Period 1: c1250-c1500, Medicine in the Medieval England

1.1 Religious Beliefs and Superstitions

• In medieval England (c.1250 - c.1500), science was not usually used by people to comprehend medical conditions. The civilization in England was deeply religious.

• As a result, superstition and religious doctrine were employed to explain, determine a condition's diagnosis and course of treatment.

Supernatural and Religious Explanations

• The Church had a significant impact on people's lives in England. Individuals were deeply devout and adhered to the the Catholic Church.

• It was thought that everything in the earth, including illness and disease, was under God's supervision.

• The majority of people were Christians, and they held that disease and illness were sent by God to punish sin.

• Additionally, it was believed that a person's health may be used as a litmus test for their religion by the Devil or by God.

Astrology

• Traditional beliefs were employed in conjunction with religion to aid in the diagnosis of illness and disease.

• Using astrology, or the study of the planets and stars, was one way to accomplish this.

• A star chart would be used by a physician. To determine what ailment or sickness a patient had, he would consider when the patient was born and when the illness first appeared.

• Astrology's use in illness and disease diagnosis gained popularity after the Black Death.

• Because of the disease's enormous impact, there was a significant need to know why it had occurred.

1.2 Medieval Medicine and the Impact of Ancient Theories

• Ancient physicians' theories served as the foundation for the Church's medical doctrine in mediaeval England.

• Hippocrates, a 5th-century BC Greek physician who practised medicine in Rome, and Galen, a 2nd-century AD Roman physician, were still closely examined.

• This was possible because, with the fall of the Roman Empire and the rise of the Islamic Empire as a centre of learning, Islamic academics like Ibn Sina (Avicenna) translated and explained their writings.

Medical Medieval Thinking

• In the Middle Ages, people also thought that reason and observation could be used to explain illness.

The Four Humours Theory

• The concept of Hippocrates is credited with developing the four humours, which remain the most significant nonreligious theory of sickness explanation.

• It was a sensible concept. According to the belief, there are four humours in the body:

  • blood

  • phlegm is a fluid expelled through sneezing or coughing.

  • black bile is a dark liquid released by vomiting.

  • yellow bile is a thin fluid that comes out when you vomit.

Galen and the Theory of Opposites

• Hippocrates, who observed his patients closely, proposed the theory of the four humours. Galen expanded on the theories of Hippocrates.

• Galen thought that the idea of opposites may be used to balance the humours.

• Cucumber, for instance, was chilly and wet and might be used to cure a patient who was hot and dry and had excessive blood.

• In medieval medicine, the theories of Hippocrates and Galen remained widely accepted.

The Theory of Miasma

• Another traditional idea was that sickness and infirmity were brought about by a poisoned air or miasma.

• People's illnesses were thought to be caused by this contaminated air.

• Because they believed that God was the source of all sickness, some individuals assumed that God had poisoned the air.

1.3 Disease Prevention in the Medieval Period

• Throughout the Middle Ages, it was not always possible to depend on efficient medical treatments.

• It was therefore very important to prevent individuals from getting sick.

• In the Middle Ages, people tried to avoid illness in a number of ways.

Religious Deeds

• It was believed that the following acts of faith may fend off disease:

  • leading a life devoid of sin

  • participating in processions and church services

  • prayer: Individuals prayed to God to pardon their wrongdoings.

  • pilgrimages

  • wearing charms, either religious or magical

  • People fasted as a way to express their regret for their sins.

  • flagellation: Some people publicly whipped themselves and begged God to pardon their transgressions.

• People could undergo pain through flagellation, fasting, and pilgrimages, just as Christians thought Jesus had while he was crucified.

• Suffering was accepted, whether brought on by sickness or by these means. This was because it allowed them to reflect more deeply on their Christian faith.

Purifying the Air

• According to the miasma theory, humans could become ill from breathing in contaminated air. By keeping the streets clean to ensure that the air was pure, they attempted to prevent sickness and disease.

• Also, people would attempt to avoid breathing in contaminated air by:

  • carrying posies, which are bouquets of fragrant flowers and herbs

  • lighting flames to expel negative energy and occasionally burning materials or herbs to "clean" the air

  • keeping the air circulating by ringing bells or letting birds flutter around the house

• The streets in medieval towns, particularly those in late medieval England, were meticulously maintained. They carried out this action by:

  • use rakers to maintain clean streets

  • penalising people for discarding waste on the streets; waste could include human faeces in addition to regular trash

  • forcing butchers to dispose of their waste outside the boundaries of the city

  • constructing restrooms for the public

Other Preventive Measures

• The Church gave advice to people and to balance the four humours, doctors should wash their hands frequently, exercise, and take breaks.

• By doing this, people would stay healthy and ward off illness. various days, we are recommended to take care of our health in various ways, but this is only because society has access to more precise scientific information regarding the human body and how disease spreads.

1.4 Treatment of Illness in the Community

• Most individuals in medieval England could not afford to go to a physician while they were sick.

• As a result, they were dependent on other community members for care.

Traditional Beliefs

• In medieval England, there was an accepted idea that disease sprang from an imbalance of the body's four humours. Bloodletting would occur if someone believed that blood was out of balance.

• This course of treatment may include:

  • cutting a vein

  • using leeches

  • covering a wound or scrape with hot cups

• It was also thought that eating upset the equilibrium of humours. People would purge the body of any leftover food in order to overcome this.

• Patients were given laxatives to help them pass gas or something to induce vomiting.

Barber Surgeons

• Basic surgical procedures including bloodletting, suturing open wounds, and excising growths from the exterior of the body were performed by barber surgeons.

• They read surgical texts and observed others to acquire their expertise.

Customs and Practices within the Family

• The majority of people in medieval England were looked after by their mothers or wives, who were female family members. Family members handed down customs and methods of care to one another.

• There were occasions when some ladies were thought to possess exceptional knowledge regarding cures and treatments. They were referred to as "wise women.”

Herbal Remedies

• The most often used medicinal ingredients were minerals, plants, animal parts, and herbs.

• Books included directions on how to combine the materials and listed the prayers that needed to be recited simultaneously.

• Honey was one of the effective herbal remedies for infections that we still use today. Both historically and currently, linseed was employed as a laxative.

Apothecaries

• When a community member needed an expensive medical treatment, they occasionally went to the apothecary.

• As with the wise women, apothecaries combined the components for the herbal remedies mentioned above.

• In addition to mixing their own herbal remedies that they marketed to the ill, they performed this service for physicians.

1.5 Treatment of Illness in Hospitals and Medical Education

Hospital Treatment

• During the medieval era, hospitals developed. In England, the Church owned and operated the majority of hospitals.

• They were frequently associated with, for instance, cloisters or monasteries.

• In exchange for a guarantee that their souls would go to heaven, some were paid for by affluent individuals after they passed away. That's why religious belief is so important.

• In addition to providing an atmosphere where patients may relax and heal, hospitals have historically taken care of the sick by praying for them.

• There were nuns and monks tending to the sick. A place to stay for tourists and pilgrims was also provided by hospitals.

• From their beds, the patients were permitted to participate in church services.

• St. Bartholomew's Hospital in London was one of the most well-known mediaeval medical facilities, and it continues to treat patients today.

Leprosy

• Leprosy was a skin illness that caused hair loss, loss of fingers and toes, and ultimately death.

• A person with leprosy was forced to reside in a "leper house" and be isolated from the rest of the community. They would ring a bell and wear cloaks as well.

• This was done to alert people to their existence and advise them to avoid them. At the time, leprosy was thought to be extremely contagious.

• People who have leprosy or another infections prohibited patients from receiving medical care in a hospital. They received care in isolated establishments known as leper houses.

• This occurred as a result of the realisation that the diseases could spread swiftly to other patients.

Physicians

• Medieval physicians received at least seven years of training at a university. There, they read the writings of classical physicians like Galen and Hippocrates.

• After closely observing a patient, a physician would make a diagnosis and suggest a course of treatment.

• Due to their high cost, only the wealthy could afford to see doctors. Women in their community or female family members took care of the poor.

1.6 The Black Death

• The British Isles were overrun by a new infectious disease in 1348. Numerous deaths occurred. The effect was enormous in England.

• The illness became referred to as the Plague or the Black Death.

• Rich and poor alike were impacted by the Black Death. The people who lived in the country and in towns were also impacted.

• The primary signs and symptoms are chest aches, fever, and buboes in the groine or underarms were symptoms of the Black Death.

• People could pass away from the Black Death in a matter of days. Rarely did those who were infected survive.

Methods of Treatment

• The Black Death spread quickly after it reached England. There was little time for therapy because the majority of those who contracted it passed away within days.

• As such, very little knwon about the treatments that were applied. Nonetheless, it is known that the following approaches were taken, based on various theories regarding the origins of the Black Deat

1.7 Attempts to Prevent the Spread of the Black Death

Individuals' Efforts

• When the Black Death struck, most people concentrated on trying to stop the disease's spread because deaths from it happened swiftly.

• A number of the techniques employed to attempt and stop the disease's spread were also some of the treatments.

• For instance, carrying posies (bunches of flowers) and herbs, fasting, prayer, and confession were all frequent practices.

Attempts by the Government

• In an effort to stop the disease from spreading, several municipal authorities also took action. It is a widely held assumption that fleas on rats were the source of the Black Death.

• Others disagree, arguing that the human-to-human transmission of bacteria occurred. Whatever the case, it is evident that if the following measures had been taken more often, they may have avoided more deaths in the medieval period:

  • New arrivals were required to isolate themselves from other people for 40 days under quarantine regulations. Places where the Black Death had broken out were quarantined for their homes.

  • Within a village, strangers were forbidden.

  • The garbage smells, according to the local officials, would dissipate any unpleasant air, so they stopped cleaning the streets.

  • Religious processions and other gatherings with huge attendance were prohibited.

  • The deceased would be buried in large mass graves at expansive burial sites. With little religious ceremony, this was completed quickly.

Period 2: c1500-c.1700, The Medical Renaissance

2.1 The Church and Scientific Research

• The word "renaissance" comes from the French word "rebirth."

• This term is used by historians to define the novel ways of thinking that were first experimented with throughout Europe in the fifteenth century and beyond.

• The years between roughly 1500 and 1700 are referred to as "the medical Renaissance" in England because they were a time of new discoveries, theories, and methods in the field of medicine.

• Following the Reformation in the middle of the sixteenth century, the Church's influence waned.

• Science started to have a bigger impact on education. By posing queries and gathering their own data, a few physicians and scientists started to doubt the established theories.

Views Regarding the Origins of Sickness and Disease

• When it came to common perceptions of the origins of sickness and disease, there was a lot of continuity over these centuries.

• Most of the time, the techniques of diagnosis, illness prevention, and medical care for the ill stayed largely unchanged.

• There was still a widespread belief that sickness and disease were brought on by an

  • imbalance of the four humours -by the year 1700, the notion of the four humours had been proven false

  • poor air, or miasma

• However, new medical theories and discoveries emerged as a result of the shift to a more scientific method of education. As an illustration:

  • Using recently developed technology, tiny seeds dispersed in the air were microscopic

  • external variables, such temperature, as opposed to the body's four humours

  • "Animalcules" refers to microscopic animals that could only be observed under a microscope; we no longer use this term because of our increased knowledge of bacteria

2.2 Andreas Vesalius

• The anatomy of the time was better understood thanks to Andreas Vesalius in the Renaissance.

• The significance of scientific procedures, particularly observation, has changed significantly as a result of his contributions to medicine.

• Things started to go against the beliefs of the Greek physician Galen. More novel theories on the human body and medicine were thereby stimulated.

Vesalius Works

• The most renowned Renaissance anatomy specialist was Vesalius.

• He was educated in Paris, where the latest humanist medical theories were widely accepted.

• Later on, he started teaching surgery at the University of Padua.

• Vesalius had a strong curiosity for the human body and a desire to learn new things.

Dissection

• Dissection was no longer prohibited since the Church's influence was waning, despite the fact that it was once thought to be highly impure and heretical.

• Obtaining a consistent supply of said bodies is hard but thanks to a local magistrate's permission to use condemned criminals' bodies, Vesalius was able to perform a lot of dissections.

• This meant that using a variety of dissection techniques, Vesalius was able to obtain up-close observations of the internal organs of the body.

Improved understanding of Anatomy

• Galen's inability to dissect human corpses led Vesalius to conclude that Galen had some misconceptions regarding the human anatomy.

• Galen's dissections of animals including dogs, pigs, and monkeys served as the basis for his theories on the human body.

2.3 Humanism and the Work of Thomas Sydenham

Humanism

• There was a surge of new knowledge and methods of thinking during the Renaissance. The Church's ability to influence public opinion has diminished.

• The new style of thinking was humanism. It acknowledged how crucial it is for each person to learn the truth about their surroundings.

• Humanist theories constituted a challenge to conventional wisdom and promoted exploration in search of the truth. They disapproved with the religious notion that God was in charge of everything.

Thomas Sydenham’s Work

• During the Renaissance, Thomas Sydenham was a well-respected physician in London. Although it was still in use at the time, the notion of the Four Humours was starting to lose favour.

• Sydenham had a significant impact on the evolution of concepts regarding the diagnosis of disease.

• He urged medical professionals to adopt the new scientific concepts of observation rather than the antiquated views of Hippocrates and Galen.

• In Sydenham's view, a physician must attentively monitor a patient's symptoms and treat the underlying ailment in order to provide an accurate diagnosis. He declined to depend entirely on medical textbooks.

• Sydenham disagreed with the notion of the four humours and thought that a disease did not vary from person to person.

• In 1676, Sydenham wrote a book titled Observationes Medicae, or Medical Observations, which contained his theories on sickness. Following the 18th century, his work contributed to a more scientific approach to medicine.

2.4 Care and Treatment in the Early Modern Period

Physician's Training

• Medical physicians continued to learn from Hippocrates and Galen's writings throughout the majority of the Renaissance.

• But with the invention of the printing press, other concepts began to appear in more readable written texts.

• Changes occurred towards the end of the Renaissance when people like Vesalius, Sydenham, and William Harvey questioned Galen's theories.

• A more scientific approach was used in medical education, emphasising experimentation and observation. The chance to examine bodies and learn with new technology, such the microscope, was given to doctors.

Taking Care of the ill

• Wealthy individuals kept paying for a nurse or doctor to visit them at home.

• But the majority of people kept looking to apothecaries for less expensive treatments, and women remained crucial in providing medical care to the ill.

• Typically, the patient's mother or wife would be the first to attend to their needs. Wealthy ladies looked after families and gave charity in some villages.

• A lot of hospitals in the Middle Ages were a part of monasteries or convents. Local government officials assumed control of the hospitals following the Reformation, when Henry VIII closed the monasteries.

• Hospitals were now managed by physicians and supported by charitable donations. In this way, St Bartholomew's was maintained open in London.

• A growing number of institutions were focusing on patient care, trying to address symptoms and illnesses.

• Nonetheless, rather than offering medical treatments, the majority of hospitals kept offering food and warmth as care.

2.5 William Harvey-Case Study

• During the Renaissance, William Harvey studied medicine at the University of Cambridge and at a renowned medical school in Padua, Italy.

• Harvey shared Andreas Vesalius' interest in anatomy. He went on to become an anatomy lecturer and Charles I's physician.

The Discovery of Blood Circulation

• Among Harvey's most well-known experiments. This demonstrated how blood travelled to the patient's forearm.

• Harvey had a keen interest in the movement of blood throughout the body. Galen had explained that the liver produced blood, which was then circulated throughout the body. Harvey, though, demonstrated that Galen's theories were incorrect.

• Harvey supported Vesalius' hypothesis that the body's veins carried valves. These valves allowed blood to move only in one direction—from the veins to the heart.

• Harvey attempted to pump additional liquids into the veins in the opposite way, but this was unsuccessful.

• Harvey's finding was published in a book titled An Anatomical Account of the Motion of the Heart and Blood in 1628. This made his discovery accessible to medical professionals.

2.6 The Great Plague, 1665

• When the plague struck England again in 1665, hundreds of people perished. The plague has returned multiple times after the 14th-century Black Death. Nevertheless, medical knowledge of it had not changed all that much.

Ideas about the Causes

• Since the Black Death, theories on the origin of the epidemic have remained unchanged. Most people were still of the opinion that:

  • All things were under God's authority, and the plague was sent to punish sin.

  • poor air miasma idea was caused by an odd planet alignment.

  • Miasma was created by rotting rubbish.

  • People contracted the illness from one another.

Methods of Treatment

• The plague was treated in a manner that was very comparable to that of the Black Death. Among them were:

  • prayer for the ill

  • wearing charms, either religious or magical

  • herbal cures like posies, which are bouquets of fragrant flowers and herbs

  • bloodletting and purging

Initiatives to Stop the Plague's Spread

• The ideas regarding what caused the epidemic were closely related to the strategies employed to stop it from spreading.

• Individuals who thought miasma was to blame for the epidemic would:

  • keep stale air from invading their home, cover windows and doorways with fragrant flowers and herbs.

  • stroll through the streets with posies stuck on their noses.

  • chew tobacco, which was novel in England, in the hopes that the potent aroma would ward off any ill air that might be harbouring the plague.

  • Individuals who held the belief that the disease was spread by interaction with others would isolate themselves at home.

  • to prevent the spread of the plague, they would soak money in vinegar before purchasing food.

Government Actions

• Charles II and his government mandated days of public prayer and fasting during the Great Plague refraining from eating to enable people to admit their transgressions.

• This was due to their belief that the illness might have been given by God. Additionally, the mayor of London issued the following directives in an effort to stop the spread:

  • In order to prevent the victims and their relatives from spreading the virus through human contact, they were kept inside their homes for 40 days and were not allowed to leave. This was referred to as confinement.

  • To purify the air, bonfires and barrels of tar were burnt in the streets.

  • Due to the belief that they could spread the disease, animals were prohibited from entering the city.

  • Events like plays and games that drew big audiences were forbidden.

Period 3: c.1700-c.1900, Medicine in 18th- and 19th-century Britain

3.1 Factors affecting Medicine in the 19th-century

• The 18th and 19th centuries saw greater changes in Britain than at any other time in history.

• The Industrial Revolution, advancements in science and technology, and a shift in the government's perspective of its place in the daily lives of the populace all brought about changes.

• Although these modifications were gradual, they had a revolutionary effect on medicine at that time.

Industrial Revolution

• Britain saw a great deal of change during the end of the eighteenth century. The period that came to be known as the Industrial Revolution was the product of significant advances in innovation and technology.

• The majority of people made the transition from rural to urban areas. They left rural jobs in farming and agriculture to work in the rapidly expanding industries, mills, and mines that sprang up all over the nation.

• The majority of people in Britain were working in factories and workshops by the end of the 19th century.

• The primary hubs of production shifted to cities.

Science and Technology

• By 1750, scientific theories were far more widely accepted and the Church and classical ideas had lost their power.

• Scientists kept testing new theories and conducting experiments as new technologies emerged. Numerous new theories were verified by the use of new tools, chemicals, and scientific apparatus, including microscopes.

• Further advancements in transportation, such the establishment of railroads, facilitated the rapid dissemination of these concepts across Britain.

The Government's Role

• The majority of the 18th and 19th century saw the government implement a hands-off approach to medicine.

• This indicates that individuals believed the government had no business interfering with people's daily lives.

• But things started to shift by the end of the 19th century. People started to agree that the government's responsibility to protect the public health included this duty.

• From then on, the government at large began implementing laws to put pressure on local government representatives to enhance living conditions and stop the spread of diseases.

3.2 Louis Pasteur’s Germ Theory

Spontaneous Generation

• Even in the eighteenth century, some individuals continued to hold the belief that miasma, or "bad air," was hazardous. But the evidence for this view was mounting quickly.

• Instead the theory of spontaneous generation was developed by scientists. Scientists were now able to see germs thanks to improved microscopes.

• When bacteria started to grow on objects that had begun to deteriorate, scientists assumed that this was the result of decay.

The Discovery of Germs and Pasteurisation

• French scientist Louis Pasteur was an expert in both chemistry and microbiology. He had a conversation with a brewer at a university in Lille, who was curious about the reason behind the occasional sour taste in the drinks he brewed.

• Thanks to Pasteur's investigations, we now know more about how fermentation occurs and how to stop it.

• In order to prevent the liquid from going bad, it was heated to a specific temperature, which would destroy any bacteria present. Pasteurisation is the name given to this procedure.

• In his investigations, Pasteur employed a variety of tools, including microscopes. He gained an improved comprehension of the role of bacteria, a sort of germ - throughout the fermentation process.

• Bacteria, which are microscopic particles, were caught in the long tube when air entered the long neck. There would be no souring if they could not get to the liquid. The liquid would turn sour when the flask tilted and the particles got a chance to reach it.

• After publishing his germ hypothesis in 1861, Pasteur's research seriously questioned the notion of spontaneous generation.

• Although Pasteur maintained that bacteria were the root cause of all diseases, he was unable to pinpoint the precise bacterium responsible for any given illness.

3.3 Robert Koch

Koch Works on Bacteria

• Louis Pasteur, a scientist, claimed that bacteria, a kind of microbe, were the root cause of sickness in the middle of the 19th century. He was unable to pinpoint the precise microorganisms that cause certain illnesses.

• Robert Koch, a German physician, made significant progress in identifying a number of the many germs that cause common illnesses.

• Koch created an innovative approach to cultivating bacteria by in a Petri dish with agar jelly.

• The bacteria was then stained with a dye such that it could be viewed well under a microscope. He was able to identify specific germs by using this technique.

• Koch discovered the germs that cause athrax. Then, in 1882, he discovered the tuberculosis-causing bacteria (TB).

• His identification of the cholera-causing germs came shortly after, in 1883.

3.4 Changes in Hospital Care and Treatment

• The years between about 1700 and 1900 saw a significant shift in the hospital care and treatment that patients received.

19th Century Hospitals

• Early 19th-century hospitals were not always secure. The circumstances on the wards would lead many patients to pass away, including:

  • insufficient restrooms and inadequate sewage systems

  • wards that are overcrowded and lacking in fresh air

  • an unclean environment that allowed the illness to spread

Florence Nightingale

• Prior to working in a hospital in London, Florence Nightingale completed her nursing training in Germany.

• She was asked by the government to tend to sick soldiers in the army hospital in Scutari when the Crimean War broke out in 1853. After accepting, Nightingale brought 15 nuns and 38 nurses with her.

• When Nightingale discovered the conditions, she was astounded. The conditions were appallingly filthy, and the overloaded medical staff was not receiving enough food or medication.

• Patients frequently contracted infections; troops would arrive at the hospital with a wound or injury but leave with cholera, typhoid, dysentery, or typhus.

• Nightingale set about immediately working with her nurses to create more hygienic procedures and improved hospital environment.

• As a result, the death rate decreased from 40% to 2%. The following were a few of the adjustments made at the hospital:

  • making certain that hands were regularly washed

  • making sewage system improvements

  • enhancing the ventilation system

Mary Seacole

• Jamaican businesswoman and healer Mary Seacole had a great deal of experience treating patients with illnesses including cholera and supporting British soldiers.

• She volunteered to go to Crimea in order to support the war effort there. However, a number of influential people refused to let her pass.

• Nightingale was kind of reluctant to meet with her or appoint Seacole to her nursing staff.

• Seacole met with Nightingale for a brief meeting before paying for her own travel to Crimea and opening a hostel there.

• British officers could recuperate in the "British Hotel," where Seacole was referred to by the soldiers as "Mother Seacole.”

Development of Hospitals

• The size, organisation, and funding of hospitals varied during the 19th century. During this time, there was a surge in volunteer hospitals and small cottage hospitals.

• Physicians worked there without pay; they were funded by charitable donations from the wealthy. If working individuals contributed to a fund to cover the cost of their treatments, some of them would receive care in these institutions.

• Physicians treating wealthy patients at home were still paid for. The government appraised the really impoverished. They were placed in a workhouse if their circumstances were deemed hopeless.

• Upon 1867, the majority of workhouses were sick and elderly patients at an infirmary.

3.5 Changes in Care and Teatment - Surgery

• The discoveries of Joseph Lister on antiseptics and James Simpson on anaesthetics led to advancements in surgery between the years of 1800 and 1900.

1800s Surgery

• Early in the 19th century, operations were exceedingly risky. Amputations and the excision of growths were frequent surgical procedures.

• Because there was no anaesthetic used during these procedures, the surgeons had to move rapidly.

• Shock and infection might kill patients, and both could occur in the operating room.

Anaesthetics and James Simpson

• Surgeons conducted chemical experiments in the early 19th century in an attempt to discover a useful anaesthetic:

  • Nitrous oxide, or laughing gas, was tried, but the pain remained.

  • The adverse effects of ether included coughing and nausea due to lung and eye irritation.

• James Simpson, an Edinburgh University midwifery professor, discovered a more potent anaesthetic in 1847.

• He was searching for an improved anaesthetic to lessen the pain that ladies went through during childbirth.

• He was experimenting with various drugs by breathing them one evening at home with his colleagues. Simpson rapidly discovered that chloroform worked as a powerful anaesthetic.

Dark Period of Surgery

• Several surgeons performed lengthier and more intricate procedures since pain management during surgery is now possible. It might, however, backfire in this case.

• Protracted and more involved procedures may result in deeper tissue infections and more haemorrhage.

• It's possible that between the 1850s and 1870s, there were more surgical-related fatalities. Surgery's "black period" is this time frame.

Antiseptic and Joseph Lister

• It still happens occasionally that surgeons arrive in the operation room with soiled clothes. It wasn't previously known that bacteria may cause illnesses during procedures, thus handwashing before surgery wasn't always done.

• Significant progress was made when a surgeon named Joseph Lister made the discovery of antiseptics in 1867.

• Lister discovered that the germs in exposed wounds were destroyed by carbolic acid after learning about Pasteur's germ theory.

• With the application of these techniques, Lister's surgical fatality rate decreased from 46% to 15%.

• By the late 1800s, aseptic surgery had been developed as a result of Lister's antiseptic techniques for eradicating bacteria from wounds.

  • In order to provide a completely germ-free environment, this meant that even more germs were eliminated from the operating room.

3.6 Edward Jenner and Vaccination: Case Study

• Edward Jenner, a physician and scientist, made a discovery in 1796 that would ultimately save millions of lives. He created a vaccination to protect people from smallpox.

• Jenner was impacted by the vaccination method, which was utilised in several West African nations in addition to the Empire of the Ottomans.

• Earlier in the eighteenth century, Lady Mary Wortley Montagu had travelled to Turkey and seen this firsthand. After her return to Britain, she organised smallpox parties where vaccinations were administered.

Smallpox

• The disease smallpox proved lethal in the eighteenth century. It killed thousands of adults annually in addition to killing more children than any other sickness.

• Because of their scars, smallpox survivors frequently felt alone or excluded in their societies.

• Immunization was the method of smallpox prevention utilised before to Jenner's vaccine.

• But there was a risk involved because each person's body was being exposed to the actual illness. If the dosage was too high, the individual might get smallpox and pass away.

Jenner and Vaccination against Smallpox

• Gloucestershire-based Edward Jenner worked as a country doctor. It had come to his attention that milkmaids who contracted the mild form of cowpox did not thereafter contract smallpox.

• Jenner chose to investigate the possibility of cowpox preventing smallpox scientifically. He conducted several tests and documented his results.

• Jenner put his smallpox idea to the test by:

  • Choose James Phipps, a healthy eight-year-old child.

  • made two incisions in Phipps' torso and transferred cowpox from a lesion on a milkmaid's hand.

  • noted that Phipps had a slight illness that caused anxiety, a loss of appetite, and a headache before getting well.

  • After receiving a smallpox vaccination, Phipps did not contract the illness.

• To support his theory, Jenner conducted 23 repeats of his experiment. He wrote a book in 1798 explaining how to give cowpox injections to individuals to prevent them from getting smallpox.

• Because the Latin word vacca means "cow," he named his method vaccination.

3.7 John Snow and Cholera: Case Study

Cholera

• The Industrial Revolution saw an increase in the population of major cities, like London. There was more trash and congestion on the streets as a result of the growing population.

• In addition, there wasn't enough sewerage or sanitary facilities to accommodate the expanding population.

• The year 1831 marked the arrival of the cholera disease in Britain. A few of them infected passed away in less than a day.

• Many would attempt to avoid cholera because they thought it was spread by contaminated air.

  • tar barrels being burned to get rid of the nasty air

  • praying

  • consuming medications that offered protection

  • destroying the victims' beds and clothing

John Snow

• When an outbreak of cholera occurred in 1854, John Snow made the decision to look into it.

• Within ten days of his surgery near Broad Street in central London, hundreds of people in the surrounding neighbourhood was dying to cholera.

  • Snow created a map of every fatality to demonstrate that the victims had all resided close to a certain water pump.

  • He was aware that people were using the pump water for cooking, cleaning, and drinking.

  • The water pump's handle was taken off so that it could not be operated.

  • Consequently, there were no additional cholera cases or fatalities in the region.

  • Through the execution of this experiment, Snow was able to demonstrate that cholera was being spread via contaminated water.

• Nonetheless, a lot of people still thought that contaminated air caused illness.

• Until Louis Pasteur discovered bacteria, this remained unchanged. Snow had been right all along, but he had no idea that the source of the cholera was bacteria in the water.

3.8 Modifications in Disease Prevention: Enhancing Public Health

The Public Health Act of 1848 and Edwin Chadwick

• Edwin Chadwick, a government officer, released his Report on the Sanitary Conditions of the Labouring Population in 1842.

• Following extensive investigation, he concluded that the life expectancy of residents of cities was significantly lower than that of country dwellers.

• Chadwick came to the conclusion that unclean and challenging living conditions were to blame.

• Better clean water supply and more frequent garbage removal were among his recommendations.

• The government didn't step in right away. But they did enact the first Public Health Act in 1848.

• This statute promoted the establishment of health boards and the provision of clean water in cities in Wales and England.

Bazalgette Joseph and the "Great Stink"

• London had an extremely hot summer in 1858. As a result, the human excrement that ended up in the River Thames began to smell worse and worse.

• The "Great Stink" was the name given to this.

• The Houses of Parliament are located near to the River Thames, and the stench became so strong that lawmakers could smell it for themselves.

• Consequently, the government took action. An engineer named Joseph Bazalgette was hired to construct a system of sewers beneath London's streets.

• The majority of London was connected to the new sewer system by 1866.

• It lessened the risk and possible spread of cholera by removing garbage from the areas where people resided.

1875 Public Health Act

A second Public Health Act was passed by the government in 1875. It was made possible by requiring of local councils to:

• upgrade waste disposal and wastewater systems

  • dispense sanitary water

  • designate medical inspectors to oversee public health institutions

• In terms of public health, this was a major breakthrough. For the first time, the British people's health was becoming the government's concern. This was primarily due to:

  • Louis Pasteur's germ theory has demonstrated the connection between disease and dirt.

  • People were more willing to pay taxes to support improved living conditions once the scientific causes of disease and illness had been established.

• Working men were granted the right to vote in 1867. If political parties were to prevail, they would need to win over people, and in order to do so, they needed to address issues in the cities.

Vaccination Campaigns

• By the late 1800s, the government was more open to the idea of immunisation campaigns.

• The contributions of Edward Jenner, Louis Pasteur, and Robert Koch had persuaded them of the viability of immunisation campaigns.

• Typhoid and rabies were among the illnesses that vaccination campaigns addressed during this time.

Period 4: c.1900-present, Medicine in Modern Britain

4.1 Influential factors in medicine during the 20th century and beyond

Lifestyle Factors

• The notion that our way of living affects our health is not new. In order to stay healthy, doctors in mediaeval England recommended rest, exercise, and a balanced diet.

• But since about 1900, knowledge on how our lifestyle decisions impact our health has grown.

• Studies have demonstrated how particular factors of our way of life contribute to health issues and diseases.

• Our lifestyle choices can contribute to some types of cancer, heart disease, and mental health issues:

  • inadequate nutrition

  • lack of exercise

  • smoking

  • consuming alcohol

  • stress

Government

• The government's role in medicine evolved during the course of the 20th century.

• The British government stopped taking a laissez-faire approach on health by around 1900. Over the course of the 20th century, the government became more involved.

• It is now generally acknowledged that the government's functions include providing funding for medical research and treatment, enacting laws to aid in the prevention of disease and illness, and informing the public about health risks.

• The way the government has responded to the rise in lung cancer fatalities over the previous fifty years demonstrates this.

• With legislation implemented in 2006, Scotland became the first of the four UK countries to outlaw smoking in public areas.

• Wales, Northern Ireland, and England came next in 2007.

• Governments all around the United Kingdom have financed public awareness initiatives aimed at educating the public about the health risks associated with smoking.

Scientific Developments

• Scientific discoveries like the identification of DNA have contributed to the growing knowledge of illness causes. It is well acknowledged that illness and disease can be caused by germs.

• By the end of the 20th century, it was also known that some illnesses, ailments, or disorders are inherited, meaning that genes pass them on from parents to their offspring.

• It has been demonstrated for:

  • The extra chromosome that causes Down's syndrome was identified in 1958.

  • The gene responsible for cystic fibrosis was identified in 1989.

  • The 1940s saw the development of the genetic understanding of sickle cell anaemia.

Breakthroughs in Technology

• Rapid technological advancements produced enormous advancements in diagnosis in the management of illness and disease after about 1900.

• Medications like miracle bullets and antibiotics may now be generated in large quantities to eradicate infections and illnesses within the human body.

• Hospitals begkan to use machines more frequently. As an illustration, X-ray, heart rate monitors, machines, and CT scans make it possible to diagnose and track illnesses quickly and accurately.

4.2 Advancements in Technology - Magic Bullet

• Medical science and technology have advanced as a result of scientific and technological developments over the 20th century. These in turn led to significant advancements in the management of illness and disease.

Salvarsan: the first magic bullet

• A chemical treatment known as a "magic bullet" eliminates particular bacteria from the body without causing any harm to the body.

• In Germany, Paul Ehrlich had collaborated with Robert Koch.

• Ehrlich proposed the idea of a "magic bullet" in 1900, claiming that a chemical could specifically target and eradicate human bodily germs.

• Ehrlich investigated compounds with arsenic to discover a syphilis treatment.

• After retesting every component, a Japanese chemist by the name of Sahachiro Hata found Salvarsan 606, the first miracle drug, in 1909.

• This chemical gave Salvarsan, a medication containing arsenic, its name since it was the 606th compound in the drug.

• It was possible to eradicate the syphilis-causing bacteria with salvarsan 606.

Prontosil: the second magic bullet

• The name of the second magic bullet was Prontosil.

• Gerhard Domagk found that Prontosil eliminated the bacteria that causes blood poisoning through mouse tests in the 1930s.

• Domagk was able to test Prontosil on a person when his daughter cut her finger on a rose shrub and got blood poisoning. She was the first person to receive a miracle bullet cure.

• After conducting a number of tests, researchers discovered that sulphonamide was present in Prontosil and Salvarsan 606.

• Drug companies used this discovery to create sulphonamide treatments for conditions including scarlet fever and pneumonia.

4.3 Penicillin and Antibiotics

Alexander Fleming’s Discovery of Penicillin

• In his London lab in 1928, a scientist by the name of Alexander Fleming investigated soldiers wounds and illnesses brought on by the staphylococci bacteria.

• He went on vacation after leaving some plates with the bacteria on the windowsill. A scientist was experimenting with penicillin mould above his lab.

• Some penicillin mould may have gotten on the dishes while Fleming was away by floating in through an open window.

• Upon his arrival back, Fleming examined the dishes and saw that the staphylococci bacteria beneath had been destroyed by the penicillin mould.

• Upon doing multiple additional trials with the penicillin mould, Fleming observed that it possessed the ability to eradicate germs without causing damage to adjacent cells.

• He tried using penicillin on a friend's eye infection and found success.

• Deeper infections were not treated by penicillin, and producing enough of the drug to be used was a lengthy process.

• Fleming did not carry out his investigation after publishing an article about his results in a medical journal in 1929.

The Development of Penicillin by Ernst Chain and Howard Florey

• Fleming's penicillin essay was read by Ernst Chain and Howard Florey in 1938.

• They received £25 in support from the British government after realising it may be successful (which would be worth around £1,300 today).

• But as World War Two drew near, the government turned its attention to other matters and decided not to fund the research any further.

• Rather, Florey and Chain obtained funding from the United States to allow them to conduct additional study. They found that infections in mice may be cured by penicillin.

• But scientists required a method for producing large amounts of pure penicillin before they could conduct experiments on humans. They got to work with close-ended bedpans.

• A small toilet bowl that individuals confined to beds use to construct a homemade penicillin factory for the production of pure penicillin.

• Florey and Chain produced enough pure penicillin by 1941 to conduct human testing on it.

• They applied it to Albert Alexander, a police officer, who had cut himself and was suffering from septicemia, a bacterial illness that is fatal.

Mass Production of Penicillin

• America enters World War Two in 1941.

• After realising the potential value of penicillin in the treatment of injured soldiers, the US government provided funding for its widespread manufacture.

• British companies followed by D-day in 1944, the Allies had created 2.3 million doses by D-Day in 1944, which they used to heal the injured.

Improved Availability of Healthcare

• The majority of sick patients in 1900 received their care at home. Traditionally, women handled this because it was seen as their responsibility to care for family.

• Furthermore, the majority of families could not afford doctors. On the other hand, over the 20th century, the government's influence in medicine expanded.

• The government started to provide funding for medical care, promote immunisation campaigns, and oversee educational initiatives.

National Insurance Act of 1911

• The National Insurance Act was first introduced in 1911 by the Liberal government of 1906–1914. This made it possible for employees to get healthcare.

• Paying for medical care and treatment would come from a fund that was contributed to by employees, companies, and the government.

• The families of the workers were not, however, included in this help.

• The Ministry of Health was established in 1919. This was the nation's first official agency to have a national health overview.

• Still, a large number of people could not afford medical attention and treatment by the 1930s.

The National Health Service

• Britain's access to healthcare changed as a result of World War Two. Many individuals were fortunate to receive free medical care throughout the war, and they wanted this to continue.

• A government employee named William Beveridge released a report in 1942 that came to be known as the Beveridge Report. It suggested:

  • universal access to a free national health service

  • access to treatment and medical care that would be funded by taxpayers

• Doctors did, however, voice some resistance to the National Health Service (NHS). Some of them didn't want to lose their money because they had worked privately in the past.

• This was overcome when Health Minister Aneurin Bevan consented to allow physicians to continue treating private individuals.

Widespread Vaccination Campaigns

• Since about 1900, the government has started a number of major immunisation campaigns. Among them are:

  • 1942,diphtheria

  • 1950, polio

  • 1961,tetanus epidemic

  • 1968, measles outbreak

  • COVID-19, 2020

Government Lifestyle Initiatives

• The government has also put a lot of effort into educating the public to help them avoid illness.

• It has achieved this by encouraging an active lifestyle. Among its actions have been:

• campaigns in opposition to smoking, excessive drinking, and unprotected sex urging individuals to exercise and eat healthier.

4.4 Technological advancements: Diagnosing and Treating Diseases

• 20th-century technological advancements brought about fresh insights into the cause of genetic illnesses and improved diagnostic and therapeutic approaches.

Advancements in the Identification of Illness

• Thanks to technological advancements, doctors can now diagnose patients more accurately thanks to machines and computers.

• Sometimes surgery is not necessary because of new diagnostic techniques.

• For patients, this has frequently resulted in a speedier and more comfortable procedure. For instance:

  • To diagnose damaged bones, X-rays are utilised.

  • CT scans are employed in diagnosis bodily growths and tumours.

  • Blood tests are used to analyse blood samples and make a variety of medical diagnoses.

• An endoscope is a tiny camera that can be swallowed and used to diagnose digestive system issues. It is attached to a flexible cable.

Hospital Medical and Surgical Treatment

• Hospital treatments have changed as a result of technological advancements. Every day, high-tech medical and surgical procedures are performed in a secure hospital setting. As an illustration:

  • Radiotherapy is a treatment used to reduce internal tumour growth. It is a successful cancer treatment.

  • Surgery and medical therapy both involve the use of small machines. For instance, a machine replaces a patient's heart when they have a cardiac bypass.

  • Amputated limbs are replaced by prosthetic limbs.

  • Keyhole surgery allows for the completion of an operation with a tiny incision by using tiny cameras and surgical instruments. The patient can recover significantly more quickly as a result.

DNA’s Structure Discovery

• In 1953, the structure of DNA was discovered because to technological advancements. The scientists James Watson and Francis Crick made the discovery.

• Using advanced microscopes and X-ray photos obtained by Rosalind Franklin, they constructed a model of DNA.

• They found that the structure of DNA is a double helix.

• All of a person's information is stored in their DNA and is passed down from parent to child.

• Scientists were able to identify the underlying causes of hereditary illnesses including cystic fibrosis and Parkinson's disease after deciphering the DNA coding.

The Human Genome Project

• In 1990, the Human Genome Project was initiated.

• Together, scientists from all across the world have mapped the human genome, which is the complete collection of genetic information contained in an individual's DNA.

• Only due to significant advancements in computers and technology was this feasible.

• After the project was finished in 2003, researchers were able to use the data they had gathered to find variations in human DNA that pointed to inherited diseases.

• Better treatments have resulted, for instance, from scientists' discovery that certain individuals contain a gene linked to breast cancer.

4.5 Lung Cancer in 21st Century

• In Britain, lung cancer ranks among the most frequent cancers, taking thousands of lives annually.

• Consequently, efforts are made by the government and the National Health Service (NHS) to guarantee that it can be identified, avoided, and successfully treated.

Lung cancer and smoking

• Lung cancer is primarily caused by cigarette smoking, according to medical research.

• Passive smoking, or breathing in cigarette smoke from others, has been linked to lung cancer in certain situations.

• However, smoking was extremely prevalent until the mid-20th century, when people's perceptions began to shift, and very few would have considered it to be a deadly pastime.

• Indeed, a lot of medical personnel smoked, and smoking was even permitted in doctor's offices.

Diagnosis and Prevention

• Early-stage lung cancer diagnosis is quite challenging. It is possible to diagnose more advanced lung cancer utilising CT imaging.

• Therefore, the government works to inform the public about the risks and stop the illness before it starts. It accomplishes this in a few ways:

  • Ads against smoking inform people of the risks associated with smoking. For instance, cigarette packaging often includes very graphic warnings and pictures of the harm and diseases smoking causes.

  • Campaigns for advertising draw attention to the signs of lung cancer. Television advertisements frequently operate in this way.

  • Cigarette advertisements are no longer permitted. In the past, tobacco firms even funded athletic competitions.

  • The legal age to purchase tobacco has been raised from 16 to 18 by laws.

Treatments

• Lung cancer treatments have evolved during the course of the 20th and early 21st century as a result of scientific and technological advancements as well as government assistance.

• As of right now, the following are a few lung cancer treatments:

  • Radiation therapy: radiation targets and destroys cancer cells.

  • Chemotherapy is the employment of strong chemicals to attack and destroy cancer cells.

  • Immunotherapy: the individual's treatment strengthens the immune system to enable it to target and destroy cancer cells.

  • Lungs from an organ donor are used in transplants to replace damaged lungs.

• Lung cancer causes, diagnosis, prevention, and therapy are still being studied medically today. More technological and scientific developments will result in greater understanding and more therapies.