History Health and The People

Galens 4 humours

Galens 4 humours

• blood, phlegm, yellow bile and black bile

• need to be in balance for good health

• followed as it made sense of symptoms at the time

medieval ideas about causes of illness

• punishment from God

• bad air

• astrology / superstition

• unbalanced humours (common)

how to fix an illness that was a punishment from god (medieval)

• prayers and herbal remidies

• blessing / asking for forgiveness

how to fix an illness caused by miasma (medieval)

• filth in streets removed e.g. 1349 plague slowed by Mayor asked by king to remove dirt in streets

how to fix an illness cause by unbalanced humours

• unrine charts

• bloodletting

• purging

• trepaning (get rid of demons)

physicians (medieval)

• highest ranking doctors

• well paid - treated kings

• very few

wise women (medieval)

• most common

• remedies and superstition

• midwives

• did everyhting

barber sugerons (medieval)

• most common

• blood letting and tooth extraction

• guild of master surgeons

• trained by apprenticeship

how did islamic golden age progress medicine?

• hospitals in Cairo and Bhaghdad

• crusades spread islamic knowledge into west europe

• books translated into latin and spread

• Avicenna ‘Canon of Medicine’ book described 700 drugs some still used today

new diseases / developments due to Islamic golden age?

• pulmonary circulation discovered

• vaccination 50y pre Jenner

• parasites described in 1100s, questioning Galen

• alchemy invented so new drugs

christianity helped development of medicine (medieval)

• people could learn from Greek / Roman ideas - not all knowledge lost

• church controlled unis - every doctor thought the same

• hospitals to look after poor / elderly - not sick

christianity hindered development of medicine (medieval)

• knowledge didn’t change and ideas were not questioned

• taught to follow Galen + not question - banned any deviation and human dissection

• if God sent diseases then u couldn’t fix it, disease as proof of god and cure as miracles

anaesthetics (medieval)

• mandrake root

• opium

• hemlock

• whiskey

surgical procedures (medieval)

• bloodletting

• amputation

• cauterisation

people with ideas (medieval)

• Galen most widely supported

• Hugh of Lucca and Theodoric - some good ideas e.g. wine on wounds to reduce infection but didn’t support Galen so was cancelled

• De Chauliac - famous textbook (Great Surgery 1363) dominated surgical knowledge for 200 years

public health in towns (medieval)

• generally bad

• towns near to rivers (waste and water supply)

• cesspits - not emptied regularly so would leak into river

• no knowledge of germs, but removed unpleasant smells

• some local laws to keep towns clean but nothing huge

places with good public health in medieval era?

• isolated places as disease didnt spread

• monks - water very important

• monasteries were wealthy from money for prayers

• monks had access to medial books, and learned sanitation from Greeks/Romans

what did people think caused Back death

• postion of stars

• miasma

• jews poisoning wells

• god punishing people

what actually caused black death

• bubonic and pnuemonic plagues

• pneumonic infected lungs - more infectious

when did Black death hit england

1348-49

what did the black death affect

• both rich and poor

• towns and ports hit worst

preventions for black death (medieval)

• strangers not allowed into villages

• prayers

• mayor asked to clean london up by kind edward 3

• huge candles lit in streets (miasma)

• doors and windows shut and sealed

treatment for Black Death (medieval)

• prayers

• holy charms around neck of sick

• let pus out of buboes

• leches to bleed patients

• based on Galen’s theory of opposites

Short term impact of Black Death (medieval)

• killed 1/3 of popp.

• whole villages wiped out

• food shortages - food prices increased

long term impact of black death (medieval)

• higher wages for workers

• higher education levels

• peasants revolt

hospitals in medieval times

• like todays care homes

• not for sick only for elderly

• had hospitals in ancient Arabia like today

how did people know about anatomy (medieval)

• Galen, Hippocrates, Arabs

• dissections to prove Galens ideas

• doctors not encouraged to make new discoveries

Vesalius discoveries and action

• dissected criminals for anatomy knowledge

• proved Galen wrong (breatbone 3 parts not 7)

• wrote the book ‘Fabric of the Human Body’

• first book on anatomy

short-term impact of Vesalius

• improved knowledge about anatomy in Europe

• changed attitudes

• changed training

• triggered research into anatomy

long-term impact of Vesalius

• traditional ideas challenged (Renaissance)

• Pare and Harvey

• discovery and experience encouraged not textbook

• focus on enquiry

limitations of Vesalius’ work

• no one was healthier

• doctors still basing treatments off Galen

• ideas didnt spread to everyone and lots of criticism

• was it technology w printing press in 1451 not individual?

why did medicine change in renaissance?

• move away from religion, people ignored church’s medical advice, Galen’s ideas beginning to be questioned

• rediscovery of classic ideas e.g. Avincenna

• printing press 1451 allowed ideas to spread

• more people could afford education and experiments encouraged.

consequences of renaissance

• new learning w observation, experimentation

• inventions - gunpoweder meant new wounds meant new wounds to treat

• americas discovered so new medicines

• new art style so human body more realistic

• ideas spread faster w printing press

Harvey discoveries

• circulation

• through dissection and experiments

• one way system for blood and proved Galen wrong

Harvey short term impact

• ignored

• v little impact

• 50 years before ideas accepted and taught (microscopes for capillaries)

• was the first to provide actual proof of this via empirical evidence

Harvey long-term impact

• turning point in history for med

• how poisons could spread through body

• part of disproving Galen’s theories e.g. 4 humours

• scientific rev in C17 and C18 towards practical working and dissection

• long term in blood transfusions and that in ww1

Harvey limitations

• couldnt explain all of it as microscopes werent invented so couldn’t see capillaries

• couldn’t explain anything

• didnt help day to day health of people

Pare actions and discoveries

• used turpentine, egg white and cream of rose oil instead of boiling oil to treat gunshot wounds

• ligatures not cauterization

pare short-term impacts

• challenged accepted ideas about wounds (not poisonous)

• translated Vesalius book into French so increased knowledge of anatomy in Europe

• Clowes (surgeon to Queen liz 1) inspired by him

Pare long term impacts

• Clowes

• English version of Vesalius’ work printed in 1634

Pare limitations

• just luck?

• ligatures had been used by Galen before and infected wounds

Public health in C17 and C18 (renaissance)

• still poor

• had barber-surgeons, apothecaries, wise women, quacks, and bloodletting

• printing press allowed people to get books on herbal remedies

• towns still filthy

• lots of wars which took money away from public health

• popp increasing so more strain on public health systems e.g. water supplies + sewers

When was the Great plague

1665

killed 100,000 in London

Causes of Great Plague believed at the time

• miasma

• punishment from God

• movement of planets

• similar to Back Death

Cures to Great PLague

• no cure

• smoke to keep away poisoned air

• awareness of dirt ad disease being connected

Measures taken to defend against Great Plague

• rich moved away

• mayors issuing quarrantine orders to stop spread

• women searchers to identify those with disease

• plague victims quarantined

• red cross painted on infected houses

• trade between town stopped and scottish border closed

How did Great Plague end

• not in Great fire of London 1666, as fire didnt reach poorest parts ouside city walls

• rats developing resistance to disease so fleas didnt need human hosts

Hospitals in renaissance period C17 and early C18

• hospital boom began

• modern hospitals w modern medicine but not large understanding of sanitation ect.

• built by community or rich people (dissolution of monasteries gave money)

• treatments based on 4 humours

• medical schools attached to hospitals

• attitudes towards poverty shifted as Christians wanted to be more active in helping others

John Hunter overview

• 1728-93

• scientific methods importance for research

• specimen collection - anatomy

John Hunter books

• Gun shot wounds - shouldnt be made larger but treated as any other wound (radical)

• widely read and major contribution to surgical knowledge

• discoveries on nature of disease, infections, cancer and circulation

John Hunter scientific techniques

• syphilis and gonorrhoea guy

• promoted careful observation and scientific method

Hunter short term significance

• not very - percieved as a villain due to grave robbing

• first transplants on chickens

• taught others e.g. Jenner

• scientific techniques

Hunter long term significance

• encouraged more scientific approaches to anatomy and surgery

• books translated and read all over europe

• influenced Jenner

how dd royal society help develop medicine

• royal charter granted in 1660, gave them credibility and people donated money / sent works for publishing

• more money and less dependence on patrons meant tech and equipment was hi tech and could be used for experimenting

• copy of every scientific journal preserved in english so could be spread across europe

Royal College of surgeons / barber surgeons

• Henry 8 allowed company of barber-surgeons to be formed in 1540

• maintained standards and qualifications

• 1746 surgeons wanted to be seen as superior so separate college created for them

inoculation beginnings

• medieval chine and asia using basic inoculation to prevent smallpox

• became profitable in 1700s england

• however some ha religious objections, poorest couldn’t afford, inoculated could still carry and spread, and too large a dose could kill people

Jenner dscovery

• milkmaids if had cowpox didnt get small pox worked on 8yr boy

• called it vaccination

• published in 1798

Opposition to Jenner

• couldnt really explain it

• wasnt accepted by other doctors

• snobbery as Jenner was from country

• would lose money from innoculation

Jenner short term impact

• revolutionary? and potential to save lives

• important bc 30% small pox mortality rate

• however was shunned, peer assessors used contaminated equipment, couldnt explain it bc germ theory not until 1861

Jenner long term impact

• royal family vaccination raised support

• eradication of smallpox - massive step for medicine

• vaccination central to fight against disease as medicine developed

• 1861 germ theory and Kochs microbes allowed Jenner’s work to be adapted e.g. covid -19

pain relief origins

• used since medieval period e.g opium

• had to do surgeries quickly to avoid blood loss

• difficult to judge doses

Nitrous oxide as pain relief

• fairground attraction

• 1795 in UK

• 1844 Wells used in in US in tooth extraction

• wasnt convincing

Ether as Pain relief

• 1842 Clark used in tooth extraction

• effective anaesthetic

• spread to UK with Liston

• dangerous as was difficult to inhale, cause vomiting and flammable and many patients had surgery by fires at home

Chloroform as pain relief

• discovered in 1847

• by James Simpson

• dangerous if dose was incorrect

Opposition to Pain relief in C19

• doctors used to operating quickly on conscious patients

• e.g. Crimean war docs thought soldiers should put up w pain

• religious objections

• overcome by Queen Vic using chloroform in childbirth in 1853

importance of development of pain relief

• step forward however didnt revolutionize surgery

• still v high death rate from surgery and infection

• hospital infections

belief about causes of infection in 19th century

• thought infections were chemical reactions

• if wound became infected would cauterise or burn away w acids

• spontaneous generations

• microbes viewed but no link between microbes and disease

• thought all microbes were the same and disease caused microbes

• some questioning of ideas but no proof

louis pasteur experiment

• swan necked flask and milk

• if air kept out of flask, liquid wouldnt go off

• proved that germs didnt come alive on their own but infected things they could reach

• proved bacteria caused disease and it was biological not chemical

when was Germ Theory published

• 1861

• by Pasteur

Pasteur short term significance

• theory of miasma long standing

• belief that small microbes couldnt harm large humans

• Jenners vaccination

• some opposition

• in france not england

Pasteur long term significance

• basis of understanding of disease today

• bacteriology

• Koch and Pasteurs work bringing hope of vaccination and eradication of disease

• some vaccination made mandatory by gov in coming decades

anti-contagionism vs contagonism

• anti: epidemics caused when infections interacted w environments and created the disease

• vs infections spread by contact w infected person/ bacteria

what did Lister do

• 1860s

• operations went well as long as wound was free of infection

• used carbolic acid to kill bacteria

• only irritation was due to carbolic acid

• antiseptic techniques

reaction of Lister’s work

• publicised Germ Theory in UK

• criticised in Uk as was controversial to say that infection was caused by microbes in the air and not spontaneous generation or miasma

why did people oppose Lister’s method?

• didnt accept Germ theory in britain

• antiseptic already widely used and not revolutionary

• often difficult and unpleasant to use his methods

• still couldnt fully explain it

• didnt wash hands before surgery and operated in street clothes

lister short term significance

• mostly insignificant

• incomplete ideas

• huge amount of opposition

• germ theory not yet accepted

• carbolic acid expensive

lister long term significance

• 45% death rate decrease

• increased life expectancy

• helped catalyse acceptance for germ theory

• forms the basis of disease and medical treatment

aseptic surgery

• microbes excluded fro surgery from the start

• surgeons well scrubbed, wearing gowns, using sterilised equipment

• huge public operating theatres replaced w smaller rooms

• reduced no. or infections

• depended of accepting germ theory

what did Koch do?

• found a way to stain and grow a particular germ

• changed study of bacteria

• prove a specific bactera responsible for a specific disease

• discoveries into typhoid, tetnus, meningitis