Key Developments in Medical History and Public Health

Proportion of England's population died during the Black Death

Between one-third and one-half (with some villages losing 80-90%).

Pneumonic plague vs. bubonic plague

Pneumonic plague infected the lungs and spread by contact with sufferers; bubonic plague was transmitted by plague fleas that caused large buboes on the body.

Miasma theory

Belief that bad smells caused disease; led people to avoid rotting foods and plague doctors to wear masks stuffed with sweet-smelling flowers.

Religious belief influencing responses to the plague

The plague was seen as God's punishment; flagellants were men who whipped themselves publicly to atone.

Isolation policy of Ragusa

Initial 30-day isolation, later extended to 40 days under the law of quarantino (quarantine).

Ambroise Paré's improved wound treatment

Ran out of oil on the battlefield and used turpentine, oil of roses, and egg yolk to cauterise wounds more effectively.

Vesalius's advantage from dissecting executed criminals

Increased human cadaver supply allowed repeated dissections, leading to accurate anatomy and correction of Galen's mistakes.

Impact of the Great Plague of 1665 on London

Killed around 75,000 people, revealed poor public health, and led to Lord Mayor's rules enforcing 40-day household quarantines and parish leave certificates.

Great Fire of London in 1666 and public health

Destroyed rat-infested areas, led to rebuilding with wider streets, stone/brick houses, and tile roofs, reducing fire risk and improving sanitation.

Pasteur's discovery of germ theory

Investigating souring beer, he found microorganisms in fermenting liquids and, using swan-neck flasks in 1865, proved germs in air caused spoilage.

Pasteur's experiments disproving spontaneous generation

Showed that broth exposed to air through a swan-neck flask grew microbes, but sterilised broth remained free of microbes until air contact.

Vaccines developed by Pasteur between 1880 and 1882

Chicken cholera (1880), anthrax (1881), and rabies (1882).

Great Stink of 1858

Hot, dry summer left untreated sewage in the Thames, stinking so severely that Parliament backed Bazalgette's 1,100-mile sewer system starting 1859.

Alexander Fleming's discovery of penicillin

Returned from holiday to find mold (Penicillium) on a bacterial culture plate, where the surrounding bacteria had been killed.

Significance of penicillin in medical history

It was the first true antibiotic, initiating the era of antibacterial drug therapy.

Hugh and Theodric of Luca's challenge in 1267

They advocated pouring wine onto wounds as an antiseptic to reduce infection.

John Bradmore's technique for removing an arrow

He devised a special pair of hooked tongs to extract the arrow, although his technique spread slowly before mass printing.

Growing prosperity in the medieval period

Contributed to medical communication.

Gutenberg's printing press (c.1440)

It improved the speed, cost, and accuracy of printing, allowing medical discoveries and texts to spread rapidly and widely.

Vesalius's Fabric of the Human Body

Vesalius's work became the standard anatomy textbook until the late 1800s; Geminus compiled plates into Compendiosa, sold across Europe and translated into English, making Vesalius's discoveries accessible to English-speaking doctors.

Royal Society

It encouraged experimentation and knowledge exchange; Robert Hooke, as Curator of Experiments, presented microscope-based experiments at early meetings.

Telegraph and steamships

Telegraph lines (in Britain by 1843, across Europe by the 1850s) and faster steamship travel reduced information lag from months to minutes.

Transatlantic communication

Voyages dropped from two months in the 18th century to one week by the late 19th century; after the 1850s Atlantic cable, telegrams crossed in minutes.

Demographic change in medieval England

Population doubled to ~3 million (1066-1300), leading to crowded, unplanned wooden towns.

Waste management and animal roaming

Cesspits and rivers were polluted, dung littered streets, and butchers dumped offal, attracting rats and disease.

Public health in medieval times

Disease causes unknown; public health deemed personal, and taxes funded wars rather than sanitation.

Gongfermers

They emptied cesspits; rakers removed street dung.

Ragusa's quarantine policy

30-day isolation for arriving ships, later extended to 40 days (quarantino), adopted widely.

Infrastructure improvements in medieval towns

London built the Great Conduit for clean water; York banned street dumping and installed latrines.

Great Plague of 1665

Poor sanitation killed ~75,000; rubbish attracted rats carrying plague fleas.

Lord Mayor's Rules during the 1665 plague

Infected families quarantined 40 days; exit required parish leave certificates; searchers collected bodies for mass graves.

Reformation's effect on English hospitals

Church-run hospitals dissolved; Henry VIII closed many and refounded St Bartholomew's in 1546 under new administrators.

Funding for hospitals in the late 1500s-early 1600s

By voluntary charity and Poor Law parishes via workhouse medical care for the 'deserving poor.'

18th-century movement for parish hospitals

From 1732, a drive to build a hospital in every parish, resulting in 115 new hospitals.

Franco-Prussian War's effect on medical research rivalry

France and Germany government‑funded teams, intensifying Koch vs. Pasteur competition.

Conditions in 19th-century hospitals

The specific conditions were not provided in the notes.

Houses of Death

Mostly charity‑built, overcrowded with poor ventilation and unsafe water.

Industrialisation and urban health

Cheap, dense back‑to‑back housing and unemptied cesspits spread typhus, typhoid, cholera.

Government attitude pre‑mid‑19th century

Laissez‑faire: government avoided interference, assuming poor were personally responsible.

1848 Public Health Act

Established a Board of Health to improve sanitary conditions; adoption was optional for towns.

1875 Public Health Act

Strengthened government role by making sewers, drains, and pavements compulsory duties for local councils.

1876 Artisans' Dwellings Act

Granted councils the power to clear slum housing and replace it with improved dwellings.

Expanding male suffrage

Influenced health policy as MPs needed working-class votes, pressuring improvements in public health.

New Liberal government measures (1906-1909)

Introduced free school meals, medical inspections, Pensions Act, and minimum wages in key industries.

1911 National Insurance Act

Advanced worker health by providing ill-health and unemployment protection; free children's clinics followed.

NHS launch

Launched on 6 July 1948; healthcare became free at the point of use, reducing poverty and raising life expectancy from ~47 (1900) to ~77 (1990s).

Welfare State impact

Affected Britain's death rate and population by providing free healthcare and pensions, lowering death rates and spurring population growth.

Hippocrates' contributions

Developed the Four Humours theory, pioneered clinical observation over supernatural explanations, and authored texts that shaped practice for 2,000+ years (Hippocratic Oath).

Galen's influence

Combined dissections (animals, possibly human) to refine physiology, formulated the Theory of Opposites, and wrote 60+ works used as surgical/anatomical standards for 1,200 years.

John Bradmore's innovation

Designed hooked tongs to extract an arrow from King Henry V's eye socket, an early specialized instrument.

Hugh & Theodoric of Lucca's challenge

Argued against 'pus as necessary'; recommended wine as an antiseptic to reduce infection.

Ibn Sina (Avicenna) significance

Authored the first comprehensive medical textbook, distinguished measles vs. smallpox, listed 760 remedies—used in Europe until the 17th century.

John Ardene's achievements

Authored Practica with illustrated techniques, used opium/henbane for pain, and formed London's Guild of Surgeons (1368).

Vesalius' revolution in anatomy

Insisted on human dissections, published Fabric of the Human Body with detailed plate illustrations, corrected Galenic errors, standard textbook until late 1800s.

Ambroise Paré's advances

Used ligatures (silk) instead of cautery, improvised dressings (turpentine, rose oil, yolk), debunked bezoar cures, and designed prosthetics and bullet-extraction methods.

William Harvey's major discovery

Not provided in the notes.

John Hunter

Emphasized experiment-based anatomy, trained peers (e.g., Jenner), published on teeth, and amassed a specimen museum still extant in London.

Edward Jenner

Observed cowpox immunity in milkmaids, tested on James Phipps (1796), overcame opposition, leading to smallpox vaccine and eventual eradication.

Louis Pasteur

Proved germ theory (1865 swan-neck flasks), refuted spontaneous generation, and developed vaccines for chicken cholera, anthrax (1881), and rabies (1882).

Robert Koch

Established germ-disease links, invented agar cultures (Petri dish), stained bacteria, and identified the TB bacillus (1882), inspiring 'microbe hunters.'

James Simpson

Introduced chloroform as an effective, controllable anaesthetic in 1847, gaining royal endorsement (Queen Victoria) despite early safety objections.

Joseph Lister

Applied carbolic acid dressings and invented the Lister spray, reducing surgical mortality from ~46% to ~15%, laying groundwork for aseptic techniques.

Karl Landsteiner

Discovered human blood groups (A, B, AB, O) in 1901, solving transfusion compatibility and saving countless lives.

Florence Nightingale

Crimean ward hygiene dramatically cut mortality (42%→2%), published Notes on Nursing, and founded the Nightingale School, professionalizing nursing.

Mary Seacole

Self-funded 'British Hotel' near battlefields, provided care and comforts to troops, later celebrated as a pioneering Black nurse.

Edwin Chadwick

Linked poverty, overcrowding, and disease in Sanitary Conditions of the Labouring Classes, catalyzing mid-Victorian health legislation.

John Snow

Traced 1854 Soho outbreak to the Broad Street pump, removing its handle to stop cases, and championed cleanliness over miasma.

Joseph Bazalgette

Designed and built London's 1,100-mile sewer network (1859), still vital today, ending the Great Stink and preventing disease.

Booth & Rowntree

Urban studies showed ~30% in absolute poverty, linking economic deprivation to poor health, informing early welfare policy.

Alexander Fleming

Accidentally found penicillin mould (1928) that killed bacteria on culture plates, launching the antibiotic era.

Florey & Chain

Demonstrated efficacy in mice and humans (1940-41) and partnered with US industry for mass production, saving millions.

David Lloyd George

As PM (1906-1910), implemented New Liberal welfare measures—free school meals, medical inspections, pensions—laying groundwork for social security.

William Beveridge

Significance of the Beveridge Report (1942) is not provided in the notes.

Aneurin Bevan

As Health Minister, founded the NHS in 1948, providing free healthcare at point of use and revolutionizing public welfare.

Four Humours Theory

Blood, phlegm, black bile, yellow bile; illness thought to result from their imbalance, treated by rebalancing (e.g., bloodletting).

Theory of Opposites

By applying treatments opposite to excess humour (e.g., hot/wet excess (blood) treated by bleeding to cool/dry).

Paracelsus

Argued that chemical imbalances, not spirits or stars, caused illness, pioneering chemical pharmacology.

Lady Grace Mildmay

Authored herbal remedy guides challenging superstition with botanical treatments.

Vesalius's Empirical Anatomy

Relied on human dissection and direct observation to correct Galenic errors and provide detailed anatomical illustrations.

Harvey's Circulation

The heart pumps blood in a closed circulation; valves ensure unidirectional flow; overturned Galen's liver-centric model.

Jenner's Smallpox Vaccine

Used cowpox to induce immunity against smallpox; tested scientifically (James Phipps, 1796), leading to vaccination and eradication.

Laissez-Faire Public Health

Laissez-faire: viewed living/working conditions as individual responsibility; minimal state intervention.

Pasteur's Germ Theory

Swan-neck flask experiments (1865) showed that sterilised broth remained microbe-free until exposed to air-borne germs.

Koch's Bacteriology

Developed solid culture media (agar Petri dish), staining techniques, and isolated the TB bacillus (1882).

Landsteiner's Blood Groups

Identified A, B, AB, O groups (1901), making safe blood transfusions possible by matching donor/recipient.

Lloyd George's New Liberalism

Free school meals, medical inspections, Pensions Act, minimum wages—state intervention in welfare.

Beveridge Report

Squalor, Ignorance, Want, Idleness, Disease; framework for a Welfare State 'from cradle to grave.'

National Insurance Act 1911

Provided workers with health and unemployment insurance; preceded NHS by introducing state-backed coverage.

Transition to Welfare State

How did the post-war Labour government consolidate welfare reforms?

Printing Press (c.1440)

Enabled rapid, accurate, and affordable dissemination of medical texts across Europe, spreading works by Vesalius, Paré, Harvey, and Hunter.

Scientific Method

Emphasis on empirical research: dissection, controlled experiments, careful observation, and evidence-based conclusions rather than theoretical debate.

Vesalius's Dissections

Insisted students dissect human bodies; secured judicial permission for criminal corpses; published Fabric with precise illustrative plates, correcting Galenic errors.

Harvey's Experimental Physiology

Animal vivisection (frogs), arm ligature experiments showing one-way valves, measuring blood volume to prove continuous circulation.

Hunter's Specimen Collection

Curated thousands of specimens (jars, animal preparations, fossils) and wax-inflated vessels, providing resources for anatomical and physiological studies.

Jenner's Vaccination Experiment

Observational link in milkmaids; inoculated James Phipps with cowpox then smallpox; demonstrated safety and efficacy, pioneering vaccination.

Microscopy

17th-century Robert Hooke's invention allowed Pasteur and Koch to visualize microorganisms and validate germ theory.

Chemical Revolution

Identification of gases (oxygen, nitrous oxide) spurred chemical experiments, leading to development of anesthetic gases (ether, chloroform).

Lister Sprayer & Advanced Dyes

Fabrication of carbolic acid sprayers and high-powered microscopes with chemical staining improved surgical hygiene and bacterial identification.

Culture Techniques

Creation of solid agar Petri dishes and staining methods, enabling isolation and study of pathogen colonies.

Mobile X-Ray Units

Marie Curie; her mobile units allowed rapid, on-site fracture imaging during WWI, improving surgical outcomes.