Health and medicine

UNIT 5 - Health and Medicine

Developments in health and medicine (Before 1750):

The most dramatic improvements in medicine have come in the last 2000 years, however, there were key developments before the modern era.
In the prehistoric period, serious illnesses were treated by ‘medicine men’. Often midwifery and basic care for the sick were left to women.
It was believed that illnesses had either supernatural causes, such as vengeful gods and evil spirits, or natural causes (injury from hunting or insect bites).
The treatment was a combination of ritual, prayer and basic surgery such as trephining (the frilling of a hole through the scalp and skull to relieve pressure in the brain). There is evidence that people survived this.
Treatments varied in the prehistoric time although there was some emphasis on hygiene.

Ancient Greeks:

They saw the gods as important to health and had temples to the god of healing - Asclepius.
However they also had some newer ideas about what caused illness and how it could be treated
Doctors attempted to understand what caused illness through careful observation of the sick. From observations they saw that during an illness, body fluids were usually expelled (phlegm, blood, black bile, yellow bile).
from this developed the theory that illness was caused by having an imbalance in the four humors of the body and was linked to the four elements and seasons.
This theory was followed for thousands of years.
Greek doctors observed patients’ symptoms and then diagnosed them. Some kept detailed notes of observations and used their theories to restore balance in the body.
Hippocrates: demonstrated how important it was to observe patients and record symptoms and the progress of their illness in order to better understand and treat illnesses. He wanted people to look for natural causes of illness rather than supernatural explanations.

Romans:

Galen;

Roman doctor who lived in the 2nd century. He followed Hippocrates’ methods and believed in the theory of the four humors.
He has a new idea: he thought that the humors could be rebalanced using ‘opposites’ (certain foods possess certain qualities and avoiding or seeking out right foods can bring balance back), e.g taking pepper or something hot when you have a cold, cucumbers (wet moist) for people who suffered from hot and dry choleric fevers.
Galen was also interested in anatomy and carried out dissections to gain knowledge of the body.
He learned how each body part fitted together and taught his students about how well the human body was designed.
He wrote 60 books that combined Greek ideas with Roman theories.
The key idea that flourished throughout the Roman Empire was the idea of public health. Romans attempted to keep their cities and people clean by constructing sewers and aqueducts that brought in clean water to people.

The Middles Ages:

Early Middle Ages:

Church's power grew after collapse of central governments
Establishment of universities for medical training
Rediscovery of Galen's ideas

Black Death:

Catastrophic epidemic in mid-1340s
Killed over 40% of population
Various explanations sought, including religious, astrological, and environmental factors

Flagellants:

Group seeking atonement for sins
Traveled whipping themselves
Urged repentance from others

Medical treatments:

Humor balancing like ancient times
Bleeding patients common
Use of astrology and herbal medicines

Women in medicine:

Excluded from universities
Key caregivers despite limitations
Dominant role in childbirth and midwifery

Islamic Civilisation:

When most of Europe had descended into chaos and conflict after the fall of the Roman Empire, a new civilisation developed in the Middle East founded on Islam.
The central religious text of Islam, the Quran tells Muslims that it is important to care for the sick.
Islamic scholars took on the work of Galen, and many sources suggest that their understanding and medical practices were far more advanced than those in Western Europe at the time.
Large hospitals were built across the Islamic world in the Middle Ages.
A famous Arab doctor was Ibn Sina who worked in the early eleventh century and wrote a significant, one-million-word book on medicine.
However, many Arab doctors, including Sina, believed that theory was more important than practice and did not engage with surgery.

The Renaissance:

From 1500 to 1650, a period known as the 'Medical Renaissance', marked by medical breakthroughs.
Andreas Vesalius, a Belgian, challenged Galen's anatomy, emphasizing the importance of human dissections for medical understanding.
Vesalius's work, "On the Fabric of the Human Body," revolutionized anatomical knowledge with detailed illustrations.
Ambroise Paré, a French surgeon, transformed surgical practices by abandoning cauterization and introducing ligature for wound closure.
Paré's influential methods spread through his book "Works on Surgery," published in 1575.
William Harvey, a British doctor, pioneered understanding the circulation of blood, challenging Galen's theory of blood production in the liver.
Harvey's book, "An Anatomical Account of the Motion of the Heart and Blood in Animals," published in 1628, revolutionized understanding of blood circulation.
Vesalius and Harvey's discoveries had limited impact on everyday health and life expectancy.
Paré's work, particularly bandaging wounds instead of using oil, had more immediate benefits for patients.
However, Paré's silk ligatures often led to infections due to lack of antiseptics, causing many doctors to revert to cauterization.
Despite medical advancements, plague epidemics persisted, with a catastrophic outbreak hitting London in 1665.
Treatments for the plague remained largely unchanged from the 1340s, including fasting, prayers, charms, and potions.
Limited medical progress over 300 years since the 14th century plague epidemics was evident in the recurrence of similar treatments.

Breakthroughs in medicine in the 19th Century:

Enlightenment - The Scientific Revolution

Move away from ancient texts like Galen towards observation and experiments.
Disproving old ideas, such as the four humors, with observations in the natural world.
Introduction of microscopes in the 1600s aided observation.
Sophisticated doctor training included dissections and microscope use.
Decline of Catholic Church's influence allowed challenging of Galen's ideas.

The Impact of The Industrial Revolution

Population growth and rapid urbanization led to health challenges, including poor housing and sanitation.
Overcrowding and dirty water facilitated frequent epidemics in cities.
Despite challenges, key positive factors emerged for medical progress in the nineteenth century.
Initially, in 1800, the British government did not intervene to improve public health. However, attitudes shifted, and by 1900, laws were passed to address public health concerns.

Charles Darwin's evolution ideas gained acceptance, challenging Church control over medicine.
Technological advancements increased warfare's deadliness, prompting new techniques.
Breakthroughs in the 19th century linked microorganisms to disease.
Scientists found a dye to kill bacteria and a gas for anesthesia.
Technological improvements in metals led to safer injections.
New types of glass enhanced microscopes and the invention of the first thermometer.
Transport and communication developments in the Industrial Revolution allowed faster travel for doctors.

Medicine became profitable, prompting investment in scientific research.
War provided opportunities for doctors to practice with new equipment and techniques on serious wounds.
Improvements in hygiene and nursing occurred.
Knowledge about the body advanced in the 19th century.

Vaccinations - Smallpox

Smallpox caused devastating outbreaks globally, leaving survivors scarred.
In the 17th century, merchants brought the method of inoculation from China, where it had been used for centuries.
Chinese doctors would scrape smallpox scabs and apply them to open wounds to give patients a mild dose of the disease.
Inoculation carried risks, including death or spreading the infection, and was often unaffordable for the poor.
Edward Jenner developed vaccination after noticing cowpox survivors were resistant to smallpox.
Jenner tested his theory by inoculating an eight-year-old boy with cowpox, who then remained unaffected by smallpox.
Jenner coined the term "vaccination". Vaccination against smallpox spread rapidly

Women In Medicine: Changes brought forth

In the 19th century, women continued traditional roles as midwives and caregivers.
Elizabeth Blackwell became the first female doctor in the USA in 1849.
Florence Nightingale, Mary Seacole: nursing and hospital cleanliness in Crimean War (1853-56).

Germ Theory: Prevention and treatment

Louis Pasteur investigated why alcohol vats were spoiling, leading to the development of germ theory in 1861.
Pasteur proposed that decay occurred due to tiny organisms falling from the air.
Robert Koch, a German doctor, furthered Pasteur's ideas, studying bacteria and identifying causes of diseases like tuberculosis and cholera.
Koch's methods led to discoveries of the causes of typhus, tetanus, pneumonia, plague, etc.
Pasteur developed vaccines for chickenpox, cholera, anthrax, and rabies,
Emil von Behring won the Nobel Prize in Medicine in 1901 for finding that animals produce antitoxins against harmful bacteria, which could be used to prevent diseases like diphtheria.
Patrick Manson (1884): mosquitoes spread diseases, leading to the understanding of disease carriers.
Charles Chamberland discovered viruses, smaller than bacteria, which also carry diseases.

Surgery: challenges of pain, infection and blood loss

Despite lacking anesthetics and antiseptics, surgeons attempted new surgeries
In 1884, Carl Koller introduced cocaine as a local anesthetic, useful for minor operations where patients remained awake.

Infection

Nineteenth-century doctors neglected hygiene, leading to disease spread due to unwashed equipment, reused bandages, and unwashed hands.
Ignaz Semmelweis linked high infant mortality rates to medical students' lack of handwashing after dissecting corpses.
Florence Nightingale highlighted the importance of cleanliness during the Crimean War.
Joseph Lister's experiments with carbolic acid during surgery reduced infections and gangrene
Koch's discovery of bacteria causing septicaemia supported Lister's methods, prompting sterilization of hospitals, instruments, and clothing.
Aseptic surgery in the 1890s introduced steam cleaning of equipment and clothing, rubber gloves, and face masks, significantly reducing infections.

Blood Loss

Lister's discoveries improved the safety and effectiveness of Pare's ligatures by sterilizing threads before use. (Despite advancements, blood loss remained a significant challenge in 19th-century surgery).
Experiments with blood transfusions were attempted, but storing blood was problematic due to clotting, and direct transfusions often resulted in patient deaths.

Public Health

Industrialization, urbanization, and population growth in the 19th century influenced governments' roles in public health.
In Britain, the laissez-faire approach to public health was challenged by the conditions in industrial cities, leading to the construction of sewers and improvements in water supplies.
Severe cholera epidemics highlighted the need for sanitation and clean water, with John Snow demonstrating the link between cholera and polluted water supplies.
By the late 19th century, governments implemented legislation to prevent river pollution, improve food quality, and mandate some vaccinations, expanding their role in public health.

Breakthroughs in 20th Century:

Technological developments surged in industrialized societies, aided by improved communication and urbanization.
Many societies turned to science for medical solutions as religious influence waned.
Democratic societies pressured governments to provide better healthcare.
The USA emerged as a dominant economic and military power, investing in research and spreading medical ideas globally.
Key medical discoveries included Karl Landsteiner's identification of blood groups in 1901 and Richard Lewisohn's use of sodium citrate to prevent blood clotting in 1913.
Understanding of the human body expanded with Ernest Starling and William Bayliss discovering the first hormone in 1902, and Casimir Funk identifying the first vitamins in 1912, linking poor diet to disease.
The 20th century also saw significant loss of life due to disease, famine, and war.

WW1

The scale of war led to millions of casualties, driving significant improvements in surgery:

Surgeons faced thousands of horrific injuries daily, prompting innovation.
Collaboration among surgeons increased, facilitating idea-sharing.
Doctors and researchers worked collectively for the war effort.
Governments allocated resources to develop new medical materials and equipment.

Blood Loss

The First World War introduced weapons causing severe injuries, including gunshot wounds and injuries from artillery bombardments.
Identification of different blood groups in 1901 explained why transfusions worked only for some patients, prompting the need for blood storage solutions.
Doctors discovered they could separate blood plasma from corpuscles, enabling blood storage without clotting and later use by adding a saline solution.
French doctors implemented the 'triage' system to prioritize treatment for mass casualties based on their likelihood of benefiting from treatment.
X-rays, invented in 1895 by Wilhelm Rontgen, were used routinely during the war to locate bullets and shrapnel in patients.
Marie Curie won a Nobel Prize in medicine for her research into radiation in 1903, established a front-line X-ray service on the battlefields in France and Belgium.

Infections

Bullets and shrapnel took infection deep into the body
Soldiers' wounds were often infected by fragments of their clothing that carried bacteria and caused deadly gas gangrene.
Through experimenting on many, doctors found that cutting away infected tissue and soaking the wound in saline had the best results.

Surgery

Broken bones were common, prompting the use of new techniques like skin grafts, laying the foundation for plastic surgery.
Soldiers with head or facial injuries received improved surgery on eyes, ears, throat, and even the brain.
Harold Gillies, known as the father of modern plastic surgery, achieved notable success, such as reconstructing William M. Spreckley's nose using rib cartilage and skin flaps.

Did WW1 benefit medicine?

During the war, key medical breakthroughs were hindered as thousands of doctors and researchers were drafted to work on the frontlines and in military hospitals.
Trench warfare led to widespread illnesses like trench foot and typhus, spreading diseases in unsanitary conditions, and causing psychological issues like shell shock.
The war spurred governments to intervene in public health, with conscription revealing widespread physical problems and malnutrition among men.
After the war, victorious countries pledged better conditions for workers, with initiatives like Lloyd George's promise to build half a million new homes in Britain and the establishment of a Ministry of Health to improve sanitation and health.
Government involvement in public health persisted even during the 1930s economic depression, with measures like the introduction of free milk for school children in 1934.

WW2

The Second World War was larger and more widespread than the First World War.
War impacted the home front significantly during WW2.
Between 1918-1939, research on disease prevention and cures advanced with new inventions.
1931: Electron microscope invented.
1923: Edgar Allen discovered the female hormone estrogen in the USA.
1930s: Testosterone, the male hormone, was discovered.
1909: Paul Ehrlich found a chemical compound to treat syphilis.
1932: Gerhard Domagk discovered Prontosil, effective against blood poisoning.
Domagk tested Prontosil on his daughter with positive results.
French scientists identified sulphonamides, the active ingredient in Prontosil.
Sulphonamides led to new drugs for diseases like pneumonia.

Penicillin

In addition, in the interwar period, penicillin was developed. The mold from which it is made was first discovered in the nineteenth century and Lister had used it to treat an infected wound.
However, Lister did not document his work and it was not until 1928 that penicillin was rediscovered and experimented with by Alexander Fleming in London.
It seems that he found the mold growing by accident in a dish and realized its potential to fight infections.
However, he did not have financial support to develop his ideas.

1939: Howard Florey, an Oxford scientist, asked the British government for funding to develop penicillin.
1941: Penicillin tested successfully on mice; needed more for human trials.
Penicillin production was slow and costly.
The British government lacked funds and faced the risk of aerial bombings.
End of 1941: USA joined WWII.
1942: US companies received $80 million for mass production of penicillin.
1943: Penicillin was being mass-produced and used by the British Army in North Africa with great success.
Lieutenant Colonel Pulvertaft of the British Army noted its astonishing effects in 1943.

1944: Enough penicillin for every injured soldier during the D-Day landings in Normandy.
Penicillin was effective in preventing gangrene after D-Day.
1945: US army used approximately 2 million doses of penicillin a month.
Allied deaths might have increased by almost 15% without penicillin.
Time from injury to surgery had not improved since WWI; estimated 14 hours in the British army.
Delayed treatment allowed dangerous infections; penicillin reduced infections and increased survival rates.
1945 penicillin was 20 times more powerful than in 1939.

Surgical Techniques:

WWII spurred advancements in severe burn treatment.
Britain: Archibald McIndoe pioneered new techniques.
Russia: Vladimir Filatov pioneered reconstructive plastic surgery with new skin graft methods.
Russians researched 'biogenic agents' to aid healing.
The war led to a more sophisticated blood transfusion system.
Blood could be stored in bulk and quickly transported where needed.

Combating Diseases:

WWII was fought globally, with main theaters in Europe, North Africa, and Asia.
The Pacific war exposed troops to mosquitoes and malaria.
First coherent scientific investigation into mosquito bites conducted.
Australian doctor Neil Hamilton Fairley found one tablet of Mepacrine daily could limit malaria spread.
German scientists found Atebrin effective against malaria.
Soldiers were immunized against tetanus before battle, which proved very effective.

Public Health:

Post-WWII, governments improved public health, similar to post-WWI.
1942: Britain set up a government commission to offer post-war benefits.
The Beveridge Report recommended creating a welfare state with free healthcare, education, housing, and employment.
The British National Health Service (NHS) began in July 1948.
Hundreds of thousands of new homes were built in Britain.
Bombing destroyed much 'slum' housing, causing acute housing, food, fuel shortages, and lack of clean water across post-war Europe.
Many countries were economically devastated and couldn't afford urgent medical treatment for servicemen; public health was not the priority.