History - Changes In Medicine

What did they believe caused illness in the middle ages?

That God is responsible for disease and health outcomes, influencing the understanding of medicine in historical contexts.

What some Medieval Physicians used to figure out what illness a patient had

Astrology charts - they believed the positions of celestial bodies could influence health and disease.

The Four Humours Theory

Idea developed by the Greeks that health is maintained by a balance of four bodily fluids: blood, phlegm, black bile, and yellow bile.

What did they believe about the Four Humours

They believed that an imbalance in the four humours caused illness and that restoring balance was essential for health.

Fire =

Yellow Bile

Earth =

Black Bile

Water =

Phlegm

Air =

Blood

Miasma

an unhealthy condition of the atmosphere believed to cause disease, often associated with foul odours.

Two ways disease and illness were prevented in the middle ages

. Religous Actions

. Purifying the air

. Regimen Sanitatis

Religious actions believed to prevent illness in the middle ages

. Life free from sin

. Attending church sermons

. Prayer

. Pilgrimage

. Fasting

. Self whipping as a form to beg God for forgiveness and penance

Purifying the air believed to prevent Illness and disease

. Cleaning the streets

. Carrying Posies and other sweet herbs and flowers

. Lighting Fires - to drive away bad air, burning herbs too

. Ringing bells or allowing birds to fly around the house to keep the air moving

. Employing Rakers

. Punishing those who threw away waste

. Building public latrines.

Why was there lack of progress in understanding disease in Medieval ages

Because people had respect for tradition, lack of education + scientific knowledge, along with the power of the church

Treatment of Disease in the middle ages include

. Herbal Remedies

. Religous tactics

. Four Humours

. Supernatural tactics

Religious tactics to treat disease

. Healing prayers and incantations

. Prayers for mass to be said

. Fasting

. Pilgrimages

Herbal remedies to treat disease

Herbal remedies to drink/sniff/bathe in were given by wise women or apothecaries. Many remedies worked. Most remedies using herbs, minerals and animal parts.

Using Four humours to treat disease

. Blood Letting - Most common way to remove bad humours/blood

. Cupping - Putting warm cups onto open cuts to draw out the blood into the cup

. Leeching - Using leeches to suck out the blood

. Bottling - Warm baths prescribed with herbs to draw out the humours

. Purging - Swallowing a mixture of herbs and animal fat to make you sick or taking laxatives to empty your bowls and ‘cleanse’ them

Supernatural tatics to treat illness

. Barber surgeons would tree pan skulls to release demons making them ill but dangerous

. e.g magpies break around your neck for tooth ache

Who treated the sick during the middle ages

. Wise Women

. Physicians

. Apothecaries

. Barber Surgeon

Wise women

Local woman with medical experience - Would use herbal remedies, sometimes charms and spells - Often helped with child birth - Not allowed to be physicians

Physicians

Trained medically at university for 7 years - however didn’t pratice disection so little anatomical knowledge - Would dianose illness and suggest treatment by surgeons or apothecaries - Used four humours - took clinical observation - very expensive

Apothecaries

Like a pharmacist or chemist - Trained but 0 medical qualifications - Produced medicines for physicians - Understood herbal remedies - Cheaper than a Physicians

Barber surgeon

Untrained but experienced - Could pull out teeth, let blood, lance balls and remove humours - cheapest surgery available - performed basic surgery - No anaesthetic - Very low success rate

What was a catalyst for the push in medical research

The black death

Technology - the printing press

Introduced 1450s - Made it easier to mass produce books - Made it easier to publish books on medicine

How art improved medicine

Allowed anatomists to develop more realistic illustrations of anatomy. Along with producing them for medical textbooks

How humanism improved medicine

Humanists rejected the religious reasons for illness so they sought out to find alternative ways

Humanists

Belief that human beings can make up their own minds when it comes to discovering the truth of the world

Medicinal ideas which changed a lot from medieval age to renaissance

. The four humours

. Anatomy of the human body

. Diagnosis using urine

Medicinal ideas which changed slightly from the medieval age to renaissance

. The Use of medical books

. Influence of the church

. Supernatural

Medicinal Ideas that stayed the same from medieval ages to renaissance

Miasma - Bad air

Anaesthetic

A drug which stops you from feeling pain

Amputation

Cut of a limb during an operation

Tourniquet

Something wrapped tightly around a wound to slow the rates of blood flow

Sepsis

When the body is fighting an infection, the blood supply to vital organs is limited causing organs to die. Also known as blood poisoning

When did supernatural medicinal beliefs like

the four humours begin to fall out of favour

By the 1700s

Two main medicinal theories by 1700s

. Miasma

. Spontaneous Generation

Spontaneous Generation

The claim that rotted matter created maggots, fleas and disease

Lack of Research

Major reasons for lack of research were lack of funding. Doctors where paid by patients for diagnosis and treatment. Hospitals were mainly funded by charities, so there was very little money going towards the research that doctors and scientists did

Lack of Technology

The 19th century had major improvements in technology but even by 1948 it was still limited. Development of things like the microscopes was huge as it allowed the tiniest of organisms to become visible for the first time in the 1950s

Lack of understanding about the Body

While advances were made there was still a lack of understanding about the body and how it worked, often relying on old theories and discoveries, viewing few dissections but most doctors never carried out dissections themselves

Doctors training in the 1840s

During the Mid 1980s the typical medical training course took 4 years. Often comprised of lectures on illness and treatments, practice experience in hospitals and practical experience of midwifery and surgery.

Key Problems of operations in the 1800s

. No anaesthetic

. Unsanitary Room

. Infection risks

.Wooden tables as operating desks

. No way to replace lost blood

Pain problems in 19th century surgery

No anaesthetic - Most patients were awake, or to lessen the pain would be made drunk and knocked out - Patients had to be held down

Bleeding Problems in 19th century surgery

Major bloodloss - Tourniquets used to restrict blood flow - Lack of knowledge of blood types made attempts at blood transfer fatal

Infection problems in 19th century surgery

Most operations carried out in patients homes which wasn’t hygienic but the hospitals weren’t better either - No understanding on how infections happen - Unsanitary equipment and surgeons

Amputation fatality

In the 19th century around 1 in 5 amputations in hospital would end in death

How surgery is improve today

. Sterilised equipment

. Blood transfusions

. Trained doctors and nurses

. Rubber gloves

. Germ free operating room

. Anaesthetics

. Electrical power

Nitrous Oxide (Laughing Gas)

Discovered in 1799 by Humphrey Davy. In 1844 an american dentist Horace Wells attempted to use it as an anaesthetic but doctors weren’t convinced

Ether - Discovery

January 1842, an American dentist William Clark experimented with a chemical known as Esther while extracting teeth. Doctors took notice of this and in march an American country doctor Crawford Long used the chemical to remove neck growth from his patient.

Ether - gaining recognition

On the 16th October 1846, William Morton helped hold a public demonstration in a Boston hospital. The news of this anaesthetic spread to Europe leading Britain’s most acclaimed surgeon, Robert Liston to want to use ether as an anaesthetic. He called it “Yankee Dodge” and used it for a leg amputation. This was one of the first successful anaesthetic

Ether - Drawbacks

Difficult to inhale, caused vomiting and was highly flammable. Correct dosage was hard to figure out. Would cause coughing which would disturb the patient mid surgery, even causing some to wake up. Operations would have to be done at home Infront of fire instead of a hospital, results could be disatrous

Chloroform - Introduction

In 1847, a Scottish doctor, James Simpson discovered Chloroform, which induces dizziness, sleepiness and unconsciousness. He used it on 30 patients the same week.

Chloroform - Drawbacks

Dosage was difficult to get correct and could cause death such as Hanner Greener who died in 1848 during her toe surgery because of high dosage, since it can affect the heart, however John Snow solved the dosage problem by creating a chloroform inhaler later on in 1848.

Reasons people opposed anaesthetic

. Some people feared side effects like overdose

. Some rejected it during childbirth because they believed that pain was sent by God

. Unsure how it’d effect the body, especially during childbirth

Reasons why some doctors opposed anaesthetics

. During the Crimean War (1853-56), many army surgeons believed that the soldiers should put up with the pain out of duty

. Some doctors felt like the patient would give in to death easier when unconscious

. Some surgeons were used to operating quickly on conscious patients and feared how the rise of anaesthetics would affect them

Acceptance of Chloroform/Anaesthetics

In 1853, Queen Victoria, was given Chloroform during the birth of her 8th child, her approval helped change the publics opinion.

James Simpson

When he died in 1870, around 50k People lined up at his funeral, money was collected to create a statue in his honour. The work of him, Liston and such helped propel huge advances in the medical industry.

Novocaine

Still looking for the perfect anaesthetic, cocaine was used but it was addictive, however in 1885 it was discovered it could be used as an anaesthetic to numb a part of the body. The safer version called Novocaine was developed in 1905.

Why wasn’t the link between microorganisms and disease realised before the work of Pasteur

. Micro-Organisms were only visible through microscope for people didn’t believe that they existed or significant enough to cause disease

. Dissecting bodies after death was taboo so either dead or alive research through dissection was rare

.Other beliefs on disease seemed reasonable - Miasma and Spontaneous Generation

Louis Pasteur

A French chemist researcher, known as the “Father of Biology”, he discovered the link between micro-organisms and disease

Louis Pasteur’s germ theory

Discovered on accident in 1857 when investigating how vats of Beer became sour, he used the recently developed microscope to see the microorganisms in the sour beer. in the theory of Spontaneous generation the decay would’ve, created such organisms but Pasteur didn’t believe this.

How Pasteur proved his theory

He suggested that the microorganisms were what causing the beer to go sour. This was proved when the organisms where killed by heating the liquid, he carried this out on other substances like milk, wine and vinegar.

He was convinced that each liquid became contaminated due to microorganisms in the air. In 1860 he entered a 1960 science challenge on whether spontaneous generation could be proved, however his results disproved the theory entirely.

Impact of pasteur’s work

It wasn’t for another 20 years that other scientist recognised this link. But pasteur’s work provided an explanation between hygiene and health. With this improved understanding surgery was improved, especially with the problem of infection. Brining impact to the public health sector too. Also leading to the development of vaccines 30-50 years later.

Biggest cause of death post-surgery

Sepsis infection also known as Hospital Gangrene, which was usually caught during of after the surgery

Ignaz Semmelweis

The pioneer of antiseptics during 1840s. Through insisting that all the doctors wash their hands with Calcium chlorine before treating patients, this lead the death rates i his ward from 35% to 1%. He published these results however only a few hospitals followed.

Pasteurise

A liquid which has been heated to kill off harmful microorganisms

Joseph Lister (1827-1912)

The professor of surgery at the University of Glass glow royal infirmary in 1861, then moving back to London in 1877 to become the professor of surgery and king’s college hospital. He promoted the first antiseptic and antiseptic methods.

The Lister medal (prestigious award given for contributions towards surgical science) was named in his honour

Lister and carbolic acid

After reading Pasteur’s work he realised that carbolic acid (used to treat sewage) was responsible for killing microorganism, wondering if it could be used to treat infections

Lister’s experiment

He used carbolic acid in treating people who had compound fractures, where bone breaks through skin, usually infections would develop in these wounds but after applying it and wrapping bandages which were soaked in carbolic acid, he realised the wounds healed and didn’t develop gangrene.

Jamie Greenlees

A patient of lister, a young boy who was ran over by a cart and fractured his leg. The usual procedure would be to amputate the fracture but instead Lister set the bones and users dressing which were soaked in carbolic acid, this stayed for 4 days. While there was some irritation, it was indeed healing well, these dressings were replaced regularly and after 6 weeks Jamie walked out of hospital.

Lister and Antiseptic

He continued to test it out on other surgeries. Beginning to use the carbolic acid solution to clean the wounds, equipment and bandages, causing a fall in the rates in death by infection. Later Creating carbolic spray

The method is called anti sceptic

Opposition to listers sceptic

. Slowed down operations and created more work

. The spray was smelly and caused the skin to crack

. Some surgeons who copied lister using the spray, didn’t get the same results

. Pasteur’s germ theory wasn’t wide spread yet so surgeons refused to believe how infection was caused by microbes

. Many refused to believe listers figures on the death rate

. People thought of lister as a fanatic

. Nurses resented extra workload

. Refusal for change

Lister overcoming opposition

In 1877 he moved to London to train young surgeons. His work began to be acknowledged especially by Robert Koch. Others began to copy his methods and he became known as the “father of antiseptic surgery.” Both Lister and Pasteur were given an award in Sorbonne in 1892 , lister was also rewarded a Baronet.

Robert Koch

A German physician, in 1878 he discovered the bacterium which caused Septicaemia, (the micro-organism which caused blood poisoning), he was inspired by Pasteur’s work

Sterilise

Make something free from bacteria or other living microorganisms

Ligature

Used for tying or binding something tightly

Catgut

Used to tie of arteries and vessels during surgery. The catgut was covered in carbolic acid. Lister introduced catgut ligatures in 1869 as a part of his antisepsis techniques

Local Anaesthetic

The temporary loss of feeling in one small area of the body being caused by anaesthetics. The patient will stay awake but has no feeling in the area of the body affected with the aesthetic

Heat to sterilise

In 1878 Robert Koch, developed the idea of using heat to sterilise equipment and dressings. through using steam

What operation happened successfully for the first time in 1896

Heart operation - surgeons repairing a heart damaged from stab wounds

What type of operation happened of the first time in the 1880s

Removal of an infected appendix

When did sterilised rubber gloves began to be used

1894

When Lister published his findings on using catgut for ligatures

During 1881, after experimenting on how to solve blood loss issues along with infections

The person who discovered different blood types

Australian doctor, Karl Landsteiner, in 1901, discovered types A,B and O, and later in 1902 Type AB

What doctors realised in 1907 about blood

That patients would die if given the wrong blood type, but all could receive type O blood

What happened by the end of the 19th century

Different needles were developed to transfer the blood , implant vaccines and anaesthetics

Wilhelm Rontgen

A German scientist, who discovered how rays of light could pass through black paper, wood and flesh yet still light up a wall. He called them X-rays.

When X-ray machines were stalled

By 1896 many hospitals had x-ray machines installed

X-rays

Used to show the details of broken bones so the break can be set properly, also used to diagnose other problems.

What caused the further development of x-rays

The first world war, led to this

In Glasgow Royal infirmary what was the death rate for upper limb amputations in 1845 and the 1850s

Around 30% of patients in 1945, rates rose to around 75% by the 1950s.

In Glasgow Royal infirmary, what was the death rate for patients by 1895

The rate dropped to 15%

Cottage Hospital

A small hospital in a country or a small town area, usually run by a GP

GP

A doctor based in the community who treats patients with minor or chronic illnesses and refers those with serious conditions to a hospital

Infirmaries

A place in a large constitution for the care of those who are ill

Philanthropist

A person who donates time, money, experience, skills or talent to help create a better world. Anyone can be one despite status or networth

How poorer people received medical care in the early 1800s

Middle and upper classes were able to pay fees for a doctor to treat them at home, and carry out operations there, however poorer people couldn’t afford a doctor, and would usually be cared for by a family member, if they could they could by herbs and drugs from an apothecary and could also get diagnosed by them or a local wise woman.

What did Henry the VIII do to hospitals

After the reformation (closing down of monasteries) many hospitals were closed down to.

When were local cottage hospitals began to be opened

Around the 1860s