temperatures
* Pus-filled swellings

Pneumonic:

* Airborne (spread by coughs and sneezes)
* Attacked the lungs
* Painful to breathe
* Cough up blood

How much of the population of Britain is thought to of died from the black death

At least 1/3

How did they try to cure the black death?

Pop open buboes

Attach a live chicken or pigeon

Drink vinegar and mercury

Flagellation (whip yourself)

Bleeding

Pray

Avoiding infection

What was believed to of caused the black death?

Miasmas

Four Humours out of balance

God

Jews poisoning wells and springs

Planets

Earthquake in China

What does renaissance mean?

Rebirth

When was the medical Renaissance?

1500-1700

When was the royal society founded?

1660

When was the college of physicians set up?

1518

What did the college of physicians do?

* Read Galens books
* Studied recent medical developments
* Dissections to show how the body actually worked
* Encouraged the licencing of doctors to stop the influence of quacks

Andreas Vesalius

* Vesalius was born in 1514 and studied medicine in Paris and Italy
* He was allowed to perform dissections but couldn’t look closely at the skeleton
* He was so dedicated he stole the body of a criminal from the gallows
* He became professor of surgery at Padua in Italy where he performed more dissections
* He wrote books on his observations including The Fabric of the Human Body in 1543
* His illustrations were carefully labelled and he used his powers of observation to point out some of Galen’s mistakes
* Galen thought that blood passed through the septum of the heart through little holes. Vesalius proved there were no holes in the Septum.
* Galen believed that human jaw bones were made of two pieces. Vesalius proved it was one.

This was important as it proved Galen could be wrong

Ambroise Pare

* Pare was a barber surgeon born in 1510
* Surgery was still a low status profession
* He first worked for a public hospital and then became an army surgeon


* At the time the wound left by amputation was sealed by burning the end with a red hot iron, known as cauterisation,this was very painful
* Pare invented the method of tying off vessels with thread, known as ligatures
* This was less painful, but may have caused infection as they did not yet know about germs
* Gunshot wounds were, at the time, treated by pouring boiling oil into the wound
* During one battle, Pare ran out of oil and resorted to an ointment of his own
* To his surprise, these patients recovered better than the ones scalded with oil
* He received opposition to his ideas from doctors who didn’t want to listen to a lowly surgeon
* However, when he became surgeon to the King of France and gained the King’s support, people started listening to his ideas

William Harvey

* William Harvey was born in 1578 and studied medicine in Padua in Italy
* He then worked in London as a doctor and lecturer to James I and Charles I
* He realised he could observe living animal hearts in action and his findings would also apply to humans
* He chose cold-blooded animal so the heart beat was slow
* In 1628, he published a book showing that blood was going around and around and NOT being used up and remade like Galen thought
* He also proved the difference between arteries and veins
* Although Harvey’s discovery was useful for knowledge of anatomy and for challenging Galen, it did not radically change surgery
* Bleeding continued to be performed and blood transfusions were not generally successful until the discovery of blood groups in 1900

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What did Henry VIII do in 1930s and what effect did this have (relating to medicine through time)?

Dissolution of the monasteries (closed down most of Britain’s monasteries)

Also lead to closure of many hospitals because they had been set up and run by monasteries

What replaced monasteries after Henry VIII shut them down?

Free hospitals

Paid by charitable donations

Thomas Sydenham

The English Hippocrates

Treatment for smallpox = ‘cool therapy’ – lots of fluids, moderate bleeding, keeping patient as cool as possible

Believed in close observation of the patient and monitor symptoms and treatments given, in order to build up a body of knowledge and experience

Some praised his efforts, but most thought him eccentric

When was printing introduced to Europe and who by?

1454

Johann Gutenburg

Who set up the first British printing press and when?

William Caxton

1476

When was America discovered and why was it important?

1492

Brought new knowledge and trade back to Europe

When was the Great Plague?

1665

What was Londons death toll because of the Great Plague?

100,000 (20% of the city's population)

How was the Great Plague treated?

* Through superstitious treatments such as:
* Lucky charms
* Amulets
* Prayers
* Fasting
* Special remedies that used ingredients like dried toad
* Bloodletting
* Carrying herbs or flowers (miasma theory)
* Strapping a live chicken to swellings (they thought the plague could be transferred from the person to the chicken)

How did they try to prevent the spread of the Great Plague?

* Quarantining victims (the victims house was locked and a red cross was painted on the door to warn others along wit the words “Lord have mercy on us”)
* Areas were crowds could gather like theatres were closed
* People tried not to touch each other
* In a shop money was to be placed in a jar of vinegar
* Dead bodies were buried in mass graves
* Carts organised by the authorities roamed the city to the infamous cry “bring out your dead” collecting corpses for burial
* Local councils paid for cats and dogs to be killed as they thought they carried the plague

John Hunter

Surgeon and anatomist

Trained surgeons and dissected bodies

He was accused of burking because he always seemed to have fresh supplies of bodies

What is Burking?

Named after William Burke and William Hre who committed ten murders in a few months in order to sell fresh bodies to surgeons and schools of anatomy

What year was it made that you had to attend at least one course in anatomy and one in surgery to be a licensed doctor?

1811

What year was it that you also required a minimum of one year’s experience in a hospital?

1813

Who invented the microscope and when?

Antony Van Leeuwenhoek

1683

Who invented the thermometer and when?

Daniel Gabriel Fahrenheit

1709

What is quackery?

* Quack’ doctors in search of profit, peddled all sorts of nonsense cures


* For example, ‘piss prophets’ emphasised diagnosis by examining urine
* Others recommended useless pills or claimed that evil worms caused illness
* A German doctor Franz Mesmer claimed he could cure patients through hypnotism
* The main reason people bought from quack doctors? Desperation
* Main ingredient in quack medicines was alcohol and opium

When did Thomas Coram open a hospital, what was it for and how did he get the money?

1741

To help abandoned children

He collected funds for 10 years

How did individuals affect the development of medicine?

People were willing to challenge old ideas. By experimenting they could prove they were correct

How did war affect the development of medicine?

Public health was made worse but developed knowledge of anatomy and treatment

How did education affect the development of medicine?

Literacy was increasing and there were more schools

How did technology affect the development of medicine?

Printing helped with the spread of ideas; there were improvements in clocks, watches and pumps; more realistic artwork

How did ancient learning affect the development of medicine?

Renewed interest in the writings of Greek/Roman thinkers

When was smallpox a big killer?

18th century

Who learnt about inoculation in Turkey and introduced it to Britain?

Lady Montagu

What is inoculation?

This was when pus from a sore of someone with mild smallpox was given in a small cut to the person being inoculated

After a mild reaction, they were immune to smallpox

Unfortunately inoculation sometimes led to full blown smallpox and death

However, as people feared smallpox, they took the risk

Doctors were made rich from this

In 1751 how many people died from smallpox in London?

Over 3500

Edward Jenner

Jenner (born 1749) was a country doctor

He heard that milkmaids didn’t get smallpox, but they did catch the much milder cowpox

Using his skills of experimentation and observation, he found that this was true

In 1796, he tested his theory on a boy called James Phipps using pus from Sarah Nelmes a milkmaid with cowpox

He injected him with pus from a milkmaid who had cowpox

Jenner then injected him with smallpox but he didn’t catch the disease

When did Jenner publish his findings?

1789

Where died the word vaccination come from?

The Latin for the word cow, vacca, gives us the word vaccination

How did the government help Jenner?

In 1802 they gave him £10,000 to open a vaccination clinic

In 1807 they gave him a further £20,000

In 1840 parliament passed an act that made smallpox vaccination free for infants

In 1853 parliament made it compulsory

It was a success numbers of cases fell

Why was it shocking that parliament help Jenner?

They usually had a laissez-faire attitude

How did women help in medicine?

Due to a number of changes, the role of women in medicine had gradually reduced:

* In the middle ages, the Church allowed only men to train as physician
* By 1700, surgeons also had to have a university degree. As women could not go to university, they were unable to become surgeons
* With the introduction of medical forceps,midwifery also was taken over by men
* In 1852, there was the Medical Registration Act which required all doctors to belong to one of the College of Physicians, Surgeons or Apothecaries, all of these were closed to women

Some women did fight to overcome this, Elizabeth Garrett was the first woman to qualify as a doctor in Britain

Women still played a major role as healers in the home, and as nurses, in the 1850s, female nurses went to work in the Crimea,this was the first time women were used as army nurses

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When did the Crimean war begin?

March 1854

Florence Nightingale

1820-1910

She became a nurse despite opposition from her family

When the Crimean War broke out, horror stories emerged about the hospitals that were treating the wounded British soldiers

The secretary of war, who was a friend of the Nightingale family, asked Florence to go and sort out the nursing care in the hospitals over there

Florence took 38 hand-picked nurses and made changes such as bringing in good food and boiling the sheets

The death rate in Scutari hospital was 42% before she arrived, and 2% afterwards

When she returned, she set up the Nightingale School of Nursing and wrote her book ‘Notes on Nursing’ which became the standard textbook

Men were not admitted onto the Royal College of Nurses until 1960

When did Florence Nightingale publish ‘Notes on Nursing’?

1859

How much did the public raise to help Florence Nightingale train her nurses?

£44,000

What was the name of the school Nightingale set up and where was it?

Nightingale school of nursing

In St.Thomas’ hospital in London

In Nightingale school of nursing how long did they have to train for before being qualified?

3 years

By 1900 how many trained nurses were there in Britain from colleges across the country?

64,000

When was the nurses registration act passed and what did it do?

1919

Made training compulsory for all nurses

Mary Seacole

* Mary Seacole learnt nursing from her mother, who ran a boarding house for invalid soldiers in Jamaica
* She came to England to volunteer for the Crimea
* She was rejected, probably due to racism, but raised money to make her own way
* She nursed soldiers on the battlefield and was loved by many
* However, when she returned to England she was unable to find any work and went bankrupt

Louis Pasteur

He was employed in 1857 to find out why alcohol was going bad in a brewing company

His answer was to blame germs in the air

Pasteur proved this and showed how to kill these germs by boiling the liquid

Pasteur was a scientist, not a doctor, and he carried out his early experiments with beer, wine and silkworms

He published the germ theory in 1861 arguing microbes in the air causes decay not the other way around

Robert Koch

1843–1910

In 1882 he identified the specific bacillus (bacteria that cause disease) that caused tuberculosis (known as TB)

In 1883 and 1884 he identified the bacillus responsible for cholera

His students and him found the causes of many diseases such as diphtheria, typhoid, pneumonia, plague, tetanus and whooping cough, all of which are killer diseases in Britain

He managed to identify the anthrax spores in 1876

He developed a solid medium to colour microbes, and dyeing techniques to colour them

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