Medicine through time
6 key features of medieval life
-rural communities
-majority of people worked in fields growing crops on land owned by lords-feudal system
-not many towns and cities and they had dirty crowded streets
-catholic church dominated all ideas including medicine
-limited scientific knowledge
5 key effects on medicine of the catholic churches domination
-controlled learning (including uni's) so controlled ideas
-books produced and kept in monasteries-only monks and priests could read and write so the church controlled what was read
-supported Galens ideas because they fitted with Christian ideas i.e having a soul and being created by God
-discouraged dissection-only to show Galen's ideas
-encouraged care of the sick-hospitals in monasteries and nunneries
what was the main supernatural idea for causes of illness in the medieval period ?
-disease was a punishment or test from God because of sin
what natural theories did people have about the cause of disease in the medieval period?
-Theory of 4 humours-Hippocrates wrote the body had 4 liquids(blood, phlegm, black bile and yellow bile) and if they were out of balance illness was caused-humours had to be balanced to cure the illness-blood letting and purging
-miasma
4 supernatural ways to prevent illness in medieval England
-keep God happy-be a good christian with no sinning
-self-punishment-flagellants in the black death-if they punished themselves God wouldn't give them the plague so they walked through streets whipping themselves
-chanting incantations and prayers
-carrying lucky charms
3 natural ideas about how to prevent illness in the middle ages
-keep humours in balance- not overeating, exercising, blood letting and purging
-keeping streets clean to avoid miasma-laws passed to purify the air with sweet smells and streets cleaned
-regimen sanitatis-advice on how to maintain a healthy lifestyle-list of instructions from a physician on exercise, diet and bathing and keeping away from miasma
how were physicians trained in the middle ages ?
-went to universities that followed catholic churches ideas
-Galen's ideas taught with dissection only to prove Galen's work
how did medieval physicians diagnose illness ?
-check balance of humours-checked the colour, taste and smell of urine in their handbook (vadememcum)
-check alignment of the planets for influence on humours and used zodiac charts on when to treat a patient
what supernatural treatments were used in the middle ages to cure disease ?
-pray,fasting, going on pilgrimage, paying for special mass to be said
-treatments based off specific ideas for specific illnesses
why did the sick get touched by the monarch ?
-belief in divine right of kings and link to God so thought to be able to cure illness
theory of opposites
-made by Galen
-believed the humours could be balanced by giving the patient the opposite of their symptoms
how could the humours be rebalanced ?
-bleeding-cutting a vein or leeches, done by barber surgeons
-purging-using herbal remedies to evoke vomiting or diarrhoea
-herbel remedies to drink, sniff, bath or rub in
medical professionals in the middle ages
-physicians-trained at university and ideas based of Galen and Hippocrates-very expensive so they were rich
-Apothecaries-like chemists who mixed herbal remedies for everyone in society
-barber surgeons-did barbering work but also dealt with more physical problems like pulling teeth and surgery
-wise women-local women who knew many herbal remedies and often used by the poor
5 key points about medieval hospitals
-monasteries offered hospitality to travellers but had infirmary connected to them
-1100/1500 with 30% church ran, the rest ran by charity from a rich person
-followed religious teachings so focused on caring not curing-only prayed to cure
-mainly places to rest and recover, kept clean with fresh food
-monks and nuns did the caring
-people with infectious disease were usually not admitted, and those with incurable conditions
-few specialised hospitals for lepers, insane and old
When was the Black death
1348
3 causes for the black death people believed
-supernatural:
-God as punishment for sins
-astrology
-natural:
-miasma
-imbalance of the humours
-blaming outsiders like jews
what actions based on natural ideas did people try to do to prevent the black death ?
-miasma:
-clear streets of rubbish
-carry herbs and spices
-light fires and ring bells to keep air moving
-imbalanced humours:
-bleeding, purging, diet and exercise
-herbal remedies
how did people try and treat the black death ?
-supernatural-praying,holding lucky charms
-natural-rebalance humours and herbal remedies
3 reasons why there was continuity around ideas in the cause of disease throughout the medieval period
-influence and power of the church in the middle ages
-attitudes in society-medical ideas had always been the same so people didn't think they needed a change
-lack of scientific understanding
3 reasons why there was little change in the care provided by hospitals in the middle ages
-influence and power of the church
-treatments didn't change
-lack of training-monks and nuns were the only caregivers and only trained in biblical ideas
continuity between renaissance life and medieval life
-rural communities dominate with towns still experiencing poor public health
-increases in population during this period in villages and towns
-Galen and Hippocrates ideas still followed with limited alternative ideas
the english reformation in the renaissance
-England became protestant not catholic
-church no longer dominated society and monasteries closwd
change between life in the middle ages and renaissance life
-weakening of the catholic church so now there could be challenges to the churches beliefs including medical ideas
-church no longer controlled learning
-key individuals begin to use scientific methods to investigate medical ideas as people were more curious about the world around them
how important was the printing press to medical understanding ?
-new ideas could be published more quickly and accurately
-work of important individuals could be spread to a wider audience
-catholic church couldn't control ideas
4 facts about the Royal Society
-British organisation set up in 1660 by scientists and physicians who wanted to share experiments and discuss new scientific ideas
-support from King Charles II gave it credibility
-published work in English not latin
-sponsored scientists to carry out research
why was the Royal Society important to the development of medical understanding ?
-new ideas shared and discussed
-new medical ideas to be confirmed or dismissed
-new ideas spread more quickly
what supernatural ideas about the causes of disease did people still believe in the renaissance ?
-God caused disease
-astrology
What natural ideas did people still believe about the cause of disease ?
-Theory of 4 humours
-miasma
What was beginning to change in ideas about the cause of illness in the renaissance ?
-move away from the supernatural
-more emphasis on natural ideas of cause like bad air, which became the most popular idea of cause by 1700's
-illness based on external factors
what stayed the same on how illness was prevented in the renaissance from the middle ages ?
-getting rid of miasma
-living a good christian life
-keeping humours balanced
-regimen sanitatis
what was different in how illness was prevented in the renaissance compared to the medieval period ?
-more emphasis on removing miasma by temoving waste and dirt
-believe God would cure but not cause illness
-work of Sydenham encourages to look at surroundings eg weather and diseases in the area as well as external factors eg not humours
what area of medical knowledge did Vesalius improve ?
anatomical knowledge of the body
how did Vesalius find his new knowledge ?
-dissected human bodies
-checked bodies with Galen's work
Give 3 examples of what Vesalius found out about the body which Galen got wrong
-human jaw bone in 1 part not 2
-human breast bone in 3 parts not 7
-men didn't have fewer ribs than women
why is Vesalius important?
-proved Galen wrong about anatomy
-encouraged experimentation, dissection, questioning
what was Sydenham's ideas about disease ?
-not die to the nature of the patient but external factors
-could be organised into different groups
-observation of patient's symptoms important to diagnose
why is Sydenham important ?
-moved Britain away from concentrating on Galen's ideas on diagnosis and encouraged observation of patients symptoms
-developed a new way of classifying and differenciating between diseases
-came up with alternative treatments eg cinchona bark from Peru to treat malaria
What area of medical knowledge did Harvey find out ?
physiological knowledge about how the circulatory system worked
What did Harvey find out ?
-heart was a pump
-heart pumped blood around the body in 1 direction
-arteries took blood away from the heart
-veins took blood back to the heart
-there was only so much blood in the body
the factors which helped Harvey make his discovery
-experimentation-dissection of animal and human hearts
-challenging old ideas-found out Galen was wrong about the body making blood and using it like a fuel
-credibility-physician to King Charles I
-technology-saw how water pumps worked and it gave him inspiration
-individual abilities-determined to find out for himself
-impact of others-influenced by work and teachings of others who supported investigation eg Fabricus in Padua
How was Harvey's work important short term and long term ?
-short term:
-encouraged other scientists to dissect human bodies
-no practical use in medical treatments so treatments didn't change because of his work
-many doctors ignored his work and continued to use Galen's until 1651
-long term:
-proved Galen wrong and how the circulatory system worked
-helped doctors understand how the body worked and understand the importance of not bleeding
-Harvey's ideas appeared in universities in 1673
-ideas were the basis of future treatments like blood transfusions
-importance of blood linked to surgical developments in the 19th century
what stayed the same from the middle ages in physician training compared to the Medieval period ?
-still trained at universities
-many ideas about causes and treatments from Medieval period still taught like Galen's ideas
How had physician training changed in the renaissance ?
-trainee doctors could get more medical textbooks with new ideas eg books by Vesalius, Harvey and Sydenham
-by 1700 doctors studied anatomy and botany as well as traditional texts
-new ideas of diagnosis from Sydenham
-more observation and examination of patients from Sydenham
-didn't use urine to diagnose illness
what stayed the same and changed in apothecaries work in the renaissance ?
-continuity-mixed herbal and chemical remedies and still cheaper than doctors
-change-more training with apprenticeships run by a guild and needing a licence to practise-use of iatrochemistry
what stayed the same and changed in the work of a barber surgeon in the renaissance
-continuity-carried out surgical procedures and used by all of society
-change-needed a licence to practise
How much change was there in medical treatments ?
-very little
-no new ideas about cause of illness so no new treatments
-ordinary people continued to use the treatments used for years
-medical training at university continued for many years to teach Galen's work
What changed in the treatments available in the Renaissance compared to the middle ages ?
-new herbal remedies using plants from the new world (the america's)
-iatrochemistry-new focus on chemical cures-alchemy was the study of metals to try and turn ordinary metals into gold-knowledge discovered about chemicals used in trying to develop new cures
-transference-the belief that an illness or disease could be transfered to something else eg rubbing a boil with an object or sleeping in the same room as an animal to transfer a fever
how was treatment similar to the middle ages in the renaissance ?
-still mainly provided by female relatives at home
-hospitals existed for care of sick
how was care different compared to the middle ages in the renaissance ?
-changes to hospitals :
-fewer hospitals
-hospitals secular and not religious
-care was based more on medical treatment
-new types of hospitals :
-pest houses-hospitals that looked after people with 1 type of disease
-also known as plaguehouses or poxhouses depending on the disease of the patients
when was the great plague ?
1665
what did people believe about the causes of the great plague ?
-miasma-most popular belief
-God and astrology
-it could be passed between people
what was the most important way tjey tried to prevent the great plague ?
-increased efforts by local government to get rid of rubbish which was causing bad air eg removing rubbish off streets and killing stray animals
how did people try to treat the great plague ?
-prayer and lucky charms
-herbal remedies eg. mint and rosemary
-transference-the idea that illness could be transferred from one organism to another
-sweating-disease could be sweated out so sufferers wrapped in blankets in hot rooms
what was the same and what was different when comparing the great plague and the black death ?
-continuity:
-cause-miasma
-preventation-getting rid of miasma with nice smells and fires
-treatment-praying to God and herbal remedies
-change:
-cause-more emphasis on miasma
-preventation-more scientific approach to getting rid of miasma
-treatment-more herbal remedies available (nutmeg) and the ideas of transference and sweating
3 reasons why there were advances in medical understanding in the 17th century
-weakening of the power of the catholic church
-work of important individuals
-work of royal society
3 reasons why the impact of medical discoveries in the renaissance were so small
-discoveries weren't about what caused illness
-medical training at universities still concentrated on Galen's work
-attitudes in society remained the same about causes-ordinary people still believed in the 4 humours and that God would cure illness
key features of industrial period life
-dramatic change in how people live
-increased urbanisation
-increased use of technology
-more organised workforce
-more government control over people's lives
-increased scientific investigation about the world
how did urbanisation affect people's health in the industrial period ?
-poor public health-no clean water and lots of sewage
-easy spread of diseases-cholera, TB, typhus
what supernatural idea did people still have about the cause of illness in Industrial England
-God-especially during epidemics
what natural ideas (wrong) did people still have about the cause of disease ?
-humours-not too popular though
-miasma
new ideas about the cause of illness in the industrial period
-1800-little change from renaissance at the start
-new idea of spontaneous generation theory-microorganisms were caused by decay
-1900-major development-germ theory-microorganisms cause decay in food and disease-different germs cause different diseases
key points of germ theory
-germs are micro-organisms which cause disease
-in the air but not evenly distributed
-invisible to the naked eye
-killed by heating them
who developed germ theory and when ?
Louis Pasteur in 1861. In 1878 germ theory of infection was made
Pasteur and germ theory
-asked by brewing company to explain why liquids were going bad
-observed microbes in liquids and theorised they could be the problem
Koch and Germ theory
-read Pasteur's work and began to study microbes
-proved a specific germ causes a specific disease so proving the theory
observation and experiment and germ theory
-what Pasteur and Koch based their work off and recorded the results
institution and Germ theory
-French academy of science held competition to prove or disprove spontaneous generation theory
-Pasteur showed a series of experiments to prove Germ theory and disprove spontaneous generation
technology and germ theory
microscopes were powerful enough so that Pasteur and Koch could view micro organisms
impacts of germ theory in Britain
-positives:
-lister developed antiseptics
-more evidence to support government action to keep cities clean
-limitations:
-most doctors still followed spontaneous generation and miasma theories, like Dr Henry Bastion
-British government believed in bad air-rejected idea germs were in wayer when there was a cholera outbreak in India in 1884
-Pasteur was a scientist working on food and drink not a doctor so people not willing to believe
-only with Koch's work to prove germ theory were people more convinced but this was 20 yrs after Pasteur's first publication
how did pasteurs work link to Jenner's ?
-germ theory explained why Jenner's vacinations worked
-new vaccines could be developed
-pasteur also discovered weakened micro-organism could be used as a protection from a stronger micro-organism
what other developments did Koch make ?
-easier to grow bacteria-in agar jelly
-easier ways to see bacteira under microscope-staining with dyes
what remained constant in preventing illness in the industrial period from earlier times ?
getting rid of miasma
key changes to the preventation of illness in the industrial period
-vaccinations-Jenner developed the first ever vaccine to prevent smallpox
-work of pasteur-explained vaccinations and developed new ones
-change in government attitude- no longer attitude- public health act 1875
-more scientific approach-investigation and evidence which supported improvements
why did governmental attitudes towards public health change in the 19th century ?
-cholera epidemics of 1831, 1848-49, 1854, 1858
-1858 great stink- the river thames smelled so bad in summer that parliament couldn't sit
-1867 working men got the vote- wanted MP's who would improve their living conditions realised only government could take necessary action-building sewers and checking water had to be done by government
public health act 1875
-compulsary action by city authorities
-provide public health facilities-clean water, sewers, public toilets, street lighting and public parks
-appoint public health officer to moniter disease and health of citizens
-check new buildings- not damp, overcrowded and unsafe
what remained constant in physician training in the industrial period ?
-still trained at universities
-improvements in renaissance continue
how did physician training change in the industrial period ?
-surgery was now included in the syllabus
-germ theory gaining more acceptance
-working with professional nurses when caring for the sick
continuity and changes in apothacaries in the industrial period
-continuity:
-mixed herbal and chemical remedies and still available and sold to all in society by a variety of shops
-change:
-pharmacy developed as a profession
-pharmaceutical society of Great Britain established in 1841
-society wanted any practicing pharmacy to have training and be registered
-registration compulsary after 1868
what continued and changed for surgeons in the industrial period ?
-continuity:
-carried out surgical procedures
-change:
-by 1800 surgeons had separated from barbers
-Royal College of Surgeons establihsed in 1800
-college trained surgeons and exams increasingly rigorous with new developments in surgery
-increasingly respected by society
how much change was there in the industrial period for medical treatments ?
-progress:
-surgical developments as 2 problems solved
-no longer used idea of transference
-limited:
-concentratuon on preventation
-scientists hadn't discovered ways of destroying germs in the body
-ordinary people continued to use old treatments for years- eg herbal remedies
why was the problem of blood loss in surgery not solved by 1900 ?
didn't know about blood groups until 1901
what solutions to pain in surgery had been tried before Simpson's work ?
-alcohol-patient still moved about
-ether-was flammable and made patients sick and cough
Simpsons solution to the problem of pain in surgery
-chloroform-an anaesthetic which made the patient unconscious
-sniffed different chemicals and realised what it could be used for
opposition to Simpson's work
-dosage was hard to get right and some people died
-religious people thought pain was from God and had to be endured
impacts of Simpson's discovery
-positive-surgery could be slower so less mistakes and more complex surgery possible
-negative-more complex surgery had higher risks so more deaths and still problems of infection and blood loss
what did Lister use to solve the problem of infection ?
Carbolic acid- an antiseptic
impacts of Lister's work
-negative-took a while for Lister's work to be accepted as more acceptance of germ theory
-positive-inspired others and development of aspetic surgery
continuity in caring for the ill in the industrial period
-still mainly provided by female relatives
-hospitals existed for care of sick
what were hospitals like by the 1850's
dirty, disease spread fast, limited professionals, care by family and had a bad reputation
how was nursing viewed in the industrial period before Nightingale
-not seen as a respectable profession
-nurses unskilled with bad reputation for laziness and drunkeness
how was care in hospitals post nightingale different to prior time periods
-only trained staff- doctors employed by hospitals to provide care and treatment supported by trained nurses
-buildings clean with fresh air and good medical supplies
-government set up infirmaries-hospitals for the poorest in society
-specialist hospitals set up for mentally ill and infectious diseases
Florence Nightingale
-in 1854 took over the military hospital in Scutari during the Crimean war and became a national hero
-credibility as heroine allowed her to influence government policy
-wrote books on nursing, how to train nurses- set up nursing school for educated and respectable women so improved reputation of nurses and making nursing a profession
-she influenced hospital design concentrated on making them easy to clean with separate wards to separate infectious patients- even though she didn't believe in germ theory
what was the first way to prevent smallpox ?
inoculation-exposure to a weakened form of the disease to protect against a more serious infection
how did Jenner discover and spread his vaccination for smallpox ?
-decided to investigate the idea if you had cowpox you didn't get smallpox (observations of milk maids)
- infected local people (such as James Phipps) with cowpox and tried to then infect them with smallpox but failed proving that catching cowpox prevented catching smallpox
-1798 wrote up his findings and published them privately as royal society wouldn't as they saw him as only a country doctor
3 reasons why Jenner was able to develop a vaccination for smallpox
-determination-decided to find out for himself if cowpox was actually a preventation
-experimentation-infected people with cowpox and then smallpox
-government support-given money to set up clinic and give vaccinations
5 reasons why people didn't support Jenner's vaccination
-Jenner could prove it but not explain it
-Jenner was only a country doctor so had limited credibility
-people thought they shouldn't be given an animal disease
-inoculators and doctors lost money with the introduction of vaccination
-some doctors didn't vaccinate properly so it didn't work
how did the government help to develop Jenner's vaccination
-1802 parliament have £30000 grant to Jenner to open vaccination clinic to promote it
-1840 introduced free vaccination to children
-1852 vaccination made compulsary
3 reasons why Smallpox was prevented in the 18th century
-Jenner inventing an effective vaccination
-Government support
-Royal Jennerian Society-organisation of people who supported Jenner's ideas and spread the importance of being vaccinated-gave his development credibility as had important supporters such as the King's son
when and why were there major cholera epidemics in the 19th century ?
-1831, 1848-49, 1854, 1858
-nobody knew the real cause was germs in water so didn't know how to stop it spreading
-urbanisation conditions helped spread it- no clean water, no good sewage disposal, overcrowded conditions
Pre John Snow what action did the government take on Cholera ?
-belief in spontaneous generation led to keeping homes clean and attempts to clear away rubbish
-limited impact as actions based off incorrect theories and government reluctant to deal with public health issues