Medicine in Britain, c1250–present: Detailed Notes

Medicine in Britain, c1250–present

c1250–c1500: The Middle Ages

Ideas: Supernatural and Religious

  • The Christian Church was dominant and belief in religious/supernatural causes of illness was common.
  • God as the cause of disease: People believed God made them ill because He was displeased or testing their faith.
    • This belief held back medical research.
  • Astrology: Alignment of planets/stars was thought to cause disease and help with diagnosis; use increased after the Black Death.
  • The Church's Control of Ideas:
    • The Church taught most of what people learned and ran universities where physicians were trained.
    • Monks/priests could read/write and monasteries held many books, giving the Church influence over written material.
    • The Church approved of traditional, rational explanations (especially Galen's ideas). Galen's theories fit Christian beliefs that the body had a soul and that all parts had been created by God to work together.
    • Dissections were uncommon and mainly used to teach Galen; contradictory findings were often ignored, hindering anatomical advancements.
    • The Church taught that people should care for the sick, and many hospitals were in monasteries/nunneries.

Rational Explanations for Disease

  • Rational explanations were based on ancient ideas, especially those of Hippocrates and Galen.
  • The Four Humours:
    • Ancient Greeks believed everyone had a mix of four humours: blood, phlegm, yellow bile, and black bile.
    • Illness occurred when the mix was unbalanced, so treatments aimed to restore balance.
  • Theory of Opposites:
    • Galen developed this theory, suggesting treatments based on opposites to balance the humours.
    • Example: Eating hot peppers for excess phlegm (linked to water and cold).
  • Hippocrates:
    • Ancient Greek doctor who dismissed gods as causes of disease and believed in physical reasons needing physical cures.
    • Treatments were based on diet, exercise, and rest, along with bleeding/purging.
    • Authored the Hippocratic Oath, emphasizing respect for life and prevention of harm.
    • Clinical observation method (studying symptoms, making notes, comparing cases) is the basis of today's approach.
  • Galen:
    • Greek doctor who worked in Ancient Rome; his ideas were the basis of medical training in the Middle Ages.
    • Developed Hippocrates' ideas, using bloodletting/purging and his Theory of Opposites.
    • Drew detailed diagrams of human anatomy from operating on gladiators and dissecting animals.
  • Miasma:
    • Disease transmitted by 'bad air,' related to God because bad smells indicated sin; originated in the Ancient world and continued into the 19th century.

Approaches to Prevention and Treatment

  • Based on rational, religious, and traditional methods.
  • Rational treatments related to the Four Humours:
    • Bloodletting: Most common treatment for imbalance of humours, done by cutting a vein, using leeches, or cupping; performed by barber-surgeons or non-medical persons.
    • Purging: Removing food from the body by inducing vomiting or bowel movements; emetics/laxatives mixed by apothecaries or wise women; physicians sometimes gave enemas.
  • Traditional remedies:
    • Herbal remedies were drunk, sniffed, or bathed in; different foods rebalanced humours; ointments applied to the skin; made at home or by an apothecary.
  • Religious treatments:
    • Praying, fasting, going on pilgrimage, paying for special Mass.
  • Supernatural treatments:
    • Specific ideas for certain illnesses, like hanging a magpie's beak around your neck to cure toothache.
  • Rational Methods to prevent illness:
    • Bathing and washing, exercising, not overeating, bleeding and purging, purifying the air, trying to keep streets clean.
  • Religious and supernatural methods:
    • Living a Christian life, self-punishment, carrying lucky charms/amulets, chanting incantations.

Approaches to Caring for the Sick

  • Different people treated the sick:
    • Barber-surgeons: No training; did bloodletting, pulled teeth, lanced boils, cut hair, and did basic surgery (amputating limbs with low success rate); cost less than a physician.
    • Care in the home: Most ill people were treated at home by a female family member or the village 'wise woman'.
    • Apothecaries: Received training but no medical qualifications; mixed medicines/ointments; cost money (less than a physician).
    • Physicians: Medically trained at university and passed exams; diagnosed illnesses and gave treatments; expensive and rare; women physicians were incredibly rare.
  • What physicians did: observed symptoms, checked pulse/skin color/urine, consulted urine charts/zodiac charts, and then either treated patients themselves or sent them to a barber-surgeon/apothecary.
  • Hospitals:
    • Some were built for specific infectious diseases, or were places where travellers/pilgrims stayed.
    • Many were run by the Church, emphasizing God and healing souls.
    • People with infectious diseases/incurable conditions were usually not admitted.
    • Patients and their surroundings were kept very clean.
    • Hospitals were places of recuperation rather than treatment; patients were given fresh food and plenty of rest.

The Black Death, 1348–9

  • Symptoms: Swelling of lymph glands (buboes), fever/chills, headache, vomiting, diarrhoea, and abdominal pain.
  • Treatments: Praying, holding lucky charms, cutting open buboes, holding bread against buboes, eating cool things/taking cold baths.
  • Most historians think it was bubonic plague, carried by fleas on black rats.
  • How people thought it was caused:
    • Religion: God sent it as punishment for sins.
    • Astrology: Unusual position of Mars, Jupiter, and Saturn.
    • Miasma: Bad air/smells from decaying rubbish.
    • Volcanoes: Poisonous gases from volcanoes/earthquakes.
    • Four Humours: Imbalance in the Four Humours.
    • Outsiders: Strangers or witches.
  • How people tried to avoid catching it:
    • Praying and fasting.
    • Clearing up rubbish in the streets.
    • Smelling toilets or other bad smells.
    • Lighting a fire, ringing bells, or having birds flying around the room to keep air moving.
    • Carrying herbs/spices to avoid breathing in 'bad air'.
    • Not letting unknown people enter the town/village.

c1500–c1700: The Renaissance

Ideas: A Scientific Approach

  • Gradually, fewer people believed in supernatural/religious causes of disease; various new rational explanations were suggested (e.g., seeds in the air).
  • Changing Influence of the Church:
    • New religious ideas challenged the authority of the Catholic Church, weakening its influence.
    • People looked for new explanations rather than believing disease was caused by God.
    • Ideas of Galen, supported by the Church, were relied upon less.
  • Continuity in ideas on causes of disease:
    • Belief in miasma continued.
    • The Theory of the Four Humours continued, although by 1700, very few physicians still believed in it.
  • Change in the work of physicians and scientists
    • Physicians began to improve diagnosis via direct observation.
    • Physicians stopped using astrology charts for diagnosis.
    • Physicians realised that urine was not a good indicator of disease and stopped using urine charts for diagnosis.
    • Physicians carried out more direct observations and examinations of their patients, rather than relying on the patient explaining their symptoms.
  • Thomas Sydenham:
    • Worked as a doctor in London during the 1660s and 70s.
    • Did not rely on medical books when making a diagnosis, but observed patients and recorded symptoms in detail.
    • Instrumental in the ‘new’ idea that a disease had nothing to do with the nature of the person who had it.
    • Based treatment on the disease as a whole and didn’t treat individual symptoms.
    • Became known as the ‘English Hippocrates’.

Transmission of Ideas

  • Development of the Printing Press:
    • Invented around 1440 by Gutenberg. By 1500, there were hundreds of printing presses across Europe.
    • Many exact copies of texts could be produced in a short amount of time.
    • Helped reduce the Church’s control of ideas, as it could no longer prevent the publication of ideas it did not approve of.
    • Books, ideas, and discoveries could be shared more effectively and much faster across a wider area.
  • Setting up the Royal Society:
    • Aimed to further scientific understanding by carrying out and recording the results of experiments, sharing scientific knowledge and encouraging new theories and ideas.
    • Sponsored scientists to enable them to carry out research.
    • From 1665, the Royal Society published a journal called Philosophical Transactions, in which scientists could share their work and ideas.
    • Doctors and scientists could study, challenge and build on each other’s research; theories could be confirmed or dismissed and news of the findings could spread through the medical community quickly.
    • King Charles II granted a Royal Charter to the society and his approval of the society helped it to gain credibility.

Continuity in Prevention, Treatment, and Care

  • Superstitions and prayer. Cleanliness. Bleeding and purging. Healthy living. Traditional herbal remedies.
  • Changes in prevention and treatments:
    • More emphasis on removing miasma through draining swamps, and removing sewage and rubbish.
    • People regularly changed their clothes to keep clean rather than just bathing.
    • New herbal remedies from newly discovered countries appeared in England, and some were effective.
    • The theory of transference led people to try and rub objects on themselves to transfer the disease to the object.
    • Alchemy caused chemical cures using metals or minerals to become popular.
  • Community Care
    • Most people who became ill were cared for at home, usually by a female relative. Physicians were still too expensive for the majority; members of the community (again, usually women) helped with advice and remedies; some were paid for their services.
  • Hospitals:
    • By 1500, hospitals were treating more sick people and were being used less by travellers and pilgrims; most had their own apothecary to mix medicines and physicians frequently visited patients.
    • In 1536, the dissolution of the monasteries in England by Henry VIII caused most hospitals to close.
    • Some free, charity-funded hospitals were set up but it wasn’t until well into the 1700s that the number of hospitals returned to pre-dissolution levels.
    • More pest houses began to appear, where people suffering from a particular contagious disease could go for care.
    • When hospitals did re-appear, they were run by physicians focused on treating the sick rather than by religion.

Change in Care and Treatment

  • The importance of Vesalius:
    • He improved understanding of the human body.
    • He made the study of anatomy fashionable; it became central to the study of medicine.
    • He proved that some of Galen’s work was incorrect, which helped encourage others to question Galen’s theories.
    • He encouraged and inspired other medical professionals to carry out dissections and make further discoveries.
    • His work was widely published in England and throughout Europe, and included detailed illustrations of the human body, which were copied into other medical textbooks.
  • Andreas Vesalius:
    • Studied medicine in Paris in 1533, then became a professor of surgery in Padua, Italy.
    • Carried out a large number of dissections on human bodies and made many discoveries about how the body worked.
  • Training for apothecaries, surgeons and physicians
    • Apothecaries and surgeons:
      • Continuity: They were still not given university training and were still considered inferior to physicians and they were cheaper.
      • Change: Both were better trained through being in guild systems, where they were apprentices, then journeymen, before becoming masters; a licence was now needed to work as an apothecary or surgeon and these were only issued after completing training.
    • Physicians:
      • Continuity: They were still trained at universities and the training lasted for many years; training was still based on learning from textbooks rather than practical experience.
      • Change: There was better access to a wider variety of medical books and detailed drawings due to the printing press; gradually, new ideas about anatomy (led by Vesalius) and causes of disease inspired some physicians to become more practical and experimental; dissection was legalised but took time to become commonplace.

The Great Plague, 1665

  • Causes:
    • People’s beliefs about the causes of the Great Plague were mostly the same as their beliefs about the causes of the Black Death.
    • Miasma was by far the most commonly believed cause.
    • Far fewer people believed it was caused by an imbalance in the Four Humours.
    • People knew that disease could be passed from person to person.
  • Treatments
    • Like its causes, many treatments for the Great Plague were similar to those for the Black Death.
    • Though many used herbal remedies mixed in the home or by apothecaries, and ‘quack’ doctors but little is known about treatments, as most people with the disease were quarantined.
    • The theory of transference meant that people tried to ‘transfer’ the disease to something else, especially birds, such as chickens.
    • It was thought that people could sweat disease out, so sufferers were wrapped up in thick blankets and put by a fire.
  • Government action:
    • Theatres were closed and large gatherings were banned.
    • Dogs and cats were killed.
    • Streets were regularly cleaned.
    • Barrels of tar were burned in the streets.
    • Every day, carts collected the dead who were then buried in deep mass graves.
    • A household was boarded into its home for 28 days or taken to the pest house if a member caught the plague.
    • Days of fasting and public prayers were ordered.

William Harvey

  • Studied medicine at Cambridge, then Padua.
  • Became a lecturer of anatomy in London at the College of Physicians.
  • Was one of James I’s doctors.
  • Carried out public dissections.
  • Taught the importance of doctors observing and recording patients’ symptoms, rather than relying on textbooks for diagnosis and treatment.
  • Discovered the process of blood circulation.
  • Discovering the circulation of the blood:
    • Harvey researched Vesalius’ theory that blood flowed towards the heart, which contradicted Galen’s theory; he proved Vesalius was right using dissected bodies and pumps that showed blood only flowed one way.
    • He then proved that blood could not be produced by the liver and absorbed into the body, as Galen had thought.
    • He was influenced by new technology, such as mechanical water pumps, which made him think the human body worked in the same way.
    • He discovered that arteries and veins were part of one system and that blood was pumped around the body by the heart.
  • The importance of Harvey:
    • He proved that some of Galen’s theories were wrong, bringing into question Galen’s other theories.
    • He improved knowledge about how the body worked and passed this knowledge on. By 1700 his work was being taught in medical schools.
    • As a royal physician, Harvey’s work gained publicity and credibility, and inspired others to find out more.
    • His scientific methods of observation and use of dissection had brought results, and so were copied by others.
    • His discoveries left many unanswered questions, which encouraged further experiments.

c1700–c1900: 18th and 19th Century

Germ Theory and Microbes

  • Continuity in theory of causes of disease:
    • There were few new ideas about the cause of disease in the 18th century, though some scientists thought that germs were produced by decaying matter – this was called spontaneous generation.
    • Most people still thought miasma was a cause of disease, but this was becoming a less popular theory than it was in the Renaissance.
  • Microscopes:
    • By 1700, microscopes had developed so that cloudy images of what would become known as bacteria or germs could be seen. By 1850, microscopes had further improved so that extremely tiny images could be seen clearly.
    • This was essential in enabling the scientific breakthroughs of the later 19th century.
    • Social attitudes towards science were changing – there was an increasing awareness of the need for rational explanations for the cause of disease.
  • Change in theory of causes of disease: Germ Theory:
    • In 1861, Louis Pasteur (a French chemist) published his Germ Theory, which showed that spontaneous generation was incorrect.
    • He proved that microbes (bacteria or germs) in the air cause decay (he discovered this when investigating why liquids turned sour for the brewing industry).
    • He theorised that germs also caused disease but was unable to prove this.
  • The influence of Pasteur and Koch:
    • Pasteur’s Germ Theory had very little impact on medicine in Britain to begin with as he was not a doctor and his work focused on food and drink, not disease. Most doctors still believed in the spontaneous generation theory, but there were some (e.g. Joseph Lister) who did make the link between microbes and disease.
    • Koch developed a new, easier way of growing bacteria on agar jelly, and also discovered that chemical dyes stained bacteria, which made them easier to see under a microscope. Other scientists used these methods to identify the microbes that caused other diseases.
    • Robert Koch (a German doctor and scientist) read Pasteur’s work and began to study microbes himself; he proved that Pasteur’s theory was right, that microbes caused disease as well as decay; he identified the specific microbes that caused TB in 1882, and cholera in 1883.
  • Eventually, these discoveries were to have a direct impact on the prevention and cure of many diseases.
    • Koch’s work had more of an impact in Britain than Pasteur’s had, and he inspired others to research other microbes. However, it took time for most doctors and the British government to accept the Germ Theory of disease. Even though the real cause of many diseases had been discovered, it didn’t yet have an impact on their medical treatment and prevention.

Improvements in Hospital Care

  • Nursing wasn’t seen as a respectable job for women and there was little training.
  • Florence Nightingale attended the first nurses’ training school in Kaiserwerth hospital, Germany.
  • She was asked to lead a team of nurses at the military hospital in Scutari during the Crimean War (1854–56).
  • She believed that miasma caused disease, so emphasised hygiene, fresh air, good supplies and training for nurses; her approach greatly improved conditions in the hospital.
  • Her work was widely reported in newspapers in Britain, she published books on nursing and hospital organisation and set up a training school for nurses / midwives.
  • Changes in hospital care:
    • New hospitals (financed by charities and local councils) opened during the 19th century to look after the sick.
    • The elderly, sick or disabled poor were forced to enter workhouses.
    • Most hospitals tried to create a home atmosphere; parents and visitors had to help nurses look after the patients.
    • Public pressure led to infirmaries (separate from workhouses) being set up for the poorest in society.
    • First cottage hospital (small buildings where nurses gave care and GPs prescribed to create a home treatment) opened in 1859.
    • Middle and upper classes could afford doctors to treat them at home.
    • Nurses were given a more central role caring for patients and assisting doctors.
    • Due to the work of reformers like Florence Nightingale, hospital cleanliness and organisation improved, and nurses were better trained; Pasteur’s germ theory led to improved hygiene.
    • Specialist hospitals (such as asylums for the mentally ill and fever houses for infectious diseases) developed.

Anaesthetics and Antiseptics

  • The three main problems that made surgery so dangerous were blood loss, pain and infection.
  • Search for an anaesthetic:
    • Before 1800, alcohol and opium had little success in easing pain during operations.
    • Ether (used from 1846) made patients totally unconscious and lasted a long time; however, it could make patients cough during operations and sick afterwards; it was highly flammable and was transported in heavy glass bottles.
    • Chloroform (used from 1847) was very effective with few side effects; however, it was difficult to get the dose right and could kill some people because of the effect on their heart; an inhaler helped to regulate the dosage.
    • Laughing gas was used in 1844 in dentistry in the USA, but failed to ease all pain and patients remained conscious.
    • Cocaine was used as the first local anaesthetic in 1884; in 1905 a less addictive version – novocaine – was used as a general anaesthetic.
  • James Simpson discovered chloroform when he was looking for solutions to pain during surgery; he gave lectures and wrote articles to promote its use for surgery and for childbirth; he was the first person to be knighted for services to medicine.
  • Opposition:
    • People worried about the long-term effects of using anaesthetics and thought that being unconscious made patients more likely to die.
    • The Victorians were very religious and thought that God inflicted pain for a reason, so it was wrong to interfere with His plan. Also, it took a long time for doctors and surgeons to believe in the Germ Theory and therefore accept Lister’s discoveries.
  • Development of antiseptics:
    • Joseph Lister was a surgeon who worked at Glasgow Royal Infirmary.
    • Lister reads Pasteur’s Germ Theory and learns that carbolic acid kills parasites in sewage.
    • Lister soaks bandages in carbolic acid to avoid wounds getting infected.
    • Lister uses carbolic acid to clean wounds and equipment and invents a spray to kill germs in the air.
    • Lister states that his wards have been free from infection (sepsis) for 9 months; he publishes his ideas.
    • Lister becomes Professor of Surgery at King’s College Hospital, London.
  • The impact of anaesthetics and antiseptics:
    • Surgery became pain free and patients didn’t struggle, so surgeons could take more time and be more careful.
    • Deeper, more complex surgery became possible and the death rate dramatically decreased as surgery was more successful; aseptic surgery was possible because antiseptics were used to clean wounds and operating theatres.
    • Lister’s work inspired others to search for methods to prevent the spread of infection in hospitals. By 1900, operating theatres and wards were thoroughly cleaned using aseptic techniques, and surgeons and nurses wore sterilised clothing and used sterilised instruments.

Approaches to Prevention of Disease

  • The 19th century saw some important developments in disease prevention as the Germ Theory was used to create vaccines for some diseases; also, the government began to play more of a role in public health and increased prevention rates by reducing the conditions that fostered disease.
  • The development of vaccinations:
    • Pasteur carried out experiments to observe microbes and published his results in 1861. He called his discovery Germ Theory.
    • Pasteur’s team of scientists discovered that a weakened version of a disease-causing microbe could be used to create immunity from that disease.
    • Pasteur admired Jenner and called his new discovery ‘vaccination’ in tribute to Jenner.
    • Pasteur developed vaccines against anthrax and chicken cholera for animals, and against rabies for humans.
    • Pasteur’s work inspired other scientists to develop vaccines for human diseases.
  • Public Health Act, 1875:
    • City authorities must provide clean water, sewers, public toilets, street lighting, public parks. As well as inspect lodging houses for cleanliness, monitor the building of new houses to prevent damp and overcrowding, check the quality of food sold in shops, employ a public officer of health to monitor disease.
  • Reasons for the 1875 Public Health Act:
    • Previously the government did not believe it was its role to improve living conditions and saw it as interfering in people’s lives. It preferred a ‘hands off’, laissez-faire policy.
    • During the 19th century, the attitude of government began to change due to several epidemics (especially cholera) and the increasing scientific evidence that these diseases were caused by poor living conditions. Also, the increasing number of men who could vote influenced politicians.
    • By 1875, people recognised that it was the government’s responsibility to improve living conditions in the cities.

Jenner and Vaccination

  • In the 18th century, smallpox killed more children than any other disease; thousands of adults died, too, and survivors were often left with terrible scars; the disease spread quickly and easily from person to person.
  • Vaccination and smallpox:
    • Since the 1720s, doctors had been inoculating people against smallpox by infecting them with a mild version of the disease; this could still kill and only the very rich could afford it.
    • In the 1790s, Jenner used scientific methods for carrying out experiments to test his theory and observe and record the results; he infected local people with cowpox and then tried to infect them with smallpox; none of them caught smallpox.
    • Jenner collected evidence of the success and failure of smallpox inoculations; he regularly treated people for the mild disease, cowpox, and noticed that these people never caught smallpox.
    • In 1798, the Royal Society refused to publish Jenner’s ideas, so he paid to print his findings in An Enquiry into the Causes and Effects of the Variola Vaccinae; he included detailed instructions so that others could follow them.
    • By 1800, around 100000 people worldwide had been vaccinated, but the practice took time to become popular in Britain.
    • In 1802, the Royal Jennerian Society was set up to promote vaccination and, by 1804, over 12000 British people had been vaccinated.
    • Vaccinations were made compulsory in 1853; in 1840, vaccinations were provided free of charge for the poor.
    • In 1979, WHO, the World Health Organisation, announced that smallpox had been wiped out.
  • Jenner’s importance:
    • Jenner’s work proved that scientific methods could lead to a disease being wiped out; he saved the lives of millions!
  • Opposition to Jenner:
    • Many people opposed Jenner’s work because they thought it was wrong to give people an animal’s disease, it interfered with God’s plan, doctors lost money when the government offered vaccination free, and some doctors didn’t vaccinate people properly so it didn’t work.

Fighting Cholera in London, 1854

  • The first cholera epidemic in Britain occurred in 1831 and was followed by another in 1848–49, and another in 1854; then a London doctor, John Snow, found what was causing the disease.
  • Attempts to prevent the spread of cholera:
    • Most people, including the government, believed cholera was caused by miasma and spontaneous generation; therefore, people tried to keep their homes as clean as possible and some local councils tried to clean the streets and clear away rubbish.
    • The government’s Public Health Act of 1848 suggested that cities should provide clean water supplies, but the Act was not compulsory so few complied.
  • The work of John Snow:
    • Snow observed the cholera epidemic of 1848–49 and began work on his theory that cholera was spread through contaminated drinking water, not by miasma.
    • When cholera broke out again in 1854 in Soho, where Snow lived, he mapped all the deaths and found a strong link to one water pump on Broad Street.
    • He removed the handle from the pump so people couldn’t collect water from it and the number of deaths fell dramatically.
    • Later it was discovered that a cesspit close by was leaking waste into the well.
    • In 1855, Snow presented his findings to the government.
  • The significance of John Snow’s work:
    • Many cholera deaths in Soho were prevented after Snow stopped people using the Broad Street pump.
    • Many did not believe Snow’s theory; he had no scientific evidence to prove cholera was transmitted in water – the Germ Theory wouldn’t emerge until 1861; therefore, the government didn’t act on Snow’s recommendation to build a new sewer system for London.
    • In the longer-term, Snow’s work combined with other evidence (e.g. The Great Stink) and a new London sewer system was completed in 1875.
    • Also, in the longer-term, Snow’s work helped make the link between dirty water and disease, leading to the Public Health Act in 1875 when cities’ authorities were finally forced to provide clean water.

c1900–present: Modern Britain

Ideas: Genetics and lifestyles

  • During the 19th century, Mendel showed how human characteristics could be passed between generations.
  • In the 20th century new technology (electron microscopes, X-rays) let scientists analyse human cells in greater detail; they found that every cell in the body contains DNA – codes controlling the genes of each person.
  • James Watson and Francis Crick worked together on how the genetic codes of DNA fitted together; they analysed X-ray crystallography by Maurice Wilkins and Rosalind Franklin and eventually worked out the double helix structure of DNA (1953).
  • In 1990 James Watson led the Human Genome Project and started identifying and mapping every gene in human DNA.
  • Understanding genetics New possibilities
    • Discovering the structure of DNA and the work of the Human Genome Project has led to a better understanding of some genetic conditions, such as Down’s syndrome, predicting whether individuals are at higher risk of developing some cancers, the discovery that stem cells can be grown into different cells; however, there is not yet a cure or effective treatment for most genetic conditions; way of preventing most genetic diseases.
  • Understanding of lifestyle factors
    • Since 1900, people have discovered that some lifestyle factors can negatively affect health and increase the chance of contracting disease.
    • Smoking: Research now links smoking with many diseases, such as emphysema, high blood pressure, heart disease and many cancers.
    • Drinking alcohol: Research now links drinking too much alcohol to many cancers, as well as liver and kidney disease.
    • Diet: Scientific research has confirmed that eating a balance of different foods and limiting sugar and fat reduces the chances of getting certain types of cancer or heart disease.

Improvements in Diagnosis

  • The 20th century saw huge changes in the ways that doctors diagnosed illness; although doctors today still use their own knowledge and medical books, they combine this with medical testing, using science and technology to discover what is wrong.
  • This includes the use of laboratories to test skin or blood, x-rays, scans and endoscopes to ‘see’ inside the body with more clarity than ever before, and monitors to see what is going on over a period of time.
  • Improved scientific understanding and technology has made diagnosing disease far more accurate.
  • Medical technological advances: Incubators, X-rays, Microscopes, MRI, CT and ultrasound scans, Endoscopes, Insulin pumps, Hypodermic needles, Prosthetic limbs, Dialysis machines, Pacemakers, Blood pressure and blood sugar monitors Examples of technology used in 20th and 21st century medicine

Change in Care and Treatment

  • Koch discovered that different chemical dyes stained specific microbes.
  • Behring discovered the body manufactures antitoxins that only attack the microbe causing a disease.
  • Paul Ehrlich and his team of researchers searched for a ‘magic bullet’ – a chemical compound that would attack and kill the microbe causing a specific disease; the team, helped by German government funding, worked for many years; in 1909, Dr Hata discovered they had rejected a compound that worked – the 606th compound, Salvarsan, which was used to cure syphilis.
  • In 1932, Gerhard Domagk developed the second magic bullet, Prontosil, which cured some types of blood poisoning; other scientists checking Domagk’s work found that the key ingredient in Prontosil, sulphonamide, also cured pneumonia, scarlet fever and meningitis.
  • Antibiotics
    • Antibiotics destroy bacteria or prevent its growth; the first to be discovered was penicillin.
    • Scientists, inspired by the discovery of penicillin, experimented with other moulds and found more antibiotics that were effective against different diseases throughout the 1940s, 50s and 60s.
    • Once the chemical structure of different antibiotics was discovered, scientists were able to make antibiotics, which solved the problem of having to grow them first in order to amend them to treat further diseases.
    • Antibiotics have saved and extended millions of lives but due to overuse, super-bacteria, which are resistant to antibiotics, have evolved.
  • Advances Examples of high-tech medical and surgical treatments include: radiotherapy and chemotherapy kidney dialysis fitting pacemakers organ transplants.
    • robotic surgery Some surgery can now be carried out remotely, with surgeons controlling robots through computers; this has also made surgery more precise.
    • keyhole and microsurgery With the development of tiny cameras and surgical instruments, surgeons can use small incisions instead of large cuts to access the body, which reduces patients’ recovery time; the small instruments also make it possible to reattach nerves and blood vessels.
    • The final major problem of surgery, blood loss, had also been solved, which led to successful blood transfusions.