Medicine Through Time Revision Notes
Medieval Background Information
Wars destroyed Roman public health systems and medical libraries.
Rulers focused on armies, neglecting medical skills and public health.
War disrupted trade, causing economic decline.
Dangerous travel hindered communication between doctors.
Doctor training was abandoned; Galen's books were lost or hidden.
Church Influence
The Christian Church grew stronger, controlling education.
Monasteries were centers of education; only priests and monks were literate.
The Church established medical schools that taught Galen's ideas.
Libraries were located in monasteries; the Church sometimes banned books.
Monasteries provided clean water and toilets.
Medieval Hospitals
Hospitals, established by monasteries and run by monks/nuns, provided medical care for the poor.
They offered "hospitality" for visitors.
The ill were often turned away for fear of spreading disease.
Return of Hippocrates and Galen
Rediscovery of Galen's ideas aligned with Christian beliefs due to his references to "the creator."
Doctors considered Galen's ideas infallible.
Galen influenced doctors in the Arabic world and medieval Christian Europe.
Medical schools appeared in Western Europe, starting in Salerno, Italy.
Translations of Galen and Hippocrates were accepted as absolute truth in medical schools.
Arab Medicine
Islamic scholars developed ideas from the Greeks.
Aristotle's four humors, Galen's treatment by opposites, and Hippocrates' clinical observation persisted.
Books integrated Aristotle, Galen, and Hippocrates, transmitting these ideas back to Western Europe.
Muslims' reverence for the Koran discouraged criticism of Galen's works.
The Four Humours Theory
Medieval doctors believed illness stemmed from an imbalance of the four humors.
The theory evolved into a complex system based on astrology.
Human dissection occurred in medical schools, but findings were interpreted through the lens of the four humors theory.
Some doctors started to challenge traditional understandings.
New Developments in Medieval Medicine
More schools emerged, and human dissection was permitted.
Doubts arose regarding classical texts.
New diagnostic techniques included urine sample analysis.
Doctors believed stars caused disease and used astrology for treatments.
Trained doctors were expensive; medical care was often provided by monasteries and housewife-physicians using traditional cures.
Supernatural Beliefs and Treatments
The Church viewed illness as punishment for sins, advocating prayer.
Pilgrimages to holy shrines were believed to cure illness.
Doctors had superstitious practices, such as saying magical words and consulting stars.
Developments in Surgery
Warfare increased the demand for surgery.
Surgery was held in low regard, often performed by untrained barber-surgeons.
Wine was used as an antiseptic.
Surgical treatments were basic, as major surgery was risky.
Public Health Measures
Towns lacked Roman public health schemes.
People relied on cesspits and wells; waste was disposed of in the streets.
Beer was considered healthier than water.
The Black Death – 1348
Spread through coughs/sneezes and black rat flea bites on ships.
Arrived in Britain in 1348, causing sudden death.
Symptoms included exhaustion, high fever, swellings, and difficulty breathing.
Ships were quarantined for 40 days.
Perceived Causes and Treatments for the Plague
Miasma: Using sweet-smelling herbs and sitting between fires.
God: Praying or flagellation to appease God.
Humors out of balance: Using opposites, purging, vomiting, and bloodletting.
Poisoned water: Blaming the Jews.
Quick Summary of Medieval Medicine
Doctors followed Galen's ideas.
Illness was believed to be caused by imbalances in humours.
God and the Devil were believed to influence health.
Disease was seen as a punishment from God for sins.
Astrology was considered important for health.
Renaissance Background
Renaissance means rebirth, beginning with classical text study, critical of old translations.
Greater interest in human body workings via observation and dissection.
Artists attended dissections, creating illustrations for medical books.
Return of classical texts renewed faith in four humors theory.
Andreas Vesalius – Anatomy
Studied anatomy, became surgery and anatomy professor at Padua; performed dissections.
Wrote books with accurate diagrams, including 'On The Fabric of the Human Body' (1543).
Pointed out Galen's mistakes, such as holes in the heart septum and the jawbone structure.
Encouraged doctors to perform dissections for themselves.
Ambroise Paré – Surgery
Paré was a battlefield surgeon, a low-status profession.
Ran out of boiling oil for gunshot wounds and used Roman ointment of roses, turpentine, and egg yolk instead.
Developed ligatures to seal wounds, replacing cauterizing irons.
Conducted an experiment disproving Galen's bezoar stone theory.
Wrote 'Notes on Surgery' and became the King’s surgeon.
William Harvey – Circulation of the Blood
Discovered blood circulation, disproving Galen.
Identified differences between arteries and veins.
Became the King’s doctor, highly influential.
Wrote “An Anatomical Account of the Motion of the Heart and Blood” to spread his ideas.
Bleeding operations continued due to uncertainty on alternatives.
Blood groups discovered in 1901, enabling successful transfusions.
The Great Plague of 1665
Worst recurrence of the Black Death; ~100,000 deaths in London.
Efforts to control spread: Locked-down households marked with red crosses.
Carts collected corpses for mass burial in “plague pits”.
Realized disease was contagious, but didn't understand germs.
The Great Fire of London (1666) sterilized the city, killing plague bacteria.
Public Health During The Renaissance
Wars consumed resources.
Increasing urban populations strained water and sewage systems.
Factors Affecting Medical Progress During The Renaissance
Printing Press: Facilitated rapid spread of new ideas.
Weakening Church Power: Shift from religious to natural explanations, allowing dissection.
Artists Drawing from Life: Enhanced medical drawings in anatomy books.
Renewed Interest in Ancient Learning: Challenged old medical ideas (e.g., Galen’s septum holes).
1750 to 1900 Background Information
New understanding of the body made Galen's descriptions incomplete and wrong.
Microscopes proved Harvey's ideas correct.
The theory of the four humors no longer accepted.
Doctors carried out dissections and used microscopes, diminishing the importance of Galen's books.
Smallpox and Edward Jenner Inoculation
In the 18th century, smallpox was a significant killer.
Lady Mary Wortley Montagu introduced inoculation to Britain.
Healthy people could be immunized using pus from a mild smallpox case.
Inoculation sometimes led to smallpox and death.
Edward Jenner
Jenner, a country doctor, found that milkmaids didn’t get smallpox but got cowpox.
He discovered people who had cowpox didn’t get smallpox.
In 1796, he injected a boy with cowpox pus, then smallpox; the boy didn’t contract smallpox.
Opposition to the Smallpox Vaccination
Jenner couldn't scientifically explain how it worked.
Inoculators feared losing money.
Worries about cow-related side effects.
Some believed vaccination was unnatural.
Developments in Nursing
Florence Nightingale improved nursing's reputation through discipline and professionalism.
Despite family opposition, she became a nurse.
During the Crimean War, she improved ward hygiene, reducing the death rate greatly.
She wrote 'Notes on Nursing' and founded a hospital in London.
Mary Seacole
From Jamaica, volunteered as a Crimean War nurse but was rejected.
She self-financed her journey, nursed soldiers, and built the ‘British Hotel’.
Went bankrupt but received support due to press coverage, wrote an autobiography.
How Scientists Discovered the Causes of Disease?
Louis Pasteur’s Germ Theory (1857) shifted the paradigm in understanding disease.
Previously, microbes were thought to be caused by disease (spontaneous generation).
Pasteur found germs caused the souring of sugar beet during industrial alcohol fermentation to be from germs in the air.
Pasteur proved germs exist in the air by sterilizing water in a closed flask, which remained sterile until exposed to air.
Robert Koch
German scientist, linking specific diseases to specific microbes.
Developed solid mediums for cultures and dyeing techniques for microbes.
Identified anthrax spores and bacteria causing septicaemia, tuberculosis, and cholera.
Louis Pasteur – Chicken Cholera Vaccine
Pasteur competed to find new microbes and combat them.
Pasteur looked for cures to anthrax and chicken cholera with large teams of scientists.
Chamberland accidentally left cholera germs on his desk, weakening them.
Weakened cholera made chickens immune, leading to a chance discovery.
Louis Pasteur – Anthrax Vaccine
Pasteur’s team produced a weakened version of anthrax spore that would make sheep immune to the disease.
They demonstrated this in a public experiment.
Overcoming the Problems of Surgery
Surgery was dangerous and painful in the early 1800s; infection was the greatest risk.
Problems Faced Surgeons in 1800
Pain – Patients died of clinical shock during surgery.
Infection – People didn't know microbes caused infection. Surgeons wore the same dirty apron, spreading infection.
Bleeding – Patients died from blood loss.
How was the problem of pain overcome?
Ways to ease suffering of patients include getting them drunk, knocking them out and giving them opium.
Sir Humphry Davy discovered Nitrous Oxide or ‘laughing gas’.
Ether used by J.R. Liston during a leg amputation. However, it had very unpleasant side effects.
Chloroform used by James Simpson and some friends at his home. However, it led to unexplained deaths. The dose given could not be measured or controlled.
Reasons for opposition to anaesthetics:
They were uncomfortable for patients.
Some doctors believed that pain was good for healing.
People didn’t understand how they worked.
Didn’t understand the side effects that new substances could have on the body.
Final breakthrough came when Queen Victoria accepted chloroform during childbirth.
How was the problem of infection overcome?
Before germ theory, surgeons didn’t take precautions.
Joseph Lister used carbolic spray after reading Pasteur and knowing sewage smelled like gangrene.
Reasons for opposition to Lister:
Lister’s methods slowed down surgery.
The spray was uncomfortable for doctors to use, it affected their skin.
Pasteur’s germ theory was not widely accepted in 1857.
Surgeons did not copy his methods correctly and were therefore disappointed with their results.
By the late 1890s Lister’s antiseptic methods led to aseptic surgery.
Aseptic methods introduced:
Operating theatres and hospitals were rigorously cleaned.
All surgical instruments were steam sterilised.
Sterilised rubber gloves were first used and surgeon’s hands were scrubbed.
How was the problem of bleeding in surgery overcome?
Once William Harvey had discovered the circulation of the blood, the first blood transfusions were attempted.
Early blood transfusions often ended disastrously because…
Blood groups had not been discovered.
They could not prevent the blood from clotting.
Infection could be passed on.
Developments in Public Health
During the late 1700s and the first half of C19th, conditions in British towns became worse than ever.
Houses were built as close together as possible as more people crowded into factory towns to work.
Towns could not cope with the need to provide people with water and sewage disposal facilities.
In these squalid conditions, diseases spread easily and rapidly.
The conditions were so bad that many people’s health may have even become worse than ever before.
The Battle to Improving Public Health
Some thought that the government should force local councils to clean up their towns.
However, many believed that the government shouldn’t interfere – this attitude is called laissez-faire.
They believed the government should allow each local area to control its own affairs.
This meant that local ratepayers made all the decisions. Local ratepayers didn’t want the government to force them to pay for improvements to their towns.
Edwin Chadwick
In 1842 he was asked by the government to report on the living conditions and health of the poor.
Chadwick concluded that poverty was caused by ill health which was caused by the terrible conditions in which people lived.
He said that ratepayers can cut their taxes and save money in the long-term by looking after the poor and to spend money improving their health.
In his “Report on the Sanitary Conditions of the Labouring Population” he said industrial towns should:
Organise drainage and refuse collection
Provide a pure water supply
Appoint a Medical Officer of Health
For over 30 years an argument went on about the need for town councils or the government to take action.
Towns such as Liverpool and Manchester did start to build sewage and water-supply systems.
1848 Public Health Act
The government did nothing at first about Chadwick’s recommendations.
However, in 1848 there was another outbreak of cholera, this put pressure on the government to do something. Parliament reluctantly agreed to pass Public Health Act.
Although it was not compulsory. The government set up a Board of Health to encourage, but not to force, local authorities to improve conditions.
They gave local authorities money to make improvements in their areas if they wanted to and had the support of local ratepayers.
Only a few local authorities took any new measures.
By 1872 only 50 Medical Officers of Health had been appointed.
The Board of Health was abandoned in 1854.
1853 John Snow
In 1854 John Snow proved that there was a link between cholera and water supply. He used research, observation and door-to-door interviews to build a detailed map of a cholera epidemic in Broad Street.
Nearly all the deaths had taken place within a short distance of the water pump.
Near to the pump, there was a brewery and none of the people there had cholera. The brewery had its own water pump, and the men had been given free beer. They didn’t use the Broad Street Pump at all.
After collecting evidence, John Snow removed the handle from the Broad Street pump.
There were no more deaths. It later came to light that a cesspool near to the pump had a cracked lining which allowed the contents to contaminate the drinking water.
Snow put pressure on water companies to clean up their water supplies.
1858 Great Stink
For years human waste made its way from the latrines in London into the River Thames.
In 1858 the hot weather caused a ‘great stink’. The putrid smell was right under Parliament’s nose.
Parliament considered moving and had to coat their curtains with a deodorant to get rid of the smell.
The Great Stink prompted Parliament to sort out London’s sewage and drainage system and to clean up the River Thames.
Within a year Sir Joseph Bazalgette had begun to build an extensive system of sewers and drains that are still in operation today.
1867 Second Reform Act
Working class men were given the right to vote.
For the first time, it wasn’t just the ratepayers who got a say in improving public health.
MPs were forced to improve the living conditions of the poor.
1875 Second Public Health Act
Unlike the 1848 Public Health Act, the 1975 Public Health Act actually forced local authorities to introduce the following measures:
Provision of clean water
Proper drainage and sewage
The appointment of a Medical Officer of Health
Statistics - The government published statistics of where death rates were highest and what people died of. The statistics shamed some unhealthy towns into action.
Cholera Outbreaks - When cholera returned in 1865 and the link between disease and dirty water had been proven by John Snow, ratepayers were finally prepared to take action.
Weakening of Laissez Faire - The government saw it could no longer leave public health measures to individuals or councils, and realised that they had to take action.
By 1900 most British towns had built effective hygiene and water systems.
Result of the Public Health Act of 1875
Improved the standards of housing
Stopped the pollution of rivers from which people got water
Shortened working hours in factories for women and children
Made it illegal to add ingredients that made food unhealthy
Made education compulsory
Public Health – 1800 to Present Day
Limited – 1830s - A few towns introduced sewers, refuse disposal and clean water.
Optional – 1848 - 1848 Public Health Act, towns could set up Boards of Health if 10% voted for it.
Compulsory – 1875 - 1875 Public Health Act, councils forced to provide basic sanitation and medical officers
Comprehensive – 1948 - From cradle to grave, Pensions, National Insurance, Welfare State and the NHS.
What Medical Progress Did the First World War Bring About?
Surgeons had the opportunity to experiment with new techniques. Surgeons developed techniques to repair broken bones, and perform skin grafts – plastic surgery.
Soldiers promised good housing when they returned. This helped to get rid of unhealthy slum housing.
Surgery of the eye, ear, nose and throat all improved rapidly. Brain surgery also advanced.
The Development of X-rays
X-rays were first discovered 20 years before the war.
Hospitals installed X-ray machines, but it was the First World War which confirmed their importance.
More were manufactured to meet demand and they were installed in hospitals along the Western Front.
X-rays immediately improved the success rate of surgeons in removing deeply lodged bullets and shrapnel which would otherwise have caused fatal infections.
Blood Transfusions
In the renaissance, Harvey proved blood circulates and this encouraged experiment with transfusions.
It sometimes worked and sometimes failed. Scientists didn’t know about different blood groups.
Blood groups were discovered in 1901 by Karl Landsteiner. The discovery made transfusions successful.
During the First World War vast amounts of blood was needed. On-the-spot donors were impractical. Many soldiers bled to death in the trenches before blood could get to them.
The search began for a better method of storage and transfusion. Doctors discovered how blood can be bottled, packed in ice and stored where it was needed. This discovery helped to save many lives.
The Discovery and Development of Penicillin
Fleming discovered mould killed germs. Writes articles but publishes them in book with an obscure name.
Chain and Florey begin research in Oxford after reading an article by Fleming. They experiment with mice.
Penicillin is first tested on a human being in Oxford.
U.S. and Britain fund production of penicillin.
Enough penicillin is produced to treat all the allied forces wounded in the D-Day invasion of Europe.
Factors Leading to the Development of Penicillin
Government – British government funded Florey’s research, U.S. government funded mass production.
Technology – microscopes and bacteria growing mediums.
Scientific experiment – testing on mice.
Individuals – Florey and Chain were skilled scientists supported by a skilled team of researchers.
War – the growing casualties of World War Two added to the urgency to mass produce penicillin.
Chance – Alexander Fleming discovered penicillin by chance in 1928.
Impact of the Second World War
Blood transfusion –blood could be stored for longer, civilians donated blood.
Diet – rationing improved some people’s diet, government encouraged healthy eating.
Drugs – penicillin was developed as the first antibiotic.
Poverty – evacuation took children out of urban areas. Highlighted contrast between rich and poor.
Surgery – developments in the use of skin grafts and treatment of burns.
Hygiene – government posters education people about health and hygiene.
The National Health Service
WW2 broke down social distinctions and brought people together.
The raising of armies made powerful people take notice of the health problems of the poor.
Evacuation of children increased awareness of how disadvantaged many people were.
After the Second World War people looked for improvements in society. Such feelings led to the 1945 victory for the Labour Party.
Introduction of the NHS
Sir William Beveridge published his famous Beveridge Report in 1942. In it he called for the state provision of social security “from the cradle to the grave”. The report became a bestseller.
Aneurin Bevan was the Labour Minister for Health who introduced the National Health Service.
National Insurance was introduced to pay for the NHS. Doctors and dentists were wooed with a fixed payment for each patient. They were also allowed to continue treating private fee-paying patients.
The NHS Still Has A Few Problems…
Governments have reduced how much of the NHS is free – charging for prescriptions and dental health.
Long waiting lists and doubts about the quality of treatment have led to paying for treatment outside NHS.
Longer life expectancies have meant more need for care of the elderly and increased costs for the NHS.