Medicine Through Time - c1000-2000

Medicine Through Time flashcards for AQA history

What period is the medieval period

1000-1500

What were the four humours and who discovered them?

That four liquids make up the body and pain and sickness comes from the imbalance of these four humours

Hippocrates and Galen came up with this

What diagnosis did Hippocrates and Galen think was important?

Careful observation and measuring pulse and temperature and making detailed notes

What did Galen believe about anatomy?

Recommended dissection and advised that we should find out as much about structure and workings of body

Why were Hippocrates and Galen so influential?

They both wrote high number of books

Work fit well with Christian teaching

Arabic physicians and teachers preserved their works

What killed people in medieval century?

Small pox, typhoid, childbirth, war and famine

What did people believe caused illness in the medieval period?

Imbalance of the Four Humours

Miasma

God’s way of punishing them for their sins

Supernatural witchcraft

Who practiced medicine in the medieval period?

Barber surgeon

Local wise women and lady of the house, who acted as midwives and looked after women in labour

Apothecary and herbs to treat certain illnesses

What was used to diagnose and cure in the medieval period?

Zodiac charts

Doctrine of signatures - God gave certain herbs to cure certain illnesses

Bleeding and purging

Urine charts to find out what’s wrong

How did the medieval church help medical progress?

Cared for the sick and built over 160 hospitals

Cleaned the person and clothes were boiled and washed

Monks developed skills to amputate limbs and lots of wide herbs and plant medicines

Trained physicians taught medical practice BUT…(see flashcard on how these hindered)

How did the medieval church hinder medical progress?

The physicians only followed work of H&G, no one tried to challenge

Emphasised prayer more than medicine and encouraged offering to relics more and such

Leprecy and lunatics weren’t allowed treatment so no new development

Believed God caused illness so did not find a need to cure it

How was water supplies and waste disposal in a medieval monastery?

Water supply - Near isolated rivers with filtering systems to remove dirt

Waste emptied away from rivers and had flushing cesspits which would be clean

How was cleanliness attitudes and hygiene in a medieval monastery?

Wealth allowed them to build good facilities and uphold high attitudes of cleanliness “Filth never dear to God”

Excellent washing facilities and head face and feet washed regularly

Infirmaries to keep sick away

How was water supplies and waste disposal in a medieval TOWN?

Water supply often polluted with sewage and waste from business

Local springs and wells

Streets often muddy, drains overflowing

Privies if not emptied regularly would pollute rivers and wells

How was cleanliness attitudes and hygiene in a medieval TOWN?

Threw waste out onto street

Did not want to make improvements as these would be expensive for tax payers

No real understanding of germs

People did not bath daily and people would pay and bath together ;) in bath houses

How did John Arderne progress medieval surgery?

Urged surgeons to trust judgement and not depend on HG

Developed specialist techniques by treating anal abscess (50% surgery success)
Opium and henbane for pain dulling

How did John BRADMORE progress medieval surgery?

Covered wound with honey which is antibacterial

Washed wound with wine and dressed with barley

Operating with arrow cup to gently remove arrow

Why was Guy de Chauliac important?

He wrote 'Great Surgery' which dominated 100 years of British/French surgery

Why was Hugh of Lucca important?

Famous surgeon who used wines on wounds as the first antiseptic and he criticised that pus was needed for wounds to heal

but criticised one of the john’s

What was the general pattern of surgery in the medieval period?

Anatomy - Influenced heavily by Galen, no dissection

Preventing infection - No germ understanding, thought pus was good

Surgical skill - Impossible to do internal wounds, could sew up and cauterise and remove small tumours

Anaesthetics - Without it

What were Islamic hospitals like?

Every large town in Islamic world had hospital

Open to all and organised into wards had provided nursing care

In Cairo hospital, had specialist wards and a surgery and lecture rooms for teaching

How did the Islamic world preserve knowledge?

Many Greek medical books translated into Arabic

Multi volume encyclopedias which included Galen and other Greek medical writers

Later translated from Arabic to Latin and used in Europe to learn more about Arab and Galen

Abulcasis as a key individual

Well known expert in surgery

Produced a book describing complex abdominal operations and shows illustrations of more than 200 surgical instruments

Discovered 26 new surgical instruments and founded ligatures and cauterisation

Avicenna as a key individual

Encouraged observation and experimentation and importance of clean air and water

Cannon of Medicine became main medical textbook for physicians until the 17th century. Described for example over 700 drugs and medicines and their uses

What were the beliefs about the causes of the Black Death?

Earthquake in China caused bad air to spread disease

Four humours and acceptance of Galen’s ideas

God’s influence over disease

Hygiene problems causing bad air that spread disease

What were the beliefs about preventing infection of Black death?

March through streets praying to God to spare us

Avoid eating too much and no sex

Attend Church and murder Jews

Carry posy of sweet smelling herbs and spices

What was the significance of the Black Death?

Whole population decreased and whole villages were wiped out and much of the land used for farming became overgrown

Power of Church was undermined and many priests died, so some lost faith in Church and so religious activity failed

When was the Renaissance period?

1500-1799

What were the achievements of Pare , the surgeon to the kings of France?

Ten Books on Surgery translated to other languages

Replaced the use of burning oil with mixture of egg yolks and rose oils. Demonstrated that different is successful and encouraged other surgeons to think for themselves

Ligatures to stop bleeding instead of a cauterising iron. Helped stop bleeding in less painful way and improved chances of survival

Paré designed and arranged the making of false limbs for wounded soldiers, and included them in his books to spread ideas.

What were the limitations of Pare , the surgeon to the kings of France?

Ligatures were slow and in chaos of war using iron was more effective

Ligatures could have carried infection into wound and there were no other antiseptics

SMALL SCALE compared to problems facing surgeons. No effective anaesthetics or antiseptics and did not understand blood groups

How do the factors play into Pare’s work?

Didn’t give into critics - role of the individual

chance with the boiling oil

was a war surgeon so had lots of experience due to the wars and the battlefield which would have helped him

What were the achievements of Vesalius, the Professor of Surgery in Padua?

Made the fabric of the Human Body which was the first highly illustrated book of human anatomy. Showed anatomy was vital for developing medical knowledge and treatment

Vesalius challenged ideas of Galen, such as jaw bone was thought to be 2 bones but it was actually 1. Showed there was much to be learnt apart from Galen

Vesalius carried out dissection himself, rather than reading Galen while an assistant did so. His attitude showed others the way forward for the future – he encouraged students of medicine that he taught.

What were the limitations of Vesalius, the Professor of Surgery in Padua?

Many doctors refused to accept Galen was wrong, claimed that human body had changed and since Vesalius faced such heavy criticism that he left Padua in Italy

Nobody was healthier because of Vesalius

How do the factors play into Vesalius’ work?

Stole bodies of criminals shows his dedication

What were the achievements of Harvey, doctor to King Charles I?

Proved that body had one way system for blood and dissected live cold blooded animals. Laid the foundation for future investigation of the blood

Calculated the amount of blood going into arteries was thrice weight of body. Showed the same blood was being pumped around body and not like a fuel like Galen

What were the limitations of Harvey, doctor to King Charles I?

His discoveries were only gradually accepted after 50 years, because he contradicted Galen

Discovery did not make anyone healthier better or live longer and was not respected as a practitioner.

How do the factors play in to Harvey’s work?

Technology and chance that he saw mechanical water pumps and associated it with hear

challenged Galen’s ideas where no one should challenge

When was the Great Plague?

1665-1666

What improvements had been made since the Black Death in 1348?

People connected dirt and disease as more deaths occurred in poorer/dirtier areas

Quarantine of sufferers in their homes (watchmen),

Trade between plague towns was stopped and gatherings of crowds were banned. After 1666 quarantine laws prevented epidemics coming to England on ships

What was similar about the Black Death and the Great Plague?

Beliefs about causes to do with religion were similar

Both groups tried to ward off evil through flagellation

What were some differences between the Black Death and the Great Plague?

BD was more religion focused

GP focused more on miasma/public health,

BD caused more death but there was better economic recovery and actually better health and standard of living than after GP where businesses failed due to quarantine

How much progress was made during renaissance for causes and diagnoses of disease?

Still saw disease as punishment from God and miasma, four humours and urine charts but Thomas Sydenham seen as English H because he stressed careful observation

How much progress was made during renaissance for prevention of disease?

Great Plague shows continuity in prevention methods of prayer days and confessions. Limited however Mayor made rules that showed understanding like quarantining infected and banning public gatherings

How much progress was made during renaissance for training and status of surgeons?

Reluctant to accept Galen as wrong and there were still apothecaries for poor people

Still concentrated on teaching H and G and accepted imbalance of humours, but

Royal Society in 1600s spread new ideas about discoveries and experiments

John Hunter in 1700s, spread scientific approach and new techniques in surgery. Made royal Charter and opened one of first colleges for surgeons

GREATLY IMPROVED

What were the short term impacts of John Hunter’s work?

Dedicated and often radical methods to carry out dissection e.g. robbing graves.

Developed treatment for aneurysms which prevented need for amputation (surgery v dangerous in C18th) and gun-shot wounds

Spent most of his money on science later dying in debt

Injected himself with STI’s to work out if they were actually sex disease.

What were the long term impacts for Hunter’s work?

Improved knowledge, training and attitudes towards surgery. Set up own training school which passed attitudes on to students (Jenner).

Published books which were translated into many different languages

How much progress was made during renaissance for scientific discoveries?

Royal society discussed new ideas and printing revolution allowed work to be spread around improving knowledge

Microscope improved technology and experiments

Catholic church still DOMINATED!

How much progress was made during renaissance for treatments and cures?

Absolutely nothing (apart from the exotic medicine)

Bleeding and purging still common and Scrofula believed that touching king would cure it

Quackery started but BOOMED in renaissance and these pills made money but killed people

New rhubarb to purge bowls and Quinine for malaria

Hospitals in the renaissance

Nursing sisters and some physicians and surgeons helping but not too much

Specialist hospitals for pregnant and silly persons but still no acceptance of infectious disease

Relatively minor complaints and based around 4 humours that were given treatment

Most large towns now had hospitals 2 large medical hospitals in London with 300 patients

How was small pox cured before the vaccine?

Inoculation where they spread the pus into the person and hopefully only got a mild dose of it. However person could die,pass it on and inoculation was extremely expensive: was £20

How did Jenner make his discovery?

In 1790s, saw that milkmaids never got smallpox and carried out 23 experiments and recorded each in detail

Jenner inoculated boy with cowpox and then when given smallpox, nothing happened to boy

Impact of Jenner’s work on vaccine

Did 23 different experiments

In LONGER TERM: Small pox eradicated as a killer disease, due to more development in vaccines

Made compulsory in 1852. In 1871, parents fined for not having children vaccinated

However was a one-off discovery, but later developed with germ theory

Why were people opposed to the vaccine?

Did not like treatment linked to animals

Inoculators were bigger then him and worried about income (did not believe in Jenner because he was a country doctor)

Still believed disease was God’s plan so only wanted to live godly life which would cure it

How did public health change in the renaissance?

Little to improve however w do see mayor to try prevent Great Plague spread by quarantine

£30,000 given to Jenner to invest in vaccine

How did knowledge of the human body change in the renaissance?

Still opposition to Vesalius and Harvey but gradually accepted and allowed later for blood groups and more work to be done

Dissection also starting to be encouraged

When does the time period of C19th take place?

During the 1800s

What did Pasteur’s theory talk about?

in 1861, published that bacteria caused decay and germs caused disease. This was huge change as before wrong beliefs about how disease was caused was the main issue for little progression.

What was the short term impacts of Pasteur’s work?

Allowed Koch to link individual bacteria to a disease

Lister used carbolic spray to perform first antiseptic surgery

What was the long term impact of Pasteur’s work?

New treatments: New chemical drugs found and first antibiotic discovered to kill bacteria

Aseptic surgery developed to make sure no germs were in operating theater

Pasteur encouraged councils to build sewers and provide germ free water

What factors led to Pasteur developing his ideas?

Chance - Called in to both silk and alcohol industry to find out what made them both go off and he made link to do with airborne germs.

Individual genius - Determined to prove miasma wrong and many criticised but continued

Government - Paid for his research team

War - Rivalry between Pasteur and Koch increased after France lost a war against Germany in 1871.

What discoveries did Koch make?

Discovered anthrax and the specific bacterium that was causing the disease. Proved Pasteur correct

Developed method of staining bacteria to make them easier to study

Koch then discovers TB even though it was so small and this leads to finding cholera as well and then other scientists getting inspired and finding other killer bacteria

Pasteur’s vaccinations:

Chance: Chickens did not die when they were inoculated with an accidentally weaker piece of cholera, finds out that weak forms of virus are good for vaccines

Anthrax rabies discovered

Rabies vaccine was his first human vaccine and gave boy 13 injections of his vaccine. He survived

What were existing problems in hospitals before Nightingale came along?

Cramped and stuffy wards which allowed infection to spread quickly

Little care over sanitation, not bothered to clean so bad diseases around

Nurses were poorly regarded, seen as dirty and not trained

What did Nightingale do?

Crimean war saw how dirty everything was and set to work cleaning the wards and concentrated on improving sanitations and clothing and washing facilities for patients

Impact of Florence Nightingale?

Reducing death rate from Scutari from 40% to 2%

Wrote two books which influenced the way nurses were taught and design of hospitals changed

Limitations of Florence Nightingale?

Only set on the basis that she believed the incorrect miasma theory and rejected germ theory

Could have not occurred without government supporting new engineering and changes to surgery making the nurses better trained

What did Paul Ehrlich do?

1909 developed first chemical cure for a disease, which honed in on certain bacteria and killed it.

Called SALVARSAN 606 which by the way was his 606th ATTEMPT!!
Destroyed syphilis, within three years cured 10,000 people

Short term impact of Paul Ehrlich:

Vastly accepted and used world wide due to fast twentieth century communication

Extremely superior to Mercury which was dangerous and poisonous

Within three years saves thousands of people

Long term impact of Paul Ehrlich:

Twenty years later allows development for the second magic bullet by Domagk which cures blood poisoning

Identification of key chemical allows for other cures such as pneumonia

Pioneers chemotherapy in late twentieth century

Limitations of Paul Ehrlich:

Magic bullets could not kill germs that caused most infections and Ehrlich did not really know how the magic bullet worked until scientists discover that sulphonamide was used.

How did vaccinations and the magic bullets in late 19th-early 20th century affect prevention?

The discovery by Charles Chamberland, one of Louis Pasteur’s research team, of a vaccine against chicken cholera in 1880

- Soon afterwards, Pasteur discovered a vaccine against anthrax in animals and news of these discoveries spread rapidly through Europe.

- In 1885 Pasteur developed a vaccine for humans to protect against rabies. A boy who had been bitten by a rabid dog was saved by 13 injections in a two-week period. This vaccine was developed to protect more people.

Later vaccinations made

How did vaccinations and the magic bullets in late 19th-early 20th century affect treatment of disease?

The magic bullets are spread everywhere BUT

everyday remedies still cease to develop even through the improvements in medicine. Most common form were still home remedies

Also relied on patent medicines and were very false but still marketed them as cure alls

What were anaesthetics like in the middle ages and renaissance period?

Middle Ages - used herbs like mandrake but could kill if too much was used

Renaissance - Alcohol and opium makes the patient not fully unconscious ad opium could kill through overdose

How else did surgeons use to combat the pain?

SPEED - Only way to reduce pain was speed so they tried operating as quickly as possible, and they would pride themselves on that

But Liston goofed up because of this and others probably as well. In two and half minutes he amputated a leg but he also cut off the testicles

Laughing gas as an anaesthetic?

1799 Davy discovers laughing gas reduced sensation of pain but did not make patients completely unconscious.

Horace Wells uses it in demonstration but makes the woman in agony so public lost faith in it

Ether as an anaesthetic?

Worked better than previous attempts, but was difficult to inhale and irritated eyes and lungs

Chloroform discovery:

Chance -1847 James Simpson with colleagues Inhaled fluid and then fell onto the floor

Chloroform was faster acting and gentler than ether, used it for childbirth and other operations

What was opposition for chloroform like?

Chloroform was new and untested so no one knew about the long term side effects

Increased risk of infection , as the anaesthetics would actually make doctors try carry out more complex operations increasing risk of infections

LEADS TO BLACK PERIOD OF SURGERY AND SO STOPPED CHLOROFORM

How was opposition overcome for chloroform?

Used it regularly and communicated to other doctors

Queen Victoria used it to deliver her child and publicly praised it so ye

SHORT AND LONG TERM OF CHLOROFORM:

SHORT TERM:

Development in anaesthetics allows for more complex operations and surgeons could work more carefully and slowly

LONGER TERM:

Encouraged others to search for even better anaesthetics

Other chemicals were used which relaxed muscles as well and local aesthetics were developed to numb pain in one part of body

Surgery before discovery of carbolic acid and such:

Lots of infection spread due to no sterilisation and reusing of bandages

Operated using blood and pussy clothes

Lister’s Discovery of carbolic acid:

Believed in germ theory and wanted to look for ways to kill bacteria

1864 saw how carbolic acid used to reduce sewage smell and destroyed parasites

Used it on bandages and gangrene was not developed

Made :

Handwashing with carbolic to avoid wound infection

Carbolic spray to kill germs in air

Antiseptic ligatures

Oppposition to antiseptics

Unpleasant as it would crack surgeons skin

Slowed down operations

Pasteur’s ideas still weren’t accepted so saw antiseptics as unnecessary

Did not always work as surgeons who were not meticulous with it did not achieve same results but blamed techniques

How was opposition for antiseptics overcome?

Lister determination - ROLE OF INDIVIDUAL

Over 8 years he demonstrated methods to over 1500 medical students and trained young surgeons

ROBERT KOCH DISCOVERING SEPTICAMEIA - Showed how bacteria caused blood poisoning and by end of century his ideas were accepted

SHORT AND LONG TERM EFFECTS OF ANTISEPTICS:

SHORT TERM:

Dramatically reduced rate of infections and worked at improving his method at every stage

Went from 45% dying to only 15% from amputations

LONG TERM:

Led to aseptic surgery getting developed and surgery therefore was able to become more complex and safer operations, which allowed for surgeons status to IMPROVE

What was aspetic surgery?

Removing all possible germs from operating theatre, made sure that:

Operating theatres were carefully cleaned

All instruments sterilised

Surgeons no longer wore ordinary clothes but gowns and face masks

Examples of surgery becoming more ambitious after the aseptic surgery introduced?

Infected appendix carried out in the 1880s to remove it

1896 - First heart operation carried out

What were public health problems in the 19th century?

GREAT STINK - Summer of 1858 was very hot and caused smell of river to become unbearable and MPs had to move out of the building.

Only treated it with lime chloride on curtains due to miasma so very little impact

CHOLERA EPIDEMICS - Four major epidemics between 1831 and 1865 due to germs from cesspits infecting the water supply. Relied on supernatural remedies and new and old ways

1848 - 49 EPIDEMIC KILLED 53,000 PEOPLE

CONDITIONS IN LONDON - Living conditions were worse due to cramped shared privies and bad ventilation. No fresh food and doctors hard to come by as they were very expensive

Water supply was hard to receive

What did Edwin Chadwick contribute to public health?

Made a report in 1842 that overcrowded conditions were making illness and people were too sick to work and therefore people had to pay taxes to support the poor.

Therefore recommended:

Improving drainage and sewers, removing excretion from streets, providing clean water supplies and appointing medical officers to check these reforms were there

Impact of cholera on improvements made to public health

Chadwick mainly opposed and tax payers did not want to pay for improvements

However cholera grew across Europe and government finally followed his recommendations and passed the PUBLIC HEALTH ACT

1848 PUBLIC HEALTH ACT

National Board of Health set up

Where death rate was high govt. could force council to make health improvements and appoint medical health officer

Local councils encouraged to collect taxes to help the public health

Limitations to the 1848 PUBLIC HEALTH ACT:

Only 103 towns set up the boards of health

National Board of Health was abolished after six years

Not compulsory

What did John Snow contribute to the public health of 19th century Britain?

In 1854, over 700 people who lived in this street/nearby streets had died within 10 days so he decided to investigate
-> found that all victims got their water from the Broad Street water pump, that one lady who enjoyed the taste and then had died (OBSERVATION)
-> he removed the pump and people stopped dying
He realised it wasn't miasma speaking disease but contagion (in this case, people were coming into contact with sick or drinking contaminated water)
The discovery that cholera was a water-borne disease was a great achievement -> the government now had evidence on Britain's dirty towns and a link between cholera and water supply (however didn't do much until the Great Stink)

Impact of Snow’s work on public health:

Still clung onto miasma theory and even further cholera epidemic in 1865 didn’t do anything

Wealthy people did not want to pay taxes to cover cost of clean water supplies

Local councils did not want national government to interfere with how they ran towns

Strong belief in laissez fair and self help. Still governments weren’t expected to improve living conditions of people

Impact of the Great Stink 1858 to public health:

Stench combined with Snow's evidence about cholera caused MP's to turn to Joseph Bazalgette for help

Bazalgette had drawn up plans for a network of tunnels to intercept waste from nearly 1 million London households to be pumped into the sea (sewers)

- Sewers were finished in 1866 and cholera never returned to London
-> encouraged parliament into further action for public health

-19th century saw government taking much more responsibility for public health due to working-class getting the vote in 1867

-> incentive for political parties to promise improved public health as wanted working class men to vote for them

2nd public health act passed in 1875: local councils had to appoint medical officers to be responsible for public health and councils were ordered to build sewers, supply fresh water and collect rubbish

Death rate (deaths per 1000) fell from 39 in 1800 to 18 in 1900 and average age of death rose from 30 to 50

What happened in 1867 that helped change the government’s attitude to the poor?

Working men got the vote so now they had to improve laws designed to improve ordinary people

1875 PUBLIC HEALTH ACT

FORCED locals to improve public health and compulsory to improve sewers and drainage and provide fresh water, and medical health officials to inspect public toilets

1875 PUBLIC HOUSING ACT

Octavia Hill appalled at living conditions of poor people so over time bought 2000 houses to improve them

PERSUADED GOVERNMENT TO PASS 1875 HOUSING ACT TO KNOCK DOWN SLUMS IF THEY WERE UNHEALTHY

How did treatments of disease change in the 19th century?

Did not really, everyday treatments remained the same and patent medicines were worthless

How did surgery change in 19th century?

Dealing with pain was revolutionised so was dealing with infection

Major improvements