Medicine through time
This unit is a study of change over time focusing on developments in
medicine from 1350 up to the present day.
It is vital that you are aware of changes over time and what factors
lead to this change. There are examples of case studies throughout
this revision guide which are intended to give examples of this, e.g.
the Black Death
A simple mnemonic you might wish to use to help you remember most
of the key factors for change is;
CABSTWIG
(Communication, Attitudes & Beliefs, Science & Technology, War,
Individuals and Government)
Two key areas you must know about are;
Ideas about the causes of disease
How disease is treated or prevented over time including the role of
doctors, nurses and hospitals.
Medicine Through Time- a Summary
Ideas about the Causes of Disease
1350-1750
The Supernaturalwitches, the devil or God
punishing us. The Church
encouraged this belief.
Common sense- They had
a basic understanding
that bad smells could
make people ill.
1750-1900
Some people still believed
in the Supernaturalwitches, the devil or God
punishing us. Power of the
Church dwindling.
They still had a belief that
bad smells could make
people ill; Miasma Theory
Astrological- The
movement of the stars and
planets could cause illness
or certain emotions.
Comets could be an omen
that an outbreak of
disease was imminent.
Astrological- The
movement of the stars and
planets could cause illness
or certain emotions.
Comets could be an omen
that an outbreak of
disease was imminent.
The Four Humours- The
four liquids (blood,
phlegm, black bile and
yellow bile) could become
unbalanced and make a
person ill. This theory
dominated medicine for
the next 1500 years, even
when people believed less
in supernatural causes.
This theory meant that
people didn’t need medical
expertise or training to
treat the sick.
Spontaneous Generation –
the belief that microorganisms from decaying
objects caused disease
1900 onwards
More rational ideas based
on Science, e.g. Germ
Theory; however, this did
not explain the hereditary,
lifestyle or environmental
causes of disease.
The Origins of Medicine.
Hippocrates- Greek doctor. His Hippocratic Collection of medical books were used for
hundreds of years. He made careful observations and recorded symptoms and treatments so
that he could learn for future patients. He developed the theory of the humours and how to
rebalance them by bleeding, purging and using natural treatments like a good diet and
exercise.
Galen- Roman doctor. A surgeon to Rome’s gladiators, he also travelled with the Roman
army for 12 years. He also observed patients carefully but dissected mainly animals. He
developed the theory of the four humours by using opposites to treat illness eg blood is a
‘summer’ humour and its opposite is phlegm which is ‘winter.’ He wrote over 60 books on
Hippocrates and his own experiences.
The Medical Renaissance- increased understanding in medicine.
Vesalius- Born 1514, studied medicine in Paris and Italy
where he specialised in anatomy and became a professor of
surgery and wrote his book, ‘The Fabric of the Human
Body’ published in 1543. He found through dissections on
people that Galen was wrong on some anatomical details.
People were angry at his criticisms of Galen but he proved
that the lower jaw is in one piece, not two. He also proved
that blood couldn’t travel through the Septum in the heart
from one side to the other.
Harvey- Born 1578, doctor in London then lecturer in
anatomy. Published ‘An Anatomical Account of the
Motion of the Heart and Blood in Animals’ in 1628. He
proved that blood is not made in the liver and then used
up as Galen suggested, instead it is pumped by the heart
and moves around the body through arteries and veins.
He couldn’t prove the existence of capillaries because
microscopes were not yet strong enough. He encouraged
people to test Galen and experiment more.
Changing understanding of the cause of disease
1350-1750
Case Study 1- The Black Death 1348
Killed both rich and poor, the plague came several times after 1361. The Black Death 1348
included both the Bubonic and Pneumonic Plague. People believed it was caused by corrupt
air, the Church blamed supernatural causes or God was punishing that people. Some blamed
the Jews and said they were poisoning Christians.
Case Study 2- The Great Plague 1665
People believed it was caused by a comet that had appeared before the Plague. Religious
people believed God had sent it, others blamed the air and invisible creatures that could enter
the body.
The factors aiding understanding of cause of disease during the Medical Renaissance
 Beliefs- The Reformation weakened the Catholic Church so scholars and doctors could
question theories.
 Science and technology- Johann Gutenburg introduced the printing press to Europe
1454 so books could be made quickly and cost less. Ideas and developments were shared
much more quickly.
 Wars- many wars during the 16th and 17th Centuries meant opportunities to practice
for men like Pare but it also prevented the spread of ideas and knowledge.
 Communications- Old books, which the Church had hidden, became available and
travel to The New World brought new plants and cures eg quinine for Malaria.
 Money- European countries had grown wealthier as wars decreased and trade
increased, more money was spent on education and luxuries.
 Education- Literacy increased and the number of schools, Church control of universities
lessened, professional medical societies were set up eg The Royal College of Surgeons.
 Individuals- Vesalius and Harvey proved Galen wrong.
 Da Vinci and Michelangelo used art to improve anatomical understanding.
The Scientific Revolution- rapid growth in sciences such as astronomy, maths, physics and
chemistry, which helped doctors understand the body better. Why?
 Science & technology- interest in astronomy using telescopes, which led to microscopes.
 Beliefs- shifted from religious to scientific explanations for the universe. People wanted
proof and reasoning.
 Communications- more societies were set up such as the Royal Society in London and
the Academie de Science in France. These gave scientists the chance to meet and
discuss new discoveries; they also helped publish people’s work.
 Government- Charles II was interested in science and new medicines, he granted a
Royal Charter to the Royal Society which boosted public interest.
 Education- Medical schools in universities became more scientific as doctors had to
learn anatomy, chemistry and botany instead of reading Galen.
 Individuals- Descartes a philosopher argued everything must be reasoned so scientist
and doctors need to conduct tests and link ideas to reach judgements. Galileo proved
the earth went around the sun and Newton discovered gravity, these showed how much
more there was to understand and that things people took for granted could be wrong.
1750-1900
Louis Pasteur- French scientist hired by brewing company to stop beer going bad. He knew
something was getting into the beer from the air and went on to develop his Germ Theory. He
also worked with the dairy, silk and chicken industries. Pasteur entered a competition to
disprove Spontaneous Generation and prove his own theory, he won and his Germ Theory was
published in 1861. With government funding he proved that micro-organisms cause disease
and so he had explained the cause of contagious diseases and infections.
Robert Koch- German doctor, meticulous researcher. Worked for the German government
with a team of bacteriologists. Researched Anthrax as well as other diseases, grew and
observed bacteria, developed a method of staining bacteria so they could be studied more
easily.
What caused the breakthrough in understanding the causes of disease by 1880?
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Individuals- Dutch clockmaker Anthony Van Leeuwenhoek developed an early microscope and
saw ‘animalcules’ which were on and in almost everything. Pasteur proved his Germ Theory.
Joseph Lister developed a microscope that could magnified by 9000. Robert Koch
experimented on animals to understand illness and developed a new solid medium to study
bacteria in- this led to identifying the bacteria for anthrax, TB and Cholera and then cures
could be discovered.
Technology- By the 1800s purer glass led to more powerful microscopes. Sterilised glass
flasks, thinner tubes and other equipment could be used more reliably in experiments. New
discoveries in dyes enabled Koch to stain the bacteria he wanted to identify.
Government/Money- The French government ran the competition to disprove Generation
Theory. Pasteur was provided a team of specialists to work with him. The German
government gave Koch a full time job and research team as well as money.
Industry- Pasteur hired and paid by a brewing company to find why beer went bad and then
the French silk industry to find out what disease was affecting silk worms.
Communications- Anthony Van Leeuwenhoek published his findings in 200 papers. Pasteur’s
Germ Theory was published in 1861. People were able to travel far more to be treated as
transport improved and fewer wars were fought.
War- Germany and France had fought a bitter war 1870-71 so Pasteur and Koch were natural
rivals and spurred on to each make discoveries and find vaccines before the other.
1900-Present
The use of x-ray
X-rays were first identified by Wilhelm Rontgen in 1895 when he was experimenting with
cathode rays and found they could travel through mediums such as paper and flesh. His
discovery caused great excitement and within 6 months hospitals were installing x-ray
machines.
X-ray enabled doctors to see inside the body so that diagnosis could be made for diseases and
internal wounds or problems without patients needing to be cut open. It was particularly
useful during the World wars for injuries soldiers had gained.
Marie Curie’s discovery of Radium whilst experimenting with x-rays led to the use of
radiography to diagnose cancer.
The discovery of DNA
DNA exists as a list of instructions in every cell of our bodies. We each have more than
3000million letters of code. Instructions are grouped together in sets called codes, every gene
has a different function.
By the early 20th century scientists knew DNA existed and that it carried genetic information
but they didn’t understand how it did this.
1951- Maurice Wilkins and Rosalind Franklin worked together at King’s College London.
Franklin developed a technique to take a photo of a single strand of DNA using X-RAYS but
wasn’t able to describe it.
1953- Using Franklin’s x-ray photos, two scientists called Crick and Watson who were
working in a Cambridge laboratory discovered DNA was a double helix and a blueprint for
life.
1990- The Human Genome Project was set up to identify the role of each of the 100,000 genes
in a human DNA molecule and compile a complete map of human DNA.
Why was DNA discovered in 1953?
Individuals- Wilkins was an expert in x-ray photography, Franklin used his experience to
develop a method of photographing a single strand. Crick was a specialist in molecular biology
and genetics, he knew a lot on biophysics too and was partnered with Watson, also a genetics
specialist.
Technology- Microscopes allowed scientists to look in cells, Mendel had showed that
characteristics are passed from one generation to the next. X-ray allowed the study of DNA.
Money- This type of research involved many complex processes and expensive equipment, it
needed highly skilled people and was time consuming. Money came from both governments
and industry.
Teamwork- Crick and Watson inspired each other and were described as fun-loving,
ambitious, impatient and honest. They would tell each other if one was heading in the wrong
direction and kept each other focussed.
Why was there so much progress with the Human Genome Project?
Research teams- 18 countries took part in completing the map of DNA. Each team took
different strands of DNA to discover it’s purpose.
Money- from governments and large drug companies who hoped to profit from drugs
developed through DNA.
Technology- computerisation was vital in collecting, recording and analysing data.
Communications- Use of CDs, DVDs and the internet made sharing developments around the
world possible in minutes.
Impact of DNA
Gene Therapy- using healthy genes to cure the sick when disease is caused by one abnormal gene. This
is possible but not yet fully developed.
Customised drugs- creating drugs to suit individuals and their genetic condition.
Genetic Engineering- creating new plants and animals eg new varieties of drought resistant wheat.
Genetic screening/testing- doctors can screen patients to find faulty genes and then produce medicine
Treatments
to prevent illness. Unborn babies can also be tested for conditions such as Downs Syndrome.
Approaches to Treatment and Prevention of Illness
1350-1750
A range of treatments were used in medieval times:
Humoural- Trying to balance the 4 humours in the body through actions such as bleeding,
purging (vomiting), hot/cold foods and changes in climate.
Herbal Remedies- The main treatment used by doctors and villagers. Knowledge of herbs was
passed down by word of mouth or books. Many remedies had been developed through trial and
error e.g. anti-bacterial properties of garlic. Foreign herbs were increasingly available but
there had been little change in treatments by 1750.
Case Study 2:
Case Study 1:
The Black Death 1348
Bishops led processions and pleaded with God, the Flagellants
whipped themselves and painted crosses on their bodies. People
used perfumes and herbs to ward off deadly vapours. Church bells
were rung, people wore charms and talismans, and they cast
spells. Doctors tried to balance the four humours.
The Great Plague 1665
Charms were worn, people used
treatments like feathers from a
chicken’s tail but mostly they did the
same as in 1348. The sick were now
locked up and guarded to prevent
them spreading infection.
Who treated the sick?
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Physicians- qualified doctors who studied the works of Galen at university; it was very
expensive to see a qualified physician.
Apothecary- sold and mixed medicines, were not supposed to treat or prescribe for
patients but many did for a small fee.
Surgeon- trained by observing and copying experienced surgeons, given licenses by
local Bishops and were though of as 2nd class doctors.
Midwife- supervised the last weeks of pregnancy and delivered the baby, if there were
problems they had to refer the patient to a physician.
Family- most common, wife or mother who looked after and treated family members.
Wise Woman- good knowledge of herbs and treatments which had been passed down
through generations but they could be accused of witchcraft if things went badly.
Travelling Quack- travelled to fairs and markets and sold herbal remedies, most wee
fraudsters.
Hospitals- before 1700 there were few; after 1700 new hospitals opened by charities
and local councils; most looked after the poor but would not admit anyone with
infectious diseases; rich people paid for someone to care for them at home.
1750-1900
During this period the methods used to fight disease changed:
Case Study 1: SMALLPOX
Fighting Smallpox before the 1720s:
People avoided those who were infected. Their belongings were disinfected with vinegar after their death. Ineffective and most
people who survived were badly scarred.
Fighting Smallpox 1720-1790, Inoculation:
Matter (pus) taken from a Smallpox scab and applied to an open cut so that the person would develop a mild form of the disease.
When antibodies developed they would prevent the patient from catching the disease again.
Why did inoculation develop? Lady Wortley Montague used it with her children after seeing it used in Turkey, Travel to Asia meant
this Chinese treatment had spread, doctors could make a good profit inoculating against a terrifying disease.
Was it effective? For some, yes. Many developed more serious infections than planned and even died. The people who had been
inoculated were sometimes contagious. Many fear it or couldn’t afford it.
Fighting Smallpox after the 1790s, Vaccination:
Matter was taken from someone infected with Cowpox, a milder disease. It was put into a cut and the person was uncomfortable
whilst suffering from Cowpox but then immune from getting Smallpox.
Why did Vaccination develop? Dr Jenner in Gloucestershire learnt from observing milkmaids and then did 24 trials to prove that
vaccination worked. He recorded results carefully. Jenner wrote to the Royal Society who published his work in 1798, it was
translated into even Turkish and Arabic by 1812. The government funded Jenner £30,000 for a vaccination clinic. Napoleon
vaccinated his soldiers in 1805 and in the USA President Jefferson publically promoted vaccination. Scientific methods were used by
Jenner and other doctors to repeat tests and record all results carefully.
Impact? Vaccination was very effective and safer than inoculation but:
1. Vaccination was not free so the poor couldn’t get it done.
2. Jenner couldn’t explain why vaccination worked as there was no knowledge of germs yet so people believed the idea was
crazy. Some doctors were not convinced.
3. Vaccination could only prevent one serious illness- Smallpox.
4. People feared new ideas, especially one that meant getting a cow disease.
Fighting disease after 1879:
A range of vaccinations were developed by allowing viruses to weaken in matter before
putting it into someone. This meant antibodies had a better chance of fighting off the disease
and a person then became immune.
What helped doctors develop these vaccinations?
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Individuals- Pasteur was thorough and driven. He discovered a vaccine for chicken
cholera, chicken pox, cholera and anthrax. Koch in competition with Pasteur discovered
vaccines for TB and Typhoid.
Chance- Pasteur’s assistant tested old matter on chickens with cholera by mistake.
Government and money- research teams and labs were funded by the French
government. The German govt funded Koch due to the intense completion with the
French.
Communication- Pasteur had read about Jenner’s work and was able to develop the
idea.
Science and technology- microscopes meant they could see micro-organisms. Industrial
revolution led to new dyes which enabled Koch to see different types of bacteria- would
eventually lead to the discovery of the first magic bullets.
How did treatment change?
Domestic medicine- The development of thermometers helped home diagnosis but little
changed- people gave warmth, food and comfort. Common sense and herbal remedies still
prevailed.
Patent medicines- by 1800, ‘cure all’ patent medicines could be bought cheaply from quacks.
Most were ineffective and they were regulated by the government by the 1880s.
Pharmaceuticals- chemical drugs were developed form the 1880s including aspirin and sold by
companies like Boots, Welcome and Beecham.
Healers/practitioners- at the start of the 18th Century, ¾ of all people who practised medicine
were unqualified. The 1858 Medical Act made people get qualifications and a General Medical
Council was set up to keep a list of approved doctors and explained what student should
know.
Physicians still only available to the rich and many methods such as bleeding were used
though they did little for infectious diseases
What does Jenner’s work tell us about the training of doctors?
1) Students were encouraged to carry out experiments with careful observation and
recording. Jenner learned his methods form the surgeon John Hunter and
experimented on 23 cases before writing up his findings in detail
2) Doctors had access to learning from both Latin texts and modern discoveries. Jenner’s
own works were published and translated into many languages.
3) Professional societies helped doctors share ideas and findings. Jenner was a fellow of
the Royal Society from 1788 and his work was being used in America by 1803.
Florence Nightingale
She was a nurse during the Crimean War who was shocked by what she saw in military hospitals
that she set about improving conditions and the standard of nursing care patients received. She
published “Notes for Nursing” in 1859 and set up a training school at St Thomas’ Hospital.
1900- Present
Developments in Fighting Bacteria- contagious diseases
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The First Magic Bullet= Salversan 606 in 1905. It was a chemical which attacked the
Diptheria virus. Paul Erlich and his team discovered the correct dose on the 606th attempt.
His assistant Sahashiro Hata happened to retest a batch and found it worked. It was
dangerous for the patient but killed the disease.
Prontosil was a chemical compound containing sulphonamides which attacked the bacteria
which caused blood poisoning. It was also discovered by chance when Domagk’s daughter was
playing and fell on an infected needle in 1932. They also tested it on mice and recorded
everything carefully.
Other Magic Bullets 1932-34- cured a range of disease from Scarlet Fever to Meningitis,
Pneumonia and Gonorrhoea- all based on the sulphonamides which come from coal tar.
These were all aided by the fact they worked in research teams with modern electron
microscopes from 1931, they were also funded by drug companies keen to make a profit.
The Discovery of Penicillin
Mould first discovered by John Sanderson, 1880s Joseph Lister use it to treat an infected
wound on a nurse but he left no notes and didn’t continue to use it.
Penicillin was rediscovered by Alexander Fleming at St Mary’s Hospital 1928 and proved that
it killed infection but lacked facilities and support test it properly.
In the 1930s, two Oxford students, Florey and Chain were interested in Flemings work and
during the Second World War the British government agreed to fund research. Mass
production was eventually funded by the American government and millions of lives were
saved. Four major drug companies worked together to keep up the demand for penicillin
during the war.
The Training of Doctors
1860- Some scientific education but very hands-on training, limited understanding of causes
or equipment. They were highly respected, relied on payments from patients. There were no
specialists or females, some held surgeries for the poor in local dispensaries.
1930- Better education, some knowledge of causes, and basic equipment like stethoscopes, xray and thermometers. They were highly respected, still paid by patients and could refer them
on to specialists some did charity work and visited the poor at home. Few were female, in
1859 Elizabeth Garrett Anderson, became the first woman in Britain to qualify as a doctor.
2000+ Highly educated then trained with hands-on experience. Understanding of many
causes of disease, hi-tech equipment like body scans and laser treatment. Less respected as
greater number of patients, many are female. Salaries paid by government unless private
doctor, can refer to a range of specialists.
Improvements in other Treatments:
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Marie Curie researched and developed radiotherapy- using radium to remove cancerous
growths in patients by the early 20th Century.
Major improvements in surgical techniques.
Huge ranges of new drugs are produced each year, we have thousands of varieties of
magic bullets.
There are a variety of vaccinations such as for polio, and German measles.
Genetic engineering is possible so we are now able to treat hereditary diseases and we
can manipulate genes inside the body. We can produce insulin for people with diabetes.
Increased use in alternative therapies such as acupuncture.
Why so much progress in the last Century?
1) Industry and money- enormous profits mean companies will spend millions of pounds
on research.
2) The government- funds research and treatment through the National Health Service.
3) Science and tech- microscopes now enable us to see inside cells and even add/remove
parts of cells. X-ray machines and MRI scans allow doctors to diagnose cancer and
illnesses within the body.
4) Individuals- Fleming, Rontagen and Curie’s have individually led to improvements in
treatments of various illnesses.
Concerns for the future
Some bacteria has become resistant to antibiotics.
Mistakes still happen eg Thalidomide.
New illnesses are constantly appearing. Although we know about defective gene’s there is no
way yet to prevent them or treat them.