Medicine Through Time
Key Time Periods
• Ancient Greece
• Ancient Rome
• Middle Ages
• Renaissance
• Industrial Revolution
• Twentieth Century to Present Day
Key Themes
 Progress- Change which leads to improvements.
 Change- When things become different.
 Regress- Change which leads to decline.
 Belief- What a person accepts as true, including faith in God.
 Continuity- When things don’t change.
 Chance- When something which hasn’t been predicted
happens.
Factors Affecting Medicine
 Religion
 War
 Chance
 Communications
 Individuals
 Education
 Government
 Technology
Sometimes, these factors helped the development of medicine
and sometimes they hindered it.
Greek Medicine 1500BC-200BC
• Greek Empire was strong and successful. They took
over the Egyptian Empire, gaining the knowledge they
had.
Beliefs
• The beliefs believed in Gods for almost all aspects of
life.
• Poseidon, the God Of The Sea
• Ares, God Of War
• Asclepius, God Of Healing
Asclepius
• Temples were built to him, called Asclepius.
• They believed that if sick people went to sleep in an
Asclepion, Asclepius and his daughters would visit him in
there dreams and cure them- placebo effect?
• Asclepions had baths, gyms, libraries and temples to
visit the gods.
• ‘Simple’ surgeries were performed.
Theory Of Four Humours
• Aristotle came up with the theory.
• Hippocrates developed it further.
• It was incorrect but it was used for 2,000 years.
• ‘Humours’- Liquids
Air
Fire
Spring
Summer
Blood
Yellow Bile
Earth
Hippocrates: Who Was He?
General Information:
• Born c.460BC-c.370BC
• Born on the island of Cos.
• He worked as a doctor and a teacher of doctors.
• However, little else is known about him.
The Hippocratic Oath
• The Hippocratic Oath was made to give people
confidence and trust in doctors.
• It makes clear that doctors are not magicians.
• It makes sure that doctors keep high standards of
treatment, behaviour and work for the benefit of their
patients (not to make themselves wealthy).
The Hippocratic Collection Of Books
• It is thought that Hippocrates probably wrote some of the
books known as the Hippocratic Collection.
• Many of the books were written by other doctors.
• It is an important collection of books because it is the
first detailed list of symptoms and treatments.
• Doctors continued to use the theories and methods in
these books for many centuries.
The Four Humours
Water
Autumn
Winter
Black Bile
Phlegm
• People believed that it was an imbalance in humours
that made people ill (too much or too little of a humour)
• From what we know now, there was confusion between
symptoms and causes.
• The Theory Of Four Humours was the idea that the body
is made up of four humours (liquids)- blood, black bile,
yellow bile and phlegm).
• They believed that when people were healthy and well,
the fours liquids were balanced.
• When people were ill, it was thought that it meant that
there was an imbalance of the liquids.
• When there was an imbalance they believed that certain
things happened to the body to get rid of excess liquid:
 Blood- nose bleed
 Black Bile & Yellow Bile- sick
 Phlegm- Coughing, sneezing etc.
Observations & Recordings
• Hippocrates showed that it was important to observe and
record the symptoms and development in diseases.
• This had two advantages Doctors were more likely to choose the right cure if they
took care to find the cause of problems.
 Notes could then be used to help with diagnoses and
treatment for future patients.
Natural Treatment
• Hippocrates encouraged doctors to look for natural
treatments for illnesses rather than praying to the gods for
help.
• He believed in giving natural treatments for natural
causes.
• Many were told to rest and eat healthily and, when the
patients were stronger, to do gentle exercise.
Keeping Healthy
• Hippocrates emphasised the importance of helping
people stay healthy.
• He recommended a light diet, gentle exercise and rest to
keep the body’s humours balanced.
Hippocratic Oath
“I swear by Apollo, Asclepius and by all the gods that I
will carry out this oath. I will use treatment to help the sick
according to my ability to and judgment but never with a
view to injury of wrongdoing. I will never give poison to
anybody. Whatever I see or hear professionally will be kept
secret.”
Roman Medicine
Public Health
Why It Was Needed:
• They needed a strong, fit, healthy army to defend and
expand the empire.
• They built forts to house their soldiers away from swamps
and marshes. They were also close to water.
• Each fort had a bath-house with drains and fresh water.
• Army hospitals were also built for the soldiers.
• Soldiers got the best treatments possible from trained
doctors and surgeons.
• They used herbs, simple surgery, rest, diet and exercise“A healthy army means a healthy empire!”
• People soon realised that these ideas could then be used
in the City Of Rome itself.
Benefits Of Public Health
• Forts had sewers, a good water supply, a hospital, toilet
blocks (latrines).
• Fresh water was delivered to towns.
• Few had toilets that emptied directly into the sewers- this
way they could use pots to empty into the sewers and
rivers.
• Public health- provided for towns and villas.
• Channels travelled through towns to baths and water
tanks.
Problems With Health Facilities
• Disease was easily spread if bath-houses were not kept
clean.
• Health facilities were only available in towns or larger
areas (like cities) and so in other areas families had to sort
themselves out. Nothing was organised by local rulers.
• Sewers were often open or built close to the surface and
this spread disease.
• Fort Latrines were only available to soldiers.
• There was poor water flow through the sewers if it did not
rain.
• Lead poisoning (from the pipes).
• Sewers- released bad smells and spread diseases.
• Stone sewers were better than timber sewers and were often
used in the bigger towns. However, the water did not flow
through quickly and so left bad smells and spread disease.
How Effective Was Public Health In Roman
Times?
On one hand, public health was effective because it
provided many people with facilities where they could
clean, drink and find treatment which before public health
they could not have had and also paved the way for the
facilities available in modern day society.
However, due to occasional lack of rain, open sewers
and baths that only had clean water in them once a week,
there were problems. Many people contracted, and
ultimately died from, disease and people who didn’t live in
towns or cities were not given these facilities at all. For
Britons, the Romans brought new treatments such as
bloodletting – if they could afford to see a physician.
However, if most people became ill they relied on the old
herbal remedies and prayed to their gods to make them
well. This meant if you became ill, your chances of
recovering were little better than before the Romans
arrived.
In conclusion, although public health has contributed to
modern medicine in a big way and provided some help for
people’s health back then, at the time it did not benefit
many people.
Roman Ideas
The Romans also brought one system of government to the
whole of their conquered territory in Britain. The Romans had
different explanations for disease:
• Supernatural reasons – curse or gods
• Caused by bad air from swamps or places with bad smells
(they realised that hygiene was linked to health, although they
didn’t understand why)
• Imbalance of a person’s humours.
Treatments
Very few doctors in Roman Britain, most illnesses treated at
home – usually by the father of the family, who would use
remedies passed down by his father. People who could afford and
had access to a doctor were treated in their own homes too.
Some hospitals, mainly in forts that were reserved for soldiers.
Often equipped and provideddjdjd
excellent training for surgeons and
doctors. However, there were few hospitals open to the public, so
little impact on ordinary people.
Many people visited a temple to make offerings to gods. People
also visited public baths as it was believed they had heeling
properties. Pregnant women relied on other women to help
them. Some became experienced and were used as midwives.
The Romans believed that diet, exercise and rest were very
important in treating illness and would also use bloodletting and
purging, but the Romans would mix these practical remedies with
prayers and offerings made to Salus, the god of health.
Public Baths
Admissions to the baths were not free but it was cheap enough
for most people to attend and many visited every day. The baths
served a variety of functions:
• Social – Place for people to meet, both for business and
pleasure.
• Hygiene – people could keep clean.
• Exercise – they provided places where people could keep fit.
The Romans were big fans of being fit and strong.
• Medical – They believed the waters had healing powers, so
people with illnesses regularly visited the baths.
Water and Waste
Sanitation was important the Romans built sewage systems
which took waste away from public baths, toilets and houses and
emptied in rivers away from town. Water and sewers were far
better than anything Britain had seen. Many people could stay
healthy and did prevent some disease. However, most towns and
cities had open drains. Also, when water supply low not enough
for the sewers to work properly and waste would build up.
Good quality roads made travel and therefore communication
easier and quicker.
Central control from Rome and regular changes of officials kept
Britain up to date with new ideas.
Knowledge and ideas spread as people travelled throughout the
empire.
Who Could You Get Medical Help From?
Home Remedies
• Most asked mum for help- they had a vast knowledge
of medical treatments handed down from one
generation to the next.
• Many specialised in herbal remedies which were mainly
made from plants. Some were made out of animal fats
and minerals.
• Many remedied helped- otherwise people would not
have kept using them.
• We now know that honey can kill infections- they used
it in many remedies.
• Romans brought new plants to Britain to use in
medicines.
• The wealthy people would go to their father (the head
of the household). He would look up treatments in a
medical book (such as the huge compendium of herbal
cures which was collected by Dioscordes).
• Modern scientific tests show that at least 20% of
remedies contained ingredients like honey and garlic
which helped patients by killing bacteria in infections.
• The books might have also advised people on what to
do once they had recovered. One medical
encyclopaedia was Artes, ‘The Sciences’ by Celsus (a
wealthy landowner who built up his knowledge partly
through treating family and friends).
• Celsus stressed the importance of exercise for avoiding
illness.
• ‘He who has been busy during the day, whether in
domestic or public affairs, ought to put aside some part
of the day for the care of the body. The most important
way to care for the body is through exercise, which
ought to come to an end with sweating.’
• This was only for the wealthy; poor people would
probably have needed to get back to work.
Gods And Their Priests
• When sick, you wouldn’t just take medicine.
• You might have worn a charm (to ward of evil spirits).
• You would definitely have prayed to your household
Gods for good health and cure.
• You would also pray to the Gods of healing- the greatest
of these being Asclepius.
• People who could not get rid of their illness would go to
a temple to see the Gods’ priests and to seek help.
• Sometimes people would leave small carvings of the
sick part of the body.
• Some temples had bath-houses, guesthouses, covered
courtyards and an abatom where people could sleep
and be visited by Gods in their dreams.
• The priests also probably encouraged patients to do
exercise, cleanse themselves in the baths and to build
up strength by eating regular meals and having plenty of
rest.
Trained Doctors
•
If mum’s herbal remedies and your prayers did not get
rid of the illness, you could see a trained doctor.
• This would probably have cost money. However, many
towns in the Roman Empire employed doctors to treat
the poor- this may have happened in Britain too.
• Some of the doctors were women.
• Mainly doctors trained by acting as apprentices to
experienced doctors. This was not always a good thing.
Sometimes, doctors had so many apprentices, that they
themselves spread disease and stopped patients from
getting better.
Having A Baby
• Women cared for each other during childbirth.
• Many became very experienced and often acted as
midwives.
• According to medical writer Soranus, the best midwives
were intelligent, robust, respectable and literate and
experienced in nutrition, pharmacy and surgery.
• Handbooks on midwifery emphasised the importance of
cleanliness (listing the need for oil and hot water for
cleansing, sponges, wool coverings and bandages).
• However, midwives had no technical methods of
helping if there were problems during birth.
• One method was for four people to take hold of the
mother and shaker her violently ten times to speed the
birth.
• Pliny the elder suggested reducing labour pains by
hurling a projectile, preferably a cavalry spear, three
times over the roof of the house.
Galen
General
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Claudius Galen
AD129 in Greece (modern day Turkey)
He worked as a doctor
Started studying medicine at the age of 16 (was a
medical student)
He studied at the medical school in Alexandria
Worked as a surgeon at a gladiators’ school
He was doctor to the Roman Emperor from AD162
Was a teacher of doctors
Galen- uses Hippocrates theories and anatomy
Galen’s Work
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He was most famous for his books.
He combined Greek ideas + what he learned from his
work in Alexandria.
• He also believed in careful observation of patients.
• He also developed Hippocrates's idea of the ‘Four
Humours’ with his own ideas of ‘Opposites’.
• He was interested in dissection and surgery
Four Humours + Diagnosis
•
When it comes to the theory of Four Humours, like
Hippocrates, Galen believed that illness was caused by
an imbalance of the humours.
• Observation- Like Hippocrates, he told doctors to
observe and examine patients carefully and record
patients’ pulse and make detailed notes.
• In AD167, he made detailed notes on the Plague- how
his patients had fever, thirst, diarrhoea, skin rashes an
spat blood.
• His notes were so thorough that the plague became
known as ‘Galen’s Plague’.
Treatments
•
Galen followed Hippocrates by giving advice on diet
and exercise (to stop illness).
• His most common treatment was bleeding patients to
restore the balance of the humours.
• Used this technique a lot more than Hippocrates did (
Hippocrates preferred to interfere with the body as little
as possible).
• Galen developed the idea of ‘Opposites’ in order to
balance the humours. E.g. If someone had lots of
phlegm ( a problem related to the cold) they would be
advised to eat something hot (like a chilli pepper) . On
the other hand, if it was a heat related issue, Galen
would give them a treatment, or tell them to eat
something, with something cold in it (like cucumber).
Anatomy & Dissection
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Hippocrates did not do much work on anatomy and did
not say that dissection was important.
• Galen disagreed.
• He believed that physicians should find out as much as
possible about the structure and the workings of the
body (and if possible to dissect bodies).
• If this was not possible, he advised doctors to dissect
apes (because they were more like humans).
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He showed his discoveries about the workings of the
nervous system by dissecting a pig.
Although he often had to dissect animals, not humans,
Galen’s discoveries were important.
He proved that the brain (not heart) controlled speech
and that the arteries, not just the veins, carried blood
around the body.
He did make mistakes because the bodies of apes and
pigs are not the same as humans.
It was well over 1000 years before people dared to
challenge his findings.
• The dissection of human bodies was not forbidden it was
just not done in those days; the Church did not agree with
it.
Books & Influence/Legacy
• He wrote thousands of books covering every aspect of
medicine in a detailed and well-organised way.
• It included the work of earlier doctors (such as
Hippocrates) as well as his own knowledge on treatments,
the structure and the workings of the body.
• He covered everything and so people believed that his
books had all the answers- this was one reason why his
books became the basis for medical training for over 1000
years.
• Another reason- His ideas fitted in with the ideas of the
Christian Church (which controlled education in Europe
during the Middle Ages).
• Galen was not Christian but he did believe that the
human body had been created by God who had made all
the parts of the body fit together perfectly- this matched the
Christian belief that God had created human beings and so
for centuries, Christians did not dare question Galen’s
ideas.
What Developments Were Made By Galen During
Roman Times?
Galen made various developments during his time.
Firstly, Galen thought that learning about anatomy and
doing dissections was very important. He developed his
knowledge in this area by dissecting animals (such as
apes and pigs). One of his ideas was that the brain, not
the heart, controls speech and so proved this by
publically dissecting a pig. He also developed the idea
that the arteries (not the veins) carry blood around the
body. This meant that Galen had proved early ideas to
be incorrect and had also been able to develop ideas
about various aspects of the body and so widen the
knowledge about the entire body.
Secondly, Galen wrote over a thousand books which
covered every aspect of medicine. As well as using
work by earlier doctors, he also included his own work
and developments. Because his books covered
everything, many people believed him. They also
believed him because he developed, and believed in
the idea that the human body was created by God. This
was what the Christian Church believed in. Because he
was able to write so many books, he was able to
spread his theories about anatomy; this meant other
people could investigate Galen’s ideas and could use
his findings to continue developments on their own.
Thirdly, Galen came up with the idea of opposites as a
treatment or humour imbalances. This meant, for
example, giving someone a hot chilly pepper to
someone with too much phlegm (as a result of a cold)
and giving a heat related imbalance a treatment of
something cold (like cucumber). This meant that Galen
did not only develop ideas about anatomy but he also
developed ideas about treatments and their effects on
the body.
Middle Ages 400-1500AD
Who Treated The Sick?
• Looking after the sick was an important role of the
Christian Church.
• This led to many hospitals being founded by the Church
in the Middle Ages.
• St. Bartholomew's hospital- in London- was one of the
first to be founded.
• By 1400, there were over 500 hospitals in England.
However, most of them only had 5 or 6 beds.
• St. Leonard’s hospital in York was unusually large with
200 beds.
• You could not go into hospitals if you had an infectious
disease.
• Hospitals were sometimes set up for particular cases
(e.g. unmarried, pregnant women & for the ‘poor and
silly person’.)
• Leper houses were built outside of towns in order to
separate victims of the disease from the healthy
people.
• Most hospitals were like modern day care homescaring
for the elderly rather than treating the sick. Only 10%
actually treated the sick,
• Hospitals provided food, rest and prayer.
• Nursing care was provided by nuns (and monks) who
had a good knowledge of herbal remedies and other
remedies taken from books drawn from their libraries.
• All except the wealthy, when ill, would go to the woman
of the household.
• Like Roman Britain, women treated a vast majority of
illnesses in the Middle Ages.
• Women had a range of remedies. However, sometimes,
the local wise women had to be called on to use her skills &
knowledge.
• Women acted as midwives.
• Sometimes, women had to be apprenticed and gained
licences through doing this. They were then paid for their
work.
• Women could also qualify as surgeons through
apprenticeships.
• Family links and connections contributed to giving women
certain opportunities.
• Katherine, a surgeon in London in around 1250- her father
and brothers were also surgeons.
• Women were not allowed to be physicians and they were
not allowed to attend university either.
Training Of Doctors
• Everyone was poor & there were no towns; this meant that
there were no trained doctors.
• For hundreds of years, people relied on wise women and
leeches. Wise women were trained through practice and
were probably as good, or even better, as Roman doctors.
• Between 1000-1300AD, Landowners started to become
rich through the growing of their crops.
• Bishops and abbot were the wealthiest and they spent
their money on universities and cathedrals.
• Universities trained physicians (the highest ranking of all
the healers). It was expensive and so not many people did
it. However, the pay was very good.
• Medical students attended lectures and read books by
Galen and other scholars (the works of other medical people
like the Arab doctor ‘Ibn Sina/al-Razi’).
• They were expected to memorise all of the books then
Roger Bacon suggested they do their own research- he was
thrown into jail because of this.
• They also studies astrology because they believed that the
body was affected by the movement of the planets. They
though this caused illness.
Understanding The Human Body
How Did They Try To Stay Healthy?
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• It was said to eat light meals, do gentle exercise (didn’t
mention about sweating like the Romans did) to relax as often
as possible, stay on good terms with neighbours and to send
urine samples to the physician.
• If they had too much of a humour, you’d either purge (take
something to make yourself sick), bleed, bathe in hot water,
build your house in a windy location t take away bad smells
and avoid stressful noise.
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Physicians learned about astronomy; they dissected
bodies as Galen did but nothing was learned by doing
this.
They believed that Galen’s books contained everything
and so dissections were demonstrations of Galen’s
descriptions and so they didn’t investigate further.
The Physician was in charge but he did not do the
dissection; the surgeon was told what to do.
The physician told his assistant which of parts of Galen’s
books to read.
Students listened to the studies and watched the
dissections but were not allowed to touch and do the
dissections.
Nothing new was learned and people respected
traditional ideas and beliefs.
Regular dissections were the start of a step forward. One
day, someone would use dissection to make a new
discovery to challenge Galen.
What Did They Think Caused Diseases?
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They believed that God or the Devil caused most
diseases.
Anglo Saxons believed that elves shot arrows (elf shot)
and this caused diseases like head aches.
They still believed in the Theory Of Four Humours .
Universities taught about the Four Humours.
Many people blamed things like bad air (miasma) for
illnesses.
Desperate explanations were made (e.g. outrageous
fashion, children disrespecting their elders, minority
groups and Jews).
In some places, they burned Jews in order to get rid of
disease.
How Did They Treat The Sick?
• Urine charts were used to determine the smell, colours and
density of the patients urine.
• Physicians may have also tasted it.
• Wealthy people sent urine samples to physicians; this
method fitted in with the Theory Of Four Humours.
• Physicians followed Hippocrates and Galen by making
careful observations and finding symptoms.
• The Arab doctor al-Razi grouped illnesses.
• Physicians needed to know astrology because they believed
that parts of the body were linked to the Zodiac and the
planets.
• A bleeding chart showed where to take blood from; leeches
were used to draw blood.
• Bleeding was done to restore the balance of the four
humours.
• Ibn Sina (Avicenna)= famous Arab doctor
• In Middle Ages Britain, the quality and development of
medicine declines.
• In the Arab world, at this time, medical qualities and
development increased/improved.
Did The Church Help Or Hinder Medicine In The
Middle Ages?
Help
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Had doctors- people trusted them because they were
provided by the Church.
Some dissections were allowed to help teach students
about anatomy and so discoveries could then be made.
1200 hospitals in England + Wales- many hospitals were
founded and built by the Church.
Provided medical care for the poor + elderly.
They had a rule that said ‘care for the sick stands before
all’- like Jesus helping them (doing as he would).
Hinder
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Some of their ideas did not work- like carving religious
words onto the jaw as a treatment for tooth ache- they
were wrong.
They put Roger Bacon in prison (he challenged the
Church’s medical ideas/theories.
Dissections were frowned upon- the Church carried them
out instead of doctors. This meant that discoveries made
were limited.
Dissections were based on Galen’s ideas which were
incorrect.
Only 10% of hospitals actually treated the sick or
provided actual medical care.
Judgement
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I think that the Church did help medicine at this time
because some dissections were allowed. However, for
the most part, I think that the Church hindered medicine. I
think this because most dissections weren’t allowed and,
when they were allowed, they were carried out by the
Church and not doctors. Also, out of all the hospitals they
built, only 10% actually treated the sick. Furthermore,
there was a general lack of understanding when it came
to natural medicine.
The Black Death
What Was The Black Death?
• The pestilence that caused it was the Bubonic Plague.
• Bubonic Plague- carried by rats and spread by fleas. Fleas
became infected when it bit an infected rat then it passed the
disease onto other rats then to humans when they were bitten by
the rats.
• Symptoms- Sudden feeling of cold and tiredness. Then the
discovery of painful swellings (buboes) on the armpit and groin.
Blisters appeared all over the body followed by a high fever,
severe head aches, unconsciousness for several days and then
death.
• Second disease- Pneumonic Plague.
• This disease was spread by people coughing over others.
• Victims coughed up blood because the disease attacked their
lungs causing breathing problems.
• Victims died more quickly- a day or two at most.
What People Thought Caused It?
• The pestilence comes from a privy toilet next to a chamber or
some other thing that corrupts the air.
• Sometimes comes from dead flesh or standing water in ditches.
• Religious blame- God + Sins
• England is struck by the pestilence because of the increasing
pride and numberless sins of people’.
• Unbalanced humours.
• Jews- they were burnt in many countries. Jews were said to
have poisoned water supplies.
• Astrology- Movement and position of the planets.
How Did People Try To Treat It?
• Flagellants- Walked through towns as the plague spread,
whipping themselves to show God that they had repented their
sins and asking God to be merciful.
• Advice- Avoid too much eating and drinking + avoid baths which
open the pores.
• In cold/rainy weather, light fires in your room.
• Foggy or windy weather= inhale perfume every morning.
• If the Plague arrived in hot weather- eat cold, drink more
than you eat. Cucumber, fennel and spinach.
• Stinking air- surround self with a terrible smell to ward off
the bad air that carried pestilence. E.g. head in a bucket
of waste from toilet and breath in the fumes for ½ hour.
• King Edward III of England + bishops- ordered services
and possessions to be held in every church at least once
a day- In which people prayed for forgiveness + asked
God to put and end to the disease.
• Some went further- made candles their own height and lit
them in Church as offering to God. E.g. Barcelonacitizens made a 7km trail of candles to encircle the city
with the hopes of protecting the city.
Why Did Public Health Deteriorate In The Middle Ages?
Public Health 500AD- 1000AD
General
•Conditions did start to improve by 1200, houses (in London + York) were built on stone
foundations.
 Some made entirely of stone.
 Cesspits were lined with brick or stone and so they were less
likely to leak into the water supplies.
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1948- Pestilence arrived in Dorset.
1947- Europe arrival.
Originated in China- from the rats on the ships.
Estimated 40% population died from the disease.
Dorset, Devon, Somerset- then to Bristol- very few
people were left alive.
Then it travelled north- leaving not a town or village or
even, except rarely, a house without killing all/most of the
people there.
Shortage of people- not enough living to bury the dead.
Bubonic Plague spread by fleas carried by rats.
The disease began in China- then India- Then Europe.
• Towns dirtier than Roman towns.
• York was especially filthy.
• Water (drink + cook) was collected from rivers and storage pits
which were next to cess pits (sewage storage).
• Pigs & chickens roamed the street.
• Rats, mice and hawks scavenged.
• Fish bones, animal dung, food waste and human faeces.
• Animals were a big problem.
• Horses were used as transport.
• Cattle, sheep, geese constantly arrived for butchering.
• The problems were, however, greater than the solutions
• Medieval towns were dirtier than Roman towns.
• Romans had army engineers with good technological
knowledge.
• Romans- wealth to afford aqueducts + public baths and slaves
to do the building.
• Even so, Romans had been no better at stopping the plague
than then people in the Middle Ages.
Problems
• King collected taxes for the war instead of for cleaning the
streets and building sewers.
• There were not enough officials to punish all of those who
broke laws.
• Many Londoners did not pay the taxes required.
• God sends the disease we suffer- what has illness got to do
with dirty streets.
Monasteries
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•
•
•
•
•
•
•
•
•
Best public health facilities were in the monasteries
because they could afford it.
Monks were better fed, did less physical work and had
advantages.
Water came to the Abbey through tanks.
Water from the fish ponds flushed the latrines- which
drained into the town ditches.
Latrines were attached to the Monks’ dormitories.
If the main water supply failed, there was a backup
supply.
Reservoirs stored water coming from the piping system.
Drains took rain water and waste away.
Pipes bringing water to supply the washroom, bakery,
brew house, kitchen and fish pond.
Roman Abbeys were a little like Roman forts- The water
supply only benefited a small group of people- They
couldn’t stop the plague.
Middle Ages- Could use the facilities if they had the
money.
There were not animals this time but thousands of
people were creating litter + waste all day everyday.
Judgement: Which was better In The Improvement Of
Medicine? The Romans Or The Middle Ages?
Roman Britain was better
Public health- MA had one to
only a limited number of
people
Treatments + ideas about the
causes of disease + training of
doctors + methods of keeping
healthy
Hospitals for soldiers
They were similar
Medieval Britain was better
Renaissance 1500- 1750
What Was The Renaissance?
• Dissections- Were used in order to gain knowledge of the body.
Through doing this, they were able to find out more about how
the body worked. Students could go onto learn by watching and
people could see and investigate first hand how the body worked
and how it was made up.
• Printing press- Clearer pictures and writing (books etc.) were
available and so more people could learn more about anatomy
without the need of doing/watching a dissection because the
books could be sold all over the place and published in different
languages.
• Microscope- People could use them to see tiny things and so
could look and study the body closely and precisely in order to
learn more about it.
Some Common Ideas
• A cross on the front door- ward off plague
• ‘New Herbal’ book- tummy ache
• ‘Good Illustrations of Anatomy’ by Vesalius- popular book
• Microscopes- To see detail you can not see with the naked eye
• Bleeding- 4 humours
• God sends plague down to punish our souls
• Rhubarb
Plague struck in 1665. The mayor of London ordered watch
men to guard houses to make sure that the sick and their
families stayed shut up.
House owners were ordered to sweep the streets outside their
homes.
Taverns and theatres were closed to stop plague from
spreading.
William Harvey
Medicine Before Harvey
• Galen had said:
1) New blood was constantly being manufactured in the liver
to replace blood burned up in the body just like wood is
burnt by a fire.
2) Blood passed from one side of the heart to the other
through invisible holes in the spectrum. This had been
challenged by Ibn-Al-Nafis and Vesalius but neither could
provide any alternative explanation.
• Two other doctors had made discoveries that paved the
way for Harvey:
 Realdo Colombo (1516-1559) said that blood moved
along veins and arteries.
 Fabricus (1533-1619), Harvey’s tutor at Padua proved that
there are valves in the veins.
• Despite these pieces of knowledge, no body could explain
how blood moved around the body.
Fact File
•
•
•
•
William Harvey (1578- 1657)
He studied medicine at Cambridge and Padua then
worked as a doctor in London.
He published his book ‘An Anatomical Account of The
Motion of The Heart and Blood’ in 1628, which described
how the blood circulates around the body.
He became doctor to King Charles 1st.
Factors Which Helped Him
•
•
•
•
Tech- Mechanical water pumps in London may have given
Harvey the idea that the heart is pumping blood.
Attitudes- Harvey’s discoveries were the result of careful
dissection, observation of detail and experiment.
Individual genius- Harvey was exceptionally thorough in
his work, spending many hours repeating experiments and
going over every detail.
Communication- Harvey had read the work of earlier
doctors and was able to use it to build up his theory.
Factors Which Hindered
• He could not explain everything about the circulation of the
blood.
• He did not know how blood moves from the arteries to the
veins.
Short-term Impact
• Harvey proved that Vesalius was right about the importance of
dissection. He wrote ‘I prefer to learn and teach anatomy not
from books but from dissections’.
Long-term Impact
• His discovery laid the ground work for future investigation of the
blood and physiology) the workings of the body.
• Many aspects of medicine depends on understanding the blood
system. Surgery, for example, could not develop until after
Harvey’s discoveries.
Limitations
• Still much more to discover about the blood- no blood
transfusions until 1901 when blood groups were discovered.
• His ideas were only gradually accepted – some doctors ignored
them while others said he was wrong (because it went against
Galen). It was nearly 50 years before his ideas were taught at
the University Of Padua.
• His discoveries did not make anyone better.
Achievements
• Proved that the heart acts as a pump- pumping blood around
the body.
• Went onto dissecting animals because their hearts beat more
slowly and so he could see the movements of the muscles.
• Dissecting human bodies to build up detailed knowledge of the
heart.
• He proved that the body had a one-way system for blood. He
tried to pump liquid past the valves in the veins but he could not
do so.
Andreas Vesalius
Medicine Before Vesalius
•
Doctors believed that Galen had given a fully correct
description of anatomy.
• Dissections were carried out to show that Galen was right
(not to check or challenge him) even though Galen had said
it was important to learn by dissection.
• He used human bodies but sometimes used animal bodies
because human bodies sometimes/often were not available.
Fact File
•
•
•
Born in Belgium (1514-1564).
His father was a doctor.
Studied medicine in Paris and Padua and then became a
professor of surgery in Padua.
• Wrote ‘The Fabric of The Human Body’ (1543)- a detailed,
and fully illustrated description of human anatomy.
Factors Which Helped Him
•
Tech- made use of new inventions of printing. Supervised
printing & engraving so that everything came out the sameif he hadn’t printed/published his work, he’d have had less
impact because printing meant that he could distribute
thousands of copies which were sent all around the world.
• Individual genius- He was inventive and determined. He
once stole a criminal’s body to dissect it. In Padua, he
encouraged dissections and insisted on making sure every
detail in his books was printed correctly.
• Art- In Italy, many artists were already interested in
dissection to improve their own work. Vesalius used these
to illustrate his books.
• Attitudes/ Enquiry- Vesalius respected Galen but believed it
to be vital to ask questions and challenge traditional ideas
by carrying out as many dissections as possible.
Factors Which Hindered His Work
•
Many doctors refused to accept that Galen could be wrong.
Some said that Vesalius’s work only showed that the body
had changed since Galen’s time. Heavy criticism lead
Vesalius to leave Padua and instead work for Emperor Charles
5th.
Limitations
• Nobody was healthier as a result of Vesalius's work. His work
was only the start. Many more discoveries were needed before
people would live longer, healthier, lives.
Short-term Impact
• Vesalius's insistence on enquiry began to change attitudes and
encourage others to follow his example.
• Doctors realised there was more to be learned- Galen had not
discovered everything about anatomy nor had he got everything
right.
Long-term Impact
• Improved medicine and health.
• Accurate knowledge of anatomy was vital for the building up of
medical knowledge and so paving the way to better treatment
later on.
How Do You Think The Changes In Science Would
Affect Medicine?
The changes in science affected medicine a lot. For
example, the Royal Society explored new ideas and so the
findings could be published t for then to be used in
medicine.
Furthermore, new methods in science were being used.
Ideas were looked into more deeply and more observations
were made. They were likely to be more accurate and
correct and so the medical science would have been more
developed.
In the end, the changes in science affected medicine a lot.
There were short-term and long-term results which all
affected medicine.
Doctors and Training
Improved technology, e.g. thermometers, microscopes, etc.
Improved knowledge of anatomy and physiology through books
such as those by Vesalius and Harvey.
Growing acceptance that physicians should do the dissections of
the human body for themselves.
Introductions of some medical schools and teaching hospitals.
Growing importance of a scientific approach – observation of
symptoms and experiment with treatments.
Improved Training
More physicians travelled to universities in Europe or Edinburgh for
medical training. Training took a more practical role, observing and
examining patients, rather than just reading books. Students began
to take part in dissections themselves. Some even began to set up
their own medical schools.
John Hunter
S
Trained in the new Renaissance methodology
and his later carrer
shows the impact of these ideas on medicine and training.
His lectures on anatomy helped to develop a more professional
approach to medical training.
He emphasised the importance of observation and experiment.
His students included Edward Jenner who followed his methods
when investigating cowpox.
Employed a secretary to write up his notes and paid an artist to
draw the discoveries that he had made by dissection.
Published several important works, including one about the
changes that occurred in pregnancy.
John and his elder brother William, set up their own medical
school in London where Physicians received intense training.
Intensely curious man and a workaholic.
Studied many aspects of anatomy, using specimens to show the
medical problems like arthritis and stages of a disease.
Carries out various experiments as part of a study on the sexually
transmitted infections.
How did London get Clean Water?
In the 13h century, lead pipes were laid to bring water from the
river Tyburn to London, and people would go to the pool of
water at the end of the channel to collect water. There were also
water sellers who came through the streets, but the water was
usually taken from a polluted river so most people drank ale
rather than water.
Although London’s council recognised the need for clean water,
it could not decide what to do about it because it knew people
would oppose any increases in their local taxes. Luckily two men
were prepared to use their own money to improve the situation.
1602 Edmund Colthurst suggested constructing artificial
river to bring water to London over a 38 miles journey.
The project relied on gravity to get the water to London,
route had to be carefully planned to ensure the channels
always led downwards and the water kept flowing.
Colthurst only managed to complete 2 miles due to money
problems.
Sir Hugh Myddleton revived the idea in 1609 and offered to
pay himself.
There were many protests from landowners along the
route.
Myddleton had King James I support and James even paid
the costs.
Project was finished in 1613.
The project’s completion meant that fresh water was available in
parts of north-east London, but the supply could not keep up with
the growing population. By 1750 most water was supplied by private
companies, either piped to the house or available at standpipes on
street corners, which were turned on at certain times.
Sanitation: chamber pots and water closets
There was little recognition to improve sanitation. This created
health risks, especially when sewage polluted the water. In
medieval towns, toilets were usually wooden seats above a
cesspit, and people wiped themselves with leaves or moss.
Several families might share 1 cesspit and ashes might be
scattered over the sewage to keep out the smell – but they
needed to be cleaned regularly. These toilets were called earth
closets.
In the house most people used chamber pots, that were emptied
into the drain in the middle of the street or sometimes the
contents were just thrown into the streets from an upstairs
window.
It wasn’t much better for the rich. The king had a ‘close stool’,
which was a padded seat over a large bucket, and the most
important job within Henry VIII’s private rooms was the Groom of
the Stool – the man in charge of his chamber pot and he had to
S
wipe his bottom.
Sir John Harrington invented a water closet in 1596, using water
to flush away the sewage, Queen Elizabeth I liked the idea so
much that she had a WC installed at Richmond Palace but many
people ridiculed the idea and the WC did not develop proplerly
until 200 years later.
The Great Plague 1665
The plague killed about a quarter of its population in London.
This was the bubonic plague. However, this time there were
major differences in how the outbreak was dealt with. In
1348, people tried to prevent the plague from spreading; in
1665, there was a lot of pressure on the town authorities to
take on this role. Laws were passed to try and contain the
disease. Many of them were ineffective and many people
including King Charles II, left the city. Even isolation and
quarantine did not work because the disease was not
spread by human contact but was carried by the fleas on
the rats. Until Pasteur’s work led to a better understanding
of disease in the 19th century, neither doctors nor
governments could deal effectively with infectious diseases
such as the plague.
The problem of gin
The government were important because they had the power to
pass laws to bring about changes. There was a public concern in
the 18th century that cheap gin was having a bad effect on the
poor. In 1750 the government passed laws that made gin more
expensive. This was partly to try and improve the standard of
health among the poor but also because the government was
concerned about losing money if people were too drunk to work.
The increase in price also helped to reduce the death rate from
excessive drinking.
S
Did Hospitals And Treatment Change During The
Renaissance?
Hospitals (Middle Ages)
•
Hospitals were run by monks and nuns. They provided
warmth, food and prayer for the poor.
• There were hundreds of small hospitals but they did not
admit people with infectious diseases in case the disease
spread among residents.
• 1660s- St Bartholomew's had 12 wards and 300 beds
Hospitals (Renaissance)
•
•
•
•
•
•
•
•
•
•
Many hospitals were closed because Henry VIII closed the
monasteries.
Some were taken over by town councils.
Most of them were then used to look after the elderly.
1700s- Many new hospitals were opened. They were paid
for by local people + charities + town councils.
Nearly all of them still cared for the poor.
If you were wealthy, you could pay for home care.
Many hospitals still did not admit those with infectious
diseases. However, this was beginning to change in some
hospitals.
Doctors trained in universities and carried on their training
in hospitals to practice on the poor.
There were nurse helpers- carried out heavy, manual work:
washing, cleaning, food prep. They didn’t have any medical
training.
46 hospitals in Britain in the 1700s.
Treatments (Middle Ages)
•
•
•
•
•
•
Remedies were made up of herbs, minerals and animal
parts.
Treatments included prayers, charms and rhymes.
Bleeding, purging and other methods to restore the balance
of the four humours- this followed the methods of Galen.
Treatments included rest, exercise and a good diet.
Many home remedies were used, especially herbal.
Girls learned how to mix them up- honey and orange juice
were often used.
• Home remedies were handed down through generations
•Bleeding was also used to prevent illness- all to do with the four
humours being out of balance.
• Rhubarb was used to purge the bowels.
Treatments (Renaissance)
• Patients were kept clean and warm and were fed regularly.
• The sick were given herbal remedies or they were bled.
• Simple surgery was done- e.g. to set fractured limbs.
• Some desperate surgery too- amputation as a last resort.
• All treatments were free but people were still expected to pray
for their recovery.
Judgement
• From the Middle Ages to the Renaissance, there was little, but
some change, in treatments and hospitals. This is because it
seems small details were changed. For example, in the Middle
Ages, monks and nuns ran hospitals providing warmth, food and
prayer where as in the Renaissance, doctors, along with nurses,
ran them instead and provided cleanliness, warmth and food.
Although there was change, there wasn’t any dramatic changes
but just a slight transition.
Why Did The Discoveries Of The Renaissance
Period Have So Little Impact On Medical Treatments
In Britain Between 1500 and 1750?
Structure Tip
Answer Plan/Grid
Factor
Evidence
Explanation
Link
Attitudes
No-one
challenged
Galen; they did
not accept other
ideas.
The Church still
had authority. It
was frowned upon
to challenge.
Galen was wrong.
Doctors with
treatments based
on his idea. Noone challenged it
and so nothing
changed.
Conservative
attitudes of
people at the
time
Many treatments,
such as bleeding,
continued to be
based on the
idea of balancing
the four humours.
Most people
continued to follow
Galen’s ideas. The
Christian Church
supported Galen’s
ideas and so they
should not
question. The
Church controlled
universities and
medical training.
Doctors
discouraged
research and
developing new
ideas concerning
treatment. People
didn’t want to
challenge Galen.
People continued
to use Galen
based treatment.
Beliefs
Most people
continued to
believe Middle
Ages causes for
illness- e.g. four
humours and evil
spirits.
Harvey’s discovery
hadn’t discovered
an actual
treatment.
No treatments
were newly
discovered and so
medicine
continued to follow
Middle Ages ideas.
Government
People continued
to support Galen
because the
Church frowned
upon opposition.
Church still had
authority. It
supported Galen
and so told people
what to believe.
No body opposed
and so no-one
tried to make any
other medical
developments.
There were not
advances.
• Factor
• Evidence + Explanation
• Link to the question
Answer Example
• Attitudes- People were very supportive of Galen’s work. They
did not think he could be wrong and so weren’t ready to
accept other ideas.
• Explanation- The church were also supportive of Galen’s
ideas; it was frowned upon to accept other work/doubt
Galen’s. For example, Roger Bacon was put into prison for
challenging Galen’s ideas/work.
• Link- this meant that doctors did not develop their own
work/treatments but continued to base their work on Galen’s
ideas which were wrong. No-one challenged this.
Ancient World
Ideas about the
causes of disease
Middle Ages
Renaissance/ Scientific
Revolution
Gods & Spirits
Four Humours
Bad air
Planets + Stars
Treatments
New herbs from over seas
Herbal Remedies
Prayers
Bleeding + Purging
Rest + Exercise
Methods of avoiding
illness
Charms + Prayers
Exercise + Diet
Bleeding + Purging
Training and
hospitals
Uni training of physicians
Knowledge passed through generations
Hand written books
Printed books
Hospitals run by monks + nuns
Individuals
Hippocrates
Galen
Arab docs- Ibn Sina
Al-Razi
Building of
hospitals
Fewer hospitals
Versalius
Harvey
Industrial Revolution 1750-1900
Who Was Edward Jenner & Why Was He Significant?
Fact file
•
•
Age 13- Had an apprenticeship with a surgeon for 6 years.
Age 21- Studied with John Hunter in London. He was the
greatest surgeon of all time. He taught students to observe
carefully and make their own experiments to increase
medical knowledge instead of relying on books.
• Age 23 (1772)- Began work in Berkeley, Gloucestershire, as
a country doctor but kept in touch with John Hunter about
medical developments.
• 1798- Published his book, An Enquiry Into The Causes and
Effects of Variola Vaccine (known by the name of cow pox).
This showed that vaccination could save people from
smallpox.
• HE CREATED THE VACCINATION FOR SMALLPOX.
Background
•
Smallpox killed more children than any of her disease in the
1700s- survivors were often left disfigured by scars and
scabs formed.
• Lady Montague watched inoculation in Turkey- spreading
puss from smallpox into the cut of a healthy person. If they
were lucky, they got a bit but then never again. During the
smallpox epidemic in England, she had her daughter
inoculated in front of important doctors- the method then
became popular.
• Inoculation became a big business. People became wealthy
through carrying out thousands of inoculations.
• However, there were problems with inoculation; inoculated
people could die from too big of a dose + the inoculated
people could spread/pass on small pox to someone else +
most people couldn’t even afford to be inoculated and so
could not be protected.
What Happened?
• Some doctors realised that milk maids who caught cow pox
didn’t get small pox.
• Some doctors got the disease on purpose and spread it but
hadn’t made the method widely known or even properly,
scientifically tested it.
• Jenner knew the theory; he kept thinking about it and thinking
about how to test it and prove it.
• In 1790s, he carried out experiments observing and recording
all the details.
• 1798: He published his book which described vaccination +
presenting evidence- describing 23 different cases to prove the
theory.
• He called his method ‘vaccination’ which came from the Latin
‘Vacca’ which means cow.
• Edward Jenner’s discovery saved thousands of people’s lives in
Britain and millions worldwide.
Factors
• Attitudes & Enquiry- Jenner, following Hunter’s advice, tested
the connection between cowpox and smallpox in experiments
collecting evidence carefully as proof that catching cowpox realy
did protect against smallpox.
• Government- (1802 + 1807) Parliament gave Jenner £30,000 to
develop his work on vaccination. 50 years on, in 1852,
vaccination was made compulsory in Britain and this helped to
cause the huge drop in the number of cases of smallpox cases.
• Individuals- Jenner had the insight to realise that the link
between cowpox and smallpox was important and had the
determination to carry on and publish his research despite
opposition and criticism.
• Communications- 1798: Jenner published his own account of
his discovery to spread the details of his method worldwide.
Ideas about disease 1750-1900
During the Renaissance there had been a growing interest
in science. This affected people’s ideas about the causes of
disease, and by the 18th century they were less likely to
blame disease on supernatural causes or umbalanced
Humours. People had always been aware that disease
spread quickly in dirty, smelly and unhygienic conditions,
and so the search for a new explanation of illness based on
natural causes now developed into 2 main theories.
• Miasma –disease was caused by bad air that was filled with
poisonous fumes from rotting matter.
• Spontaneous generation – disease was caused by germs
that were produced by flesh and vegetables as they rotted.
During the Industrial Revolution, in the late 18th and early 19th
centuries, the population grew rapidly. Housing for workers
was of poor quality and many families could only afford to live
in a single room. In these conditions, disease spread rapidly,
especially as there was poor sanitation and limited access to
water.
Killer Diseases
Disease
How it spread
Effects
Cholera
Bacteria passed on
through food and water
that have been
contaminated by the
excreta of another
person.
Sickness and severe
diarrhoea; dies from
dehydration, often
within 24 hours. Up to
two-thirds of sufferers
died.
Diphtheria
Through tiny droplets
when coughing and
sneezing or through
contact with the soiled
clothing of an infected
person.
Bleeding, sometimes
paralysis; suffocation
from a blocked throat
often leads to death.
Death rate 1 in 10 but
particularly hit children
and took a long time to
recover.
S
Smallpox
By touch, or tiny
droplets when
coughing or sneezing.
A rash turns into
blisters filled with pus;
the blisters become
crusted and fall off,
leaving deep scars.
About a third of
sufferers died.
TB Tuberculosis
Tiny droplets when
coughing and sneezing.
Coughing heavily,
brings up blood, chest
pains severe, weight
loss. Nearly half died.
Typhoid
Bacteria passed on
through food and water
that is contaminated by
the excreta of a person
or food infected by
Headaches, fever,
constipation, severe
diarrhoea. One-third of
sufferers dies. Affected
the old, weak and
Stepping Stones
Why Was Their Opposition?
•
• It went against God’s law to give people an animal disease.
• Smallpox was seen as a punishment for sin- the only cure was
prayer and living a Godly life.
• It would cost the inoculators their jobs and profits.
• Royal Society- said that the ideas was too revolutionary. They
refused to publish Jenner’s book.
• Vaccinations were viewed as clumsy- they were done in a rush
and didn’t always work.
• People had enough to worry about, like finding work and food.
They didn’t have time to have their kids vaccinated.
• The Government shouldn’t interfere . They had no right to force
people who didn’t get their children vaccinated.
Vaccination is a good example of experiment and enquiry. It
showed that the killer disease could be beaten. This
encouraged other doctors and scientists to solve medical
problems.
• Vaccination was widely used in Britain. It was made
compulsory in 1852 which lead to a significant reduction in
the number of deaths from smallpox. Factors like public
health reforms also played a part in this.
• Vaccination was soon used globally. By 1803, it was being
used in USA and in 1805, Napoleon had all of the French
army vaccinated. Ironically, it was fighting a war against
Britain. In 1812, Jenner’s work was translated into Arabic and
Turkish.
• In 1980, World Health Organisation declared that smallpox
had been eradicated from the world.
But
•
Vaccination only dealt with one disease. There were many
more infectious diseases (Cholera, Typhoid etc. killed
thousands in epidemics).
• Pasteur didn’t publish his Germ Theory until 1859 and so
Edward Jenner did not know that bacteria caused disease
and so he could not figure out exactly how his vaccination
worked. Therefore, it was not possible to learn from this
discovery about how to prevent the spread of other diseases.
• Many people opposed vaccination. An ‘Anti-vaccine League’
was formed in 1896.
• The Government could not decide whether they wished to
force people to vaccinate their children. The law kept
changing.
Why Did The Discovery Of A Vaccination For Smallpox
in 1796 Not Lead To More Preventative Treatments?
(12)
•
•
•
Didn’t know about germs
People opposed him
Government were unsure about whether to back it
Answer
Firstly, one of the reasons is that Pasteur’s book about his
Germ Theory was not published until 1859. Already, Jenner
did not understand exactly why his vaccination worked and
so, because he couldn’t learn from Pasteur’s theory yet,
Jenner could not use his little understanding and knowledge
about his vaccination in order to develop it to help prevent
other infectious diseases.
Secondly, Jenner had a lot of opposition surrounding the
vaccination. He wasn’t very well known; he was just a country
doctor and many had created a bad image of him This meant
that he did not receive support of his ideas and so was
limited in the help he could use to develop his ideas. This
also meant that people were reluctant to be vaccinated which
meant Jenner couldn’t research and investigate as much as
he could have done with volunteers.
Furthermore, the Government kept changing the laws on
whether to back Jenner, and make vaccinations compulsory,
or not. Lack of Government backing would have also affected
the public’s trust of Jenner as well as giving Jenner little
support (like facilities and funding etc.) which all meant that
Jenner’s ability to develop vaccination was limited.
In 1896, the Anti-Vaccine League was set up which opposed
the compulsory vaccine, particularly against smallpox. The
organisation influenced a huge proportion of people in Britain
and so left Jenner with little backing and few to actually use
the vaccine on. As a result, he could not develop the
vaccination enough to gain knowledge and develop other
preventative treatments.
What Was The ‘Germ Theory’?
Before 1750
• God caused disease to punish people for their sins
• Bad air (like bad smells) caused miasma
• Theory Of The Four Humours
Spontaneous Generation
• This was the latest theory.
• It was developed when microscopes picked up bacteria on
decaying matter. Scientists thought that germs were
spontaneously (automatically) generated (created) by the decay
and then spread the disease further.
Louis Pasteur
• A French scientist (chemist) in the late 1850s.
• He was asked by a brewery company to investigate why their
alcohol was going sour. He thought it was because of germs and
proved that germs in the air were causing the decay (not the
other way around).
• Investigation- He took two flasks- he heated a liquid in one of
the flaks to kill the germs and make it sterile. He drove the air out
of it so that no more bacteria could grow. He then sealed the
flasks with some more liquid inside. Later on, approximately 100
years, the cleaned flask was still sterile- there were no germs in
the flask. The other flask was full of bacteria.
• This was the start of ‘pasteurisation’. The method of heating
and sterilising liquids.
• Many foods today are pasteurised- e.g. milk. The method also
paved the way for air-tight food storage, vacuum packing, airtight jars, tins and cans etc.
• He was then asked to investigate diseases in silkworms and
proved that bacteria was spreading the disease and so linked
germs to disease (in animals).
• Then- proved that germs caused disease in other animals too…
• He accidentally injected a chicken with some old chicken
cholera germs- the chicken did not die. He then injected it with
fresh germs and the chicken still didn’t die. He had proved
Jenner’s vaccination worked.
•
He now wanted to prove that germs caused human diseases
too.
• There is a link between him and Jenner but were not exactly
the same.
•
•
He then wanted to prove germs caused human diseases too.
There is a link between Louis Pasteur and Jenner but they
aren’t exactly the same.
Who Was Robert Koch?
Fact File
• Born in Germany (1843-1910)
• He was a doctor who read Pasteur’s work
• He was especially great at lab work; he had a team of
assistants
• There was a rivalry between Pasteur and Koch especially at
the time of the Franco-Prussian War (1870-71)
What He Did
•
•
•
•
•
Koch set out to find the specific microbe/bacteria causing
individual diseases- Jenner didn’t know how to develop his
vaccination to do this; he didn’t know about specific germs
etc.
Koch was the first to identify specific microbe that caused an
individual disease.
Koch did this for TB (1882) and Cholera (1883).
Koch discovered how to stain and grow bacteria in a Petri
dish. This meant that by staining each bacteria, he could
identify what bacteria caused a disease.
He went about doing all of this using a method that other
scientists could easily copy and follow.
Also At The Time
•
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•
Also, at the time, a number of other disease causing bacteria
were identified:
1882- Typhoid
1886- Pneumonia
1887- Meningitis
1894- Plague
Koch was important because he was able to identify specific
bacteria which caused those horrible epidemics.
Why Was Robert Koch Important?- Plan
• Koch used methods that were easy to follow and copy. This
meant that other scientists could do their own investigation and
so knowledge of the field would expand. It also meant that these
laboratory techniques can still be used today.
• Koch identified bacteria for different diseases. This proved how
Jenner’s method of vaccination worked and so it could all be put
together to then form vaccinations for other diseases.
• He was the first to stain bacteria. This was a very innovative
method and was vital in identifying bacteria. He was inventive
and was the first to use many methods that would go on to be
used for years to come.
The importance of research teams
Pasteur and Koch’s breakthroughs are good examples of how
important research teams were (and are) for scientific research.
Pasteur and Koch were both hugely important individuals but
they led, and were part of, large teams of researchers who
received government funding – they did not work individually.
By the end of the 19th century, scientific research was usually
carried out by a team rather than an individual. A team was more
likely to have funding and be able to afford expensive new
technology, such as more powerful microscopes. Also, working in
a team made it easier to check each other’s work and carry out
large-scale testing. Furthermore, different members of a team
could offer knowledge of different specialisms, for example,
medicine, biology and chemistry.
Who Was More Important? Pasteur Or Koch? (12)
Pasteur
Koch
• Pasteur disproved
‘Spontaneous Generation’.
• Pasteur proved that germs
caused decay and not the
other way around
• Without his work, Koch
could not have started his
own work.
• Pasteur invented
‘Pasteurisation’.
• Pasteur proved that/ how
Jenner’s vaccination
worked.
• Pasteur paved the way for
air-tight food storage,
vacuum packing, air-tight
jars, cans and tins. Made
food safer and so less
people got ill.
• Koch read Pasteur’s work.
• Pasteur found the
vaccination for ‘Anthrax’- an
animal disease.
• Thought of the ‘Germ
Theory’.
• Koch paved the way for
other scientists to develop
further ideas; he made it
easy for them.
• Koch discovered germs for
specific diseases- e.g. TB
and Anthrax.
• Koch started to stain
bacteria in order to identify
them.
• Koch worked with a team.
This meant that more ideas
could be thought up and
there were developments
were made more quickly.
• Koch realised that if he
could stain bacteria, he
could kill them.
• In conclusion, I think that Pasteur was the most important
because his discoveries paved the way for Koch. Pasteur’s
ideas, especially the Germ Theory and how it worked, it
would have taken Koch a lot longer to do what he did.
Pasteur’s Pasteurisation made food a lot safer to eat and this
saved many lives.
Explain Why Pasteur’s Germ Theory Was Important In
Improving Our Understanding Of The Cause Of
Disease (9)
Tips
• Don’t talk about the treatment
• Stick to the 1860s
Point
Explanation/
Evidence
Link to question
Pasteur proved
that bacteria was
spreading
disease- not the
other way around
Flasks- the sterile
flask did not get
germs in it- it
stayed clean.
Disproved
‘Spontaneous
Generation’
Was able to focus
on the correct
science.
His work
progressed as he
went on
Alcohol- SilkwormChicken
This meant that
constantly he was
gaining in
knowledge in
different areas and
could then apply it
to humans which
was a bigger
understanding.
Robert Koch read
Pasteur’s work
(The Germ
Theory).
Robert Koch was
able to continue
work to gain a
wider
understanding
Robert Koch
identified specific
disease- Huge
development/ new
understanding.
Answer
•
Firstly, Pasteur proved that bacteria was spreading disease
and that germs caused decay as part of his Germ Theory, not
the other way around (Spontaneous Generation). His
important experiment to prove this was his flask experiment.
This involved heating two flasks containing a liquid (to
sterilise them) and found that that the flask that had a straight
neck contained bacteria when he later checked it where as
the flask with an ‘S’ shaped neck was still clean. He
concluded that bacteria from the air got trapped in the neck
and so couldn’t reach the flask. This proved that
bacteria/germs came from the air and was the cause of
disease- he know knew the correct theory and could
disregard incorrect ideas.
• Secondly, Pasteur’s work progressed a lot throughout time.
He started off investigating why beer was going sour then the
diseases in silkworms and continued on to investigating the
causes of disease in humans. All his work in developing ideas
about disease gave him a wider understanding about disease
because he made it relevant to various things and he was
then able to apply his discoveries to humans
• Finally, Pasteur’s Germ Theory was vital for the work of
Robert Koch who read Pasteur’s work. This meant that
Robert Koch could use the findings to start his own work
concerning disease. As a result, he was able to go on to
identifying specific bacteria which caused specific diseases.
This also paved the way for other scientists to study exactly
how bacteria worked and caused disease which meant even
more developments could be made.
Who Was Florence Nightingale?
Fact File
• 1820- Born in Florence.
• Florence and her sister were educated by a governess and
then by her father.
• She enjoyed her education, especially reading and speaking
Latin. She loved maths and even taught younger children.
• She was strong and outspoken. She firmly believed in God.
She believed that she was chosen by God for a special purpose
but just did not know what that was.
• 1840s- She had an interest in social conditions of people and
wished to work in hospitals.
• Her family were against her wish to become a nurse- it was not
a suitable job for a well educated woman- at that time, they were
coarse, ignorant and often drunk.
• When she got home from a tour of Europe with friends, she
studied in different hospitals. Against the wishes of her family,
she started training to be a nurse- she trained in Alexandria,
Egypt then in London (1853). She took an unpaid role as a
‘Superintendent’ at the ‘Establishment for Gentle Women During
Illness’.
• March 1854- Worked in Britain, France, Turkey during the war
on Russia during the Crimean War (which started in 1854).
• A Times News article reported bad medical facilities. Shortly
after, Florence got a letter from a friend who invited her to
become the Superintendent of the Female Nursing
Establishment of the English General Hospital in Turkey.
• The main aim was to introduce nurses into military hospitals. In
November 1854, she got to Scutari hospital with 38 nurses.
• Because she was female, she constantly had to fight military
authorities every step of the way in a quest to reform military
hospitals.
• Conditions in the hospitals were poor. Injured men had to lie on
the floor which was extremely dirty and full of vermin. Operations
were performed in unhygienic conditions- unsurprisingly, more
men died from Typhus and Cholera than injuries.
•
•
•
•
•
•
•
•
•
•
She used her maths skills to collect data and recorded
statistics and made calculations. Her results showed that the
mortality rate of patients would improve if sanitation
improved.
By February 6th 1855, mortality rate decreased from 60% to
42%. She established a fresh water supply and bought fresh
fruit and vegetables for men with her own money. By Spring
1855, the mortality rate had dropped to 2.2%.
Deaths in British field hospitals hit its peak in January 1955,
with 3,168 deaths. Considering the man power they had for
that month and the mortality rate, if this had continued and
troops had not been replaced frequently enough, diseases
alone would have killed the entire British army in Crimea.
When she returned to England- after the end of the war- she
discovered that the mortality rate for soldiers in military
hospitals during peace time was double that of civilians.
Using her statistics, she pressed a need for reform in all
military hospitals.
May 1857, a Royal Commission on the Health of the Army
was set in to investigate military hospitals.
While in the Crimea, people donated money to Florence in a
quest to improve the hospitals. 1860- she used the money to
establish the ‘Nightingale Training School and Home for
Nurses’ based at St Thomas’s hospital in London.
She opened with 10 students and this group was the 1 st of
many who’d benefit from the principles of 1) nurses should
have practical training in hospitals organised for specific
purposes 2) Nurses should live in a home fit to form a moral
life with discipline. This made nursing a suitable career for
respectable women.
Florence acted as the Government Advisor on army medical
care in Canada and also advised the US Government on
army medical care during the Civil War (1861-1865).
For much of her later life, from illness she had contracted
from the Crimea, she was bedridden but she continued to
work to improve the standards of hygiene in hospitals but
publishing over 200 books and pamphlets- ‘Notes on Nursing
(1860) was the first text book written specifically for the training
of nurses and was published in various languages.
• 1883- Florence was awarded the ‘Royal Red Cross’ for her
work and, in 1907, became the first woman to be awarded the
‘Order Of Merit’.
Did Florence Nightingale Revolutionise Nursing &
Hospitals Single-Handed?
Other Factors Which Improved Hospitals
• Better engineering (Industrial Revolution)
• Government laws to improve public health- 1848 and 1875
• More complex surgery- better trained nurses
• Germ Theory- Had impact on all medical areas. Including
surgery and so changed the way nurses carried out their work.
What Had Changed In Nursing & Hospitals By 1920?
• 1850- 1920
• Hospitals etc.- got bigger and so the number of patients being
admitted increased.
• Hygiene improved- and so did surgery and dressings
• Nurses started to be trained
• Wards got bigger- ventilation
• Bad sanitation- now good sanitation
• Sewage- now toilets
• Lack of cleanliness- now cleanliness
• Nurses now wore proper uniforms.
Government
action
and other factors in development of
Government
Action
hospital care
Starting in London in 1867 but spreading throughout the country,
it was ordered that Poor Law Unions should join together to build
infirmaries that were separate from the workhouses and that had
a fulltime doctor appointed to them. They were to be paid for by
local rate-payers. New asylums for people with mental health
issues and fever houses for people with infectious diseases were
also built.
These changes were an improvement but didn’t completely
separate the workhouse and medical treatment for the poor: in
1887 the Birmingham Poor Law Union built a new infirmary with
1,100 beds, but 1,5000 old people were still housed in the
workhouse 3 years later. However, by 1900 the Poor Law
infirmaries and the fever hospitals and asylums run by local
authorities death with far more patients than the voluntary
hospitals, and these new infirmaries often went on to become
major general hospitals with specialist doctors.
S
Reasons Why Hospitals & Nursing Changed 18501920
Florence Nightingale’s work in the Crimea
Money raised for the Nightingale fund
She set up training schools for nurses. These nurses
showed their value, increasing respect for nurses and
leading to women becoming nurses
Florence Nightingale’s books influenced training and the
design of hospitals
The discovery that bacteria cause diseases
Increased public awareness of the need for clean hospitals
and qualified nurses
Improvements in engineering and public health
Developments in surgery, such as the use of anaesthetics
and antiseptics- wider range of surgery
Better hospitals and qualified nurses.
Essentially- Nightingale + Germ Theory + Government + Other
Factors = Cleaner facilities + better nurses (trained , more
professional/respectable, not drunk)
How Did The Training Of Doctors Change in the 19th Century?
1860 (Dr Smith, male)
1930 (Dr Jones, male)
2009 (Dr Brown, female)
Training
• Training was decided by university tutors, teachers
and private tuition.
• Government played no role in regulating the
education of doctors.
• Training at uni consisted of reading books, lectures
and practical training. They were also trained to
observe, to think for themselves and were trained in
scientific method.
• Training was decided by university
teachers + Royal Colleges could strike off
failing doctors.
• Government played no role in helping.
• Training at uni consisted of reading
books, lectures and practical training. They
were trained in scientific method (like Dr
Smith).
• Training decided by university teachers
and Royal Colleges.
• Government now play a part in regulation.
• Same as Dr Jones but now also read
scientific journals.
Understanding the cause of
illness
• Believed in ‘Spontaneous Generation’.
• Knows infectious diseases caused by
bacteria but many illnesses could not be
explained- e.g. illnesses babies were born
with.
• Knows infectious diseases caused by
bacteria but knows many illnesses have
genetic causes stemming from the DNA of
the person too.
Equipment for the diagnosis of
illness
• Little equipment to help.
• Had a thermometer and one of the NEW
stethoscopes.
• Had a thermometer and stethoscope.
• Can carry out blood tests.
• Can send patients to X-Ray but has no
charge.
• Has a thermometer and stethoscope.
• Can carry out blood tests and may have
an X-Ray at their office.
• Can send people for X-Ray and scans and
some GPs can carry out minor surgery.
Ability to treat the less well-off
• Held surgery for the poor in a local dispensary but
there were still charges for medicine.
• Does some charity work for the poor.
• Still charges a small fee for the medicine.
• NHS provides free healthcare.
Treatments
• Medicines made from herbs.
• May have needed to bleed patients.
• Recommended changes in diet and exercise.
• Could offer vaccinations against some
dangerous diseases and Sulphonamide
drugs were introduced.
• Common illnesses were treated with diet,
exercise and rest.
• Treatments for genetic diseases was
developing.
• Provided vaccinations and could remind
parents to have their children vaccinated.
• A wide range of antibiotic drugs for
common illnesses.
• Does prevention work and gives advice on
diet, smoking, exercise and weight.
Method of payment
• Payments from patients.
• Payments for visits.
• Payments for medicines he mixed.
• Payments for patients.
• Payments for visits and medicines he
mixed.
• Employed a debt collector to collect
payments.
• 1/5 of patients could not afford to pay.
• Paid by the Government directly through
the NHS trust or GP partnership she works
at.
Public Health In The Early 1800s?
•
•
•
•
•
•
Food- Fresh food was difficult to get in many towns because
it had to be brought in by horse and cart and was expensive.
Food was often adulterated- mixed with other things (chalk in
bread, sand in sugar and sawdust in flour)- by shopkeepers
to increase its weight and so make more money from sales.
Working conditions- Working conditions were at least as bad
as home conditions. Workers in mines, workshops and
factories had long hours and very short breaks. Their toilet
and washing machines were very poor, with many people
sharing one privy and only a pipe to wash at. Many people
also fell ill from the work itself, swallowing coal and textile
dust, which caused lung disease.
Patient fees- Doctors were not paid by the Government and
so had to charge fees to their patients. Therefore, the poor
could not afford to go to a doctor.
Government- Governments were still not expected to play a
major part in improving the living and working conditions of
the people. There were no pensions or help for the sick and
unemployed from governments. The first income tax was
collected in 1798 and stayed low in the 1800s.
Houses- Towns had grown very fast. Landlords made profits
from renting out houses and so wanted them to be built
quickly.
Railways- Railways were not built to take people in and out
of town centres in large numbers until the 1850s and later.
Workers, therefore, had to live close to their places of work.
How Important Was Edwin Chadwick?
How important was the role of Edwin Chadwick in improving
public health services in towns in the nineteenth century? (16)
• Positive impact of Chadwick’s work
• Limitations of Chadwick’s work
• Weigh up Chadwick’s work against other factors and
individuals.
Plan
Importance Of Chadwick
• Report- Chadwick realised that the poor were living in bad
conditions- this lead to illness- which meant that they couldn’t
work- and so others had to pay higher taxes to help them. In his
report, he came up with a solution= improve drainage and
sewage + remove waste from the streets + introduce clean
water supplies and appoint medical officers in each area.
• He was hard working and so managed to gather lots of
evidence.
• His report’s recommendations were the basis for 1848 Public
Health Act. His report influenced the Government and persuade
people that reform was needed- in 1900, people were living
longer- towns were cleaner.
Limitations Of Chadwick
• 1842 report- did not lead to immediate reform- the Public Health
Act was only introduced in 848.
• 1848 act did not force councils to reform public health- nothing
was compulsory.
• Personality- Antagonised/ annoyed/ irritated people and so he
did not win much support for his cause. He was arrogant- when
the Germ Theory was published, he refused to accept it; he still
believed in miasma.
• His influence faded in the 1850s.
• He had quite a lot of opposition- For example, many local tax
payers did not want to pay more for the improvements + the
Government were not happy because local councils didn’t want
the Government interfering.
Other Individuals
•
William Farr- Used information from birth, deaths and
marriage registers (after they were made compulsory in
1837) to build and accurate picture of where the death rate
was particularly high and what the causes of death were. He
proved the link between unhealthy living conditions. He
shamed some towns into improving public health conditions.
Evidence put pressure on local and national Government to
make changes.
• John Snow- He was a pioneer in surgery, public health,
improving medical conditions and the use of evidence to
challenge old theories. In 1849, he published a book says
that Cholera was being spread through water- not ‘bad air’.
His suggestions were mocked by many. In 1854, there was
another outbreak and this gave Snow a chance to prove his
theory that water was spreading Cholera (from using it for
things like drinking and washing).
Public Health Act 1848
In 1848, another serious outbreak of cholera finally prompted
the government to take action on Chadwick’s ideas. The
Public Health Act in 1848 set up a General Board of Health,
with Chadwick as one of the 3 commissioners. It allowed
towns to:
• Set up their own local Board of Health
• Appoint a local medical officer
• Organise the removal of rubbish
• Build a sewer system
But it did not force councils to do this, unless the local death
rate passed 23 per thousand living. Only one-third of towns
set up a Board of Health and even fewer appointed a medical
officer. Meanwhile, the terms of the Act were only temporary
so that, in 1854, the 3 commissioners had to resign and the
General Board of Health was abolished in 1858. Chadwick
was not appointed to any other official position.
Parliaments slowly became convinced during the 1850s and
1860s that they should take further action and that measures
should be compulsory.
• Snow’s work proved there was a link between water and
cholera.
• Pasteur’s germ theory showed disease spread and why
hygiene was important.
• Snow also showed the death rates varied according to
water sources and the company.
Another outbreak of Cholera in 1866 least affected those
towns where there had already been some improvements.
This reinforced the link between hygiene and health. Working
class men when given the vote in 1867, were putting more
pressure on the government to take action.
Public health Act 1875
• 1866 Sanitary Act forced all towns to appoint inspectors to
check water supplies and drainage.
• 1875 Artisans Dwelling Act gave local authorities the power to
buy and demolish slum housing.
• These led to the 1875 Public Health Act – which made local
councils responsible for ensuring that the following were
provided:
1. Clean water
2. Public toilets
3. Rubbish removal
4. Sewers and drains
• The act also made towns appoint Health and Sanitary
Inspectors and a Medical Officer of Health.
• In the years after 1875, local councils also became
responsible for:
1. Checking the quality of food in shops
2. Ensuring that the quality of new housing was improved
3. Enforcing a new law againstSpolluting water supplies such as
rivers and streams.
• Despite this, in many towns, basic services such as water,
lighting and paving were still in the hands of private
companies and individuals.
The Great Stink and Joseph Bazalgette
Plans were already being made for a new sewer system in
London in 1858. However, the extremely hot weather meant
the level of the River Thames was low and the smell of the
exposed sewage along its bank was so great that
parliament could not meet, even though sheets soaked in
disinfectant were hung at the windows to cover up the
smell. The ‘Great Stink’ combined with outbreaks of
cholera, and the work of people such as Chadwick and
Snow, to convince the authorities that more public health
reform was needed.
Josephy Bazalgette
The Metropolitan Board of Works agreed to the expensive
ideas being put forward by Joseph Bazalgette for a new
sewer system in London. He was an engineer who had
worked on large-scale sewage and drainage projects. He
designed a complex sewerage system for London that took
into consideration future population growth as well as the
needs of the time. It included 1,300 miles of sewrs, plus
pumping stations and embankments besides the River
Thames to house the stations. It took Bazalgette and his
huge team of engineers and construction workers over 7
years to complete.
Role of industry and technology
There was a lot of planning and engineering that went into
London’s new underground sewer system. Although the
Industrial Revolution led to many public health problems, it also
provided some of the solutions. Through designing and building
machinery for farms and factories, and the development of the
railway and canal systems, people had learned the best ways of
building pipelines, tunnels and embankments and how to
harness the power of steam to run engines.
The pumping station was installed in 1865 London. The engine
was one of four engines used to pump water through London's
sewers. They worked tirelessly until they were replaced by a
more modern system in the 1950s! Machines and systems such
as this would have been impossible to achieve before the
technological developments of the Industrial Revolution.
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Life expectancy 20th century
At the start of the 20th century, photographs, film, electricity,
the bicycle and the motor car had all been invented but many
people continued to live in cramped and unhygienic conditions,
using oil lamps or gas lighting. Despite advances, many people
would still not be able to afford a doctor and the average life
expectancy was 47. Pasteur’s germ theory had led to a range of
vaccinations being developed but there had been little
progress in the search for a way to cure diseases and most
medicines were still based on mixtures of ingredients such as
plants and spices.
The 20th century was a story of huge improvements in the
treatment of illness. Most people in the UK now have better
living standards than in the 19th century, and often better diets
as a result of increased prosperity.
Pasteur’s germ theory in 1861 was an important breakthrough
in understanding how disease is spread.
It led to Koch’s work in identifying the different microbes that
cause disease.
The technique to prevent people from catching a disease was
developed and applied to more and more diseases.
The government also began to intervene more in people’s lives.
They first encouraged and then later insisted that all children
were vaccinated.
First and second magic bullet
• Emil von Behring developed Koch’s work to isolate the
antitoxins used by the body to fight diphtheria – then found a
way to inject them and cure the disease.
• Paul Ehrlich (a member of Koch’s team) now set up his own
research team to build on this work. Ehlrich knew certain dyes
stained specific microbes (Koch’s work) and antitoxins only
attacked the disease microbes (Behring’s work)
• Ehrlich tried to combine a dye with other chemicals to find a
cure for syphilis – a ‘magic bullet’ that would only target the
disease microbe and not harm the rest of the body.
• Ehrlich researched for several years (this was only possible
because he received German funds).
• In 1909 Dr Sahachiro Hata joined the team from Japan and
reviewed some previous experiments. He discovered a
mistake – the 606th compound that they had tested and
dismissed was actually effective! This treatment was called
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Salvarsan 606.
• Second Magic Bullet
• The use of chemical drugs to target and cure illness was an
important breakthrough. However, it was not until 1932 that a
second magic bullet was found, when Gerhard Domagk
discovered that a particular red dye was effective against
some cases of blood poisoning and he developed the drug
Prontosil. Many people died after simple cuts or scratches
became infected, so this cure for blood poisoning could save
many lives.
• Research showed the key ingredient in Prontosil
(sulphonamide) which led to other developments in drugs that
could cure pneumonia, scarlet fever and meningitis.
Discoveries were important because medicine could now cure
many of the infections and diseases that had in the past, led to
death. At first, treatment was injections, then late 19 th century
it was mass produced pills.
Antibiotics
• Alexander Flemming was a chemist working at St Mary’s
hospital in London. In 1928 he noticed that bacteria growing
in a Petri dish was being attacked and killed by an unknown
mould growing in the same dish.
• This ruined his experiment but he decided to research the
mystery killer mould before throwing it away. He discovered
that it was an excellent antibiotic, penicillin.
• Flemming published his findings in 1929 but he was unable
to get funding to develop his work.
• It was difficult to produce pure penicillin and so it did not
seem practical to try and use it in medicine. However,
Howard Florey and Ernst Chain, 2 scientists working in
Oxford , read about Flemming’s research and in 1939 they
set up a research team to develop penicillin.
• In 1940 they tested it on mice, and in 1941 they conducted
tests on a patient. The test showed that penicillin wads like
a miracle drug on people who were dying from infection.
Unfortunately there was only a small amount of penicillin
available and the patient died when the penicillin ran out.
• Florey was determined to develop the mass production of
penicillin. The mould had to grow. This meant that they had
to use a collection of containers, including baths, bedpans,
milk churns and food tins, and had to hire 6 assistants just
to deal with this stage of the work. No British firm was able
to create the technology needed to mass produce penicillin
– partly because many factories were being damaged by
the bombing raids during WW2 or were already working to
full capacity producing other drugs needed during the war.
• In June 1941 Florey and Norman Heatley (another member
of the team) went to the USA to see if pharmaceutical
companies there would fund their research.
• At first they were unsuccessful but in December 1941 the
USA entered WW2 and the US government was now
prepared to fund the mass production of penicllin.
•
They knew that in war many soldiers were likely to die
from infection rather than from actual injuries and so
mass-produced penicillin could save many lives. This
injection of money allowed the pharmaceutical
companies to invest in large-scale.
• Florey had discovered that dying the mould at low
temperatures was the most successful method of
purifying penicillin. Scientists at the chemical company
Pfizer, in New York, used an old ice-cream freezer to
develop a method of freeze-drying that was eventually
used for large scale production in 1944.
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What Problems Remained In The 1930s?
•
Unemployment was still high- over 3 million. All the
unemployed were outside the National Insurance Scheme.
• Those in work could not afford to pay and so they could not
get free medical help. The system of 1911 was failing. The
death rate of under 1 year olds was high.
The Setting Up Of The NHS
•
There was great opposition- Doctors were worried about
losing money.
• Minister of Health (Aneurin ‘Nye’ Bevan) agreed that doctors
could treat patients privately as well as working for the NHS
as a result.
Reason For Opposition
The Beverige Report
What Did It Suggest?
•
Setting up the NHS- free for all, paid from taxes, staff were
Government employees and so they were paid through them.
This would mean that they didn’t need to charge patients to
produce a wage.
• All people in work would pay National Insurance out of their
wages (This would pay benefits- sick pay, pension,
unemployment pay) to all whether working or not (ill).
• ‘Cradle to grave plan’.
General
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His report was greeted with enthusiasm.
Sir William Beverige was a civil servant who was asked to
write a report on what should be done to improve lives. He
had previously played a part in organising 1911 National
Insurance Scheme- he helped set it up at the time. This
meant that he had lots of experience of problems and
solutions.
WW2 Change In Attitudes
•
Evacuation- Middle-class were left shocked at children’s
condition: dirty, unhealthy and under-nourished.
• After all the suffering in the war, people wanted a better
future and better health care was part of this.
• During the war, many did not get free care to keep them fit in
the war effort.
•
•
Losing money & freedom (doctors)
Some thought that the sick only got sick through laziness
and so did not think that the poor should be helped.
• Charities and councils ran hospitals and so did not want to
hand them over to the Government.
• Some thought that people would grow lazy because they’d
be getting ‘something for nothing’ and so it would make
people less likely to bother working.
The Role Of Bevan
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•
•
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Speaker
Idealist
Working-class background
Won doctors over
The End Result
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Effectiveness- Yes, life expectancy increased from the year
1919 to 1992.
• The NHS offered many services: midwifery, after-care,
dentists, hospitals, medical research, teaching hospitals,
vaccination and ambulances.
Why Was The Discovery Of DNA Important?
What To Think About:
•
•
The causes of how DNA structure was important.
The significance of why these discoveries are so important.
To Begin With:
•
1800: scientists knew that DNA existed and somehow
controlled what we are like but did not know how though.
Discovery
•
•
A series of discoveries over a long time.
First step- 1953, two scientists in Cambridge (Francis Crick
and James Watson) discovered the structure of DNA.
• They proved that DNA is in every human cell- this showed
how DNA passes on information from parents to children.
• Their discovery was the launch pad for other discoveries.
Mapping The Human Genome
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•
•
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1986: The Human Genome Project was set up in order to
identify the exact purpose of each of the genes in the human
body- they compiled a map of human DNA.
The task was completed in 2001- 15 years after the project
had begun.
The project involved teamed from 18 different countries such
as USA, UK, France and Japan etc.
Each team studied a different part of DNA.
It required computers- TECHNOLOGY WAS IMPORTANT!!
The information found through the project filled 80,000 text
books but was passed worldwide instantly via internet.
Crick & Watson
•
Were very adventurous in their ideas. They tried out
methods which other scientists did not try.
• They did not work alone; they worked with a team with a
wide range of skills and knowledge: Maurice Williams (expert
in X-ray photography and Rosalind Franklin who developed
techniques to photograph a single strand of DNA an was the
first person to take X-ray photos of DNA).
• They had the latest and best equipment. New technologiessuch as X-ray photography and improved microscopes and
built on new knowledge in other sciences (like genetics and
biochemistry).
• Their research was very expensive because of the complex
equipment and the number of highly skilled people involved.
• Most of the money came from the Government while
industries also made a contribution.
Why Is DNA So Important?
• DNA has lead to work on stem cell research.
• E.g. Christopher Reeve (paralysis) campaigned for stem-cell
research.
• At this stage (now), we do not know a lot because we are
just at the start of the DNA Revolution; it has not yet lead to
any treatments. We do not know how much it will effect
medicine in the future but there are various possibilities…
Understanding DNA Could Lead To:
•
Gene therapy- Using genes from a healthy person to cure
the sick.
• Customised drugs- Creating drugs to cure one person’s
particular heath problems.
• Genetic engineering- Choosing the nature of a child- like
genetically modifying plans- (e.g. gender, appearance and
intelligence).
• Genetic screening or testing- Identifying the illness people
could suffer from and preventing it as a result. E.g. identifying
if a person is more likely to get cancer or possible conditions
in unborn babies.
Positives Of The Discovery
•
Could lead to treatments and further medical discoveries.
Limitations Of The Discovery
•
The discovery has not yet lead to any treatments.
Double Heelix
During the 20th century, scientists could take photographs of
human cells through 2 improvements in tech. – electron
microscopes and X-rays.
It became known that each cell in the body contains DNA,
which is a set of codes controlling the genes that decide
eyes and hair colour, height etc.
Francis Crick and James Watson worked together to
investigate the structure of DNA. Crick was a physicist and
Watson a chemist.
Research into genetic conditions requires very specialised
knowledge and expensive, high-tech equipment.
DNA Table
1953 Crick and Watson discovered the structure of DNA.
1990 The Human Genome Project mapped the location of every single
one of the 30,000-35,000 genes in the 23 chromosomes in every cell
of the body.
The project involved hundreds of scientists working in 18 teams. The
first draft was produced in 2000.
Scientists have identified certain genes that pass on specific hereditary
conditions.
The result?
There are new techniques for skin grafts, better production of
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insulin for diabetics and better vaccines.
Better understanding of conditions such as Down’s Syndrome and
leukaemia, and whether people are more likely to develop certain
forms of cancer.
There has been further research to develop techniques to alter faulty
genes within the body and prevent genetic illnesses from developing.
The discovery has been made that stem cells (found in the bone
marrow and the pelvis) can transform into various types of cells used
around the body – which offers a chance of replacing faulty cells with
healthy ones.
NHS & Public Health Since 1948
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•
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Prevention of illness is not a major part of the NHS.
5th July 1948- First day of NHS
Early 1960s- Old hospitals were replaced
1970s- Health care campaigns were introduced
1992- ‘Health of the nation’ initiative helped/s prevent and
reduce death from cancer, heart disease, HIV and AIDS.
• 1998- NHS Direct began (telephone line).
What Was The Big Picture Of Public Health Changes
After 1800?
1) Government had a laissez- faire attitude (that the
Government should intervene as little as possible).
2) Governments encouraged councils to improve public health.
3) Governments forced councils to improve public health.
4) Governments passed laws to improve public health- mainly
for the poor.
5) Governments passed laws in improving public health for
everyone.
Timeline
1831- Cholera killed thousands
1842- Chadwick Report was published
1848- Public Health Act was passed
1858- The Great Stink!
1875- Another Public Health Act
1901- Rowntree Report
1901- Boer War began
1907- Bring out your babies!
1911- Nations Insurance Act was passed
1920s- Home for Heroes!
1942- Allied victory at El-Alamein
1948- Free health care for all!
Role of science and technology
In the 20th century, scientific research and knowledge has led
to:
• Chemical treatment of disease (magic bullets)
• Antibitoics, which used living organisms to fight disease.
• More vaccines to prevent the spread of disease.
• A better understanding of genetics: genetic changes that
cause problems and genetic changes that can help/
• Treatemtns being developed for conditions, such as
diabetes, which were previously incurable.
Blood Transfusions
Most attempts in the past had led to death. But in 1901 Karl
Landsteiner discovered that there were 4 different blood
groups, and transfusions were only successful if the donor’s
and patient's blood groups were the same.
This meant that:
1. People who might die from losing a lot of blood could now
be kept alive.
2. People with blood disorders (such as anaemia) could
receive treatment.
The problem was that blood could not be stored (it clotted), so
the donor and the patient had to be together, for the
transfusion to be carried out. The high number of injuries
during WW1 sped up the search for a solution.
In 1915, it was discovered that adding sodium citrate
prevented blood from clotting, but the blood cells soon
deteriorated. In 1916, new scientific techniques made it
possible to establish blood banks.
X-ray machines – discovered by scientist Wilhelm Roentgen in
1895. Used to diagnose broken bones and some diseases. Used
during WW1.
Radiotherapy and chemotherapy – By 1902, scientists used
Roentgen’s discovery to make another one – x-rays could be
used to ‘burn’ and shrink tumours. This led to techniques called
radiotherapy and chemotherapy which are used to treat types of
cancer.
X-ray crystallography – Developed in 1st half of the 20th
century, allowed scientists to take powerful images of human
cells. (This played a role in the discovery of the structure of DNA)
Microscopes – Electron microscope invented in 1931. Used in
medical research and in diagnosis.
Scans – Not just X-rays but ultrasound and MRI, which are used
to scan a patient and diagnose internal problems.
Endoscope – Flexible tube containing a camera which can be
passed inside the body so doctors can see what is happening
without the need of surgery.
Nuclear Medicine – radioactiveSelements can be injected into
the bloodstream to help track ad diagnose what is happening
inside the body.
Pacemakers – These are used to help people’s hearts work
properly.
Dialysis machines – These keep people alive when their
kidneys are not functioning properly.
Dispensing instruments – Hypodermic needles and
intravenous drips help to give a precise dose of medicine.
Care of the sick c1900-1948
At the start of the 20th century, it was still women in the family
who were mainly responsible for treating most illnesses and
caring for the sick. Because doctors had to be paid for every
visit, people would only use doctors if they were really ill., so
most illnesses were treated with preparations bought from a
chemist. Traditional ‘folk remedies’ continued to be used, such
as red cloth to help you recover from a cold or influenza and a
sweaty sock tied around the neck to help a sore throat. Minor
surgery, such as taking out tonsils, was often done by a doctor
on the kitchen table. A GP might also do some surgery in a
local cottage hospital but anything serious would be referred
to a specialist in a big hospital.
Charitable Hospitals
Many hospitals offered only basic care for the sick rather than
the range of treatments we now expect, some were aimed at
specific groups of people. Sanatoriums (medical facility) were
built to provide a healthy diet, fresh air and hygienic
conditions, which patients with TB needed to recover.
Effective fundraising was important because many hospitals
were set up through charity. In 1912, Queen Alexandra started
a national Rose Day, volunteers sold them to make money for
hospitals. The first day, the equivalent of £2 million was
collected in today’s money.
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Access to healthcare
• Standard of living among the poor was still very low.
Surveys showing how difficult it was for the poor to afford
decent housing and food were carried out by Charles
BOOTH AND Seebohm Rowntree. Their work showed that
the main reasons for poverty were ill-health and
unemployment.
• The Liberal government that was elected in 1905 began to
pass laws that they hoped would improve health among the
poor. The 1911 National Insurance Act was particularly
important. Every worker earning less that £160 a year was
expected to join the scheme, in which contributions by the
worker, employer and government were made to fund:
• Free medical treatment and medicine
• Sick pay for up to six months and support payment while
unemployed for up to 15 weeks.
• In 1919 the Ministry of Health was set up, which gave the
government an overview of health care provision in the
whole country. This was an important step in the
government taking more responsibility for health, but actual
provision continued to be a mixture of people paying for
private care, local authorities providing some support and
many hospitals relying on funding from charity.
• An epidemic of influenza in 1918-1919 showed that there
were not enough free hospital places.
• Women and children were not covered by the National
Insurance scheme and so they often delayed getting
treatment because they could not afford to pay for a doctor.
• Average life expectancy by 1931 had risen to 58 for males
and 62 for females, and the government was doing much
more to help improve the health of the nation.
• Secondary school pupils received medical inspections
• Free milk for poor primary schoolchildren was introduced in
1934
• Health clinics gave vaccinations and sold baby food
cheaply.
• Range of private health insurance schmes that could provide
treatment for women, children and those men not covered by
the government scheme.
• A better understanding of disease, development in
vaccinations and better treatment for disease meant that
people were more willing to accept government interaction.
• The death of 3,000 children from diphtheria in 1938 shocked
the government and led to a vaccination programme offering
free immunisation.
The effects of WW2
• WW2 had a major effect on people’s awareness of the effects
of poverty on health. People were shocked to find out that
many children evacuated were not used to running water or
proper toilets and that they often had nits, lice and skin
infections. This was an important factor in creating the desire
for a higher standard of health after the war and the setting up
of the NHS. The war also had an effect on people’s diets.
Food was rationed and fats and sugar were in short supply,
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while people were encouraged
their health was actually getting better than they had been.
Education and prevention
• The government now accepted that it had a role to play in
educating and encouraging people to stay healthy. The
government was starting to take more of a role in trying to
prevent illness.
• Developments in vaccinations, such as Jonas Salk’s polio
vaccine in the mid-1950s, and the introduction of a vaccine
in 2008 against cervical cancer
• Government promotion of healthy diets
• Better disposal of rubbish and treatment of sewage
• Laws to reduce air and water pollution, for example the
1956 Clean Air Act, which health with the problem of smog
(a mixture of fog and smoke from coal fires, industry and
car fumes)
• Laws to improve people’s working conditions, for example
health and safety regulations about asbestos in the
workplace.
• Provision or environmental health officers to inspect
restaurants, cafes and bars.
• Strict laws on food safety in 1990 after outbreaks of
salmonella, E. coli poisoning, and BSE in cattle.
• Public health and private companies
• Private companies are increasingly involved in public
health. For example, the responsibility for the provision of
water has now been passed to private companies but the
fact that many of the pipes are over 100 years old and need
repairs or to be replaced causes problems for the water
companies, who are reluctant to carry out the repairs
because of the cost.
Government action – smoking, communication and
private companies
• Smoking proved very popular in the mid-20th century
when cigarettes became very cheap. However, in the
mid-1960s it became clear that there were links
between smoking and cancer, heart disease and
many other health issues.
• In 1962 the Royal College of Physicians called a ban
on tobacco advertising.
• The government began taxing cigarettes heavily.
• Since 1971 packets of cigarettes have carried a
health warning.
• In 2004 it was reported that over half a million
admissions to hospital and 1 in 6 deaths were a result
of smoking.
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• In 2005 a ban was placed on most forms of tobacco
advertising.
• Smoking in public places was banned in 2006 in
Scotland and in 2007 in England and Wales.
Communication
• Communication has played an important role in the
government campaign, with messages on the
products, posters and television campaigns to raise
awareness of the effects.
• When HIV/AIDS wsa recognised as a significant
risk to health in the 1980s, the government funded a
national information campaign.
Pharmaceutical industry
Cost of medicine and private health care
The late 19th century saw the beginnings of this industry as
companies such as Beecham and Boots began making and
selling prepared mixtures and pills. Few of these first pills
did any good (and some harmed) but as progress in
science led to discoveries of first magic bullets and then
antibiotics which successfully cured disease,
pharmaceutical companies began to play an increasingly
important role they:
• Employed and financed scientists and researchers to
find other cures and remedies.
• Used and developed technology and industry to massproduce remedies.
• Used advertising to make people aware of their
products and buy them.
Through financial backing and providing scientists with
equipment needed, the industry has played an important role
in finding new cures and treatments and making them
available. However, the industry also created some problems.
The industry expects to make a profit, therefore, many
companies produce different versions of the same basic pill.
Although each new drug is tested before it is licensed for sale,
there can be problems during the tests or unforeseen sideeffects. For example, in the 1960s, a new drug called
thalidomide was used to prevent morning sickness in pregnant
women but it was found that it affected the growth of the
unborn baby and the development of their arms and legs.
Ethical Questions
There is a lot of debate about whether scientists should ‘play
God’ and use their knowledge of genetics to change people’s
bodies. Some research depends on experiments with human
embryos; others combine animal and human cells together;
cloning has already been used on animals. Many people
object to these things on religious and moral grounds or from
fear of the side effects.
The rising cost of the NHS soon became a problem for
the government. This was because:
• As people live longer, they are more likely to develop
problems needing treatment.
• Improvements in medicine mean people expect a
greater range of treatment.
• New drugs can help many conditions, but the cost
can be very high.
• Treatment is more complex and equipment more
expensive, with new technology such as MRI scans.
• Staff costs are high because of increased traning for
doctors and nurses.
Return to private healthcare?
• Long waiting lists for treatment
developed in the late
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th
20 century, with rising demand for treatment from a
growing, aging population, and many people’s
conditions deteriorated before they could get
specialist help.
• As a result, private companies grew.
• Many GPs and consultants now offer private health
care.
• GPs are encourage dot offer a wide range of care.
However, because the way GPs are funded by the
state it has meant that few of them now offer an
emergency service.
• In 2008, the NHS celebrated its 60th anniversary, but
there is much discussion about whether it should
continue in its current form or if there should be
radical changes.
Anaesthetics (use sheet)
James Simpson
• Simpson started his own experiments. He decided to use
Ether as a base and mix it with other substances. He tried
a mixture of Hydrochloric Acid and Ether (later to be called
CHLOROFORM). At dinner one night he sniffed it in from
of the family and immediately passed out. He passed his
exams for the Royal College of Surgeons and in 1836
became a doctor at an Edinburgh hospital. In 1840 he
became Professor of midwifery at Edinburgh.
• He reorganised the teaching of the subjects, and made it an
essential part of every medical student’s training. Over the
years he became more and more concerned about the
suffering endured by women during childbirth.
• Simpson started his own experiments. He decided to use
Ether as a base and mix it with other substances. He tried
a mixture of Hydrochloric Acid and Ether (later to be called
CHLOROFORM). At dinner one night he sniffed it in from
of the family and immediately passed out. On November
4th 1847 he conducted an experiment to test the usefulness
of chloroform.
• Within fourteen days Simpson completed 50 successful
operations using Chloroform. It was first given by a sponge
soaked in the liquid pressed to the patient’s nose. Later
special inhalers were developed. In 1852 Queen Victoria
used it during the birth of Prince Leopold and it soon
became completely accepted. Twenty years after it was first
tired it was used throughout Europe and in 1866 Simpson
was knighted. He died in 1870. Chloroform remained the
chief method of anaesthesia well into the Twentieth
Century.
Not everyone welcomed the use of anaesthetics:
•
Victorians were very religious and some people felt
interfering with pain interfering with God’s plan.
•
Some people didn’t trust the,.
•
Some doctors felt it was easier for patients to die if they had
been made unconscious that if they remained awake and
struggling.
•
Number of patients that died after their operations, increased
when anaesthetics were used.
•
The effects of both chloroform and ether tended to remain in
the body for some time. It was found that cocaine was
effective for pain relief, but was addictive.
Understanding infection
When the patient was conscious surgeons would have to
produce the operation quickly. Anaesthetics meant that they
could take longer. This meant that they did more difficult
operations. They did not understand germs so many people died
after their operation from things like gangrene. Doctors used
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liquids such as wine and vinegar
centuries but before Pasteur’s Germ Theory, no-one knew what
was causing infection. That was why surgeons did things that
seem obviously dangerous today. They reused bandages,
spreading gangrene and skin infections from patient to patient.
They did not wash their hands before an operation, nor did they
sterilise their equipment, and some operated wearing pus
stained clothes.
Early attempts to control infection
Ignaz Semmelweiss worked at Vienna general hospital He was
concerned about women dying in childbirth and that more
women were dying at home than in the hospital. He found that
making the students wash their hands using a solution reduced
the death rate. Many doctors made fun of his ideas and he was
sacked.
Joseph Lister and antiseptics
Another man working to defeat infection was Joseph Lister.
Lister was an outstanding surgeon who had researched
infections thoroughly. He wanted to apply his scientific
methods to solving the problem. Lister had seen carbolic
spray used to treat sewage. He experimented and he found
that a thin mist of carbolic acid sprayed over the wound
during surgery could reduce infection. If the wound was
then carefully bandaged in clean material, it would prevent
infection setting in after an operation.
In 1877, Lister moved to London to train surgeons under his
own supervision. When, in 1878 Koch found the bacterium
for Septicaemia (blood poisoning) which both Semmelweiss
and Lister had tried to tackle, Lister’s work suddenly
seemed even more important. People paid more attention
to his methods. Other doctors and patients realised that the
spray wasn’t useless but killed real germs and prevented
common diseases.
Lister didn’t stop there. By the late 1890s Lister had improved
his technique. He was now able to remove all possible
germs from the operating theatre, not just the wound. This
lead to several measures to ensure cleanliness being
introduced:
Operating theatres and hospitals were cleaned thoroughly
From 1887 all instruments were sterilised
In 1894, sterilised rubber gloves were introduced for the first
time
Now that pain and infection had been limited in operations,
more and more complex procedures could be attempted.
The first operation to remove an appendix occurred in the
1880s and the first heart operation was carried out in 1896.
However, even after Lister’s careful research, some people
were still reluctant to use antiseptics. Firstly, the carbolic
spray reduced the speed of operations. It also required
extra work and expense and made everything smell, even
cracking the surgeon’s skin.
Moreover, when some surgeons tried to copy Lister’s work, they
often got different results because they did not copy his routine
exactly. Many doctors simply could not believe that it was
possible for fewer patients to die, and were disbelieving and
defensive. Finally, Lister failed to present his ideas well. When he
gave talks, he seemed cold and aloof.
Blood Loss
Bleeding was another great problem. It was not possible to
replace blood by transfusion although blood vessels could be tied
with ligatures to stop the blood loss. The usual way to deal with
wounds or amputations was to seal the blood vessels by placing
a hot iron onto the wound or puring hot oil over it. In the 16th
century a French surgeon (Amroise Pare) developed metal clips
to place on arteries during an operation. He also tried to use silk
thread to tie the blood vessels after an amputation instead of
using heat to seal them. This was before Pasteur’s germ theory
so there was no understanding of dirty hands inside a wound
increasing the chance of infection.
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Problems with Blood Transfusion
Blundell was specialised in women and their care through
pregnancy and giving birth. He found that a transfusion of human
blood could sometimes stop the mother from dying:
• Clotting – a scab forms, blood starts to clot. Blood clots the
transfusion tubes.
• Availability – clotting also meant that blood couldn’t be stored.
They could only be done with a donor attached to the patient.
• Immune response – transfusing blood from an animal into a
human seemed to destroy human blood cells, often leading to
death.
Blood Types – 1901 Karl Lansteiner suggested there were
different blood groups A,B and O. AB was then added. He
identified some types were incompatible, could not be mixed.
They had to be the same type. This breakthrough did not
increase the number of transfusions because the donor still
needed to be present to provide the blood whenever it was
needed. This was not practical.
•
•
•
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•
Blood Transfusions
Blood transfusion was used effectively for the first
time after blood types were discovered in 1900.
Methods of storing blood and transporting it were
improved. In 1915 an American doctor Richard Lewisohn
found that adding sodium citrate stopped the blood from
clotting. This meant that the donor did not have to be
present.
Richard Weil found that this could then be stored in
refrigerated conditions.
1916 Francis Rous and James Turner found adding a
citrate glucose allowed for it to be stored longer.
Geoffrey Keynes, developed a portable machine that
could store blood.
First blood depot established in 1917.
• After WW1
• Further improvements in blood transfusions. Including
better ways to store blood and the introduction of
donations of blood from civilians.
• Bllod groups sometimes got confused: dif. Classification
systems and mix-ups.
• Bottles that blood was stored in not always free from
bacteria. This could cause infection.
• Type O worked for everyone but that meant hospitals only
targeted type O people for donations. As giving blood also
involved a big cut into the vein, it became difficult to find
donors.
• Doctors and surgeons were reluctant to change.
Science and Technology
Chemistry played an important part in developing anaesthetics and
antiseptics. Surgeons were more willing to try complex operations,
for example, removing tumours. They also began to deal with
internal obstructions , such as hard ‘stones’ inside the gall bladder. In
the 1880s operations to remove gallstones and the gall bladder
became routine as a result of anaesthetics and antiseptics. Infection
was controlled by using Lister’s carbolic spray, steralising the
instruments, wearing rubber gloves and using sterilised catgut for
ligatures.
The discovery of X-rays in 1895 made surgeons more confident about
internal operations.
The London Royal Hospital had its first X-ray machine in 1896. X-rays
also made it possible for surgeons to extract bullets and shrapnel
without having to dig around in the wound. The importance was
quickly recognised by surgeons, and mobile X-ray units were
developed. Carbolic spray, the steam
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the hypodermic needle used in blood transfusions were also
important.
War and developments in surgery
• In WW1, surgeons treated soldiers close to front line and
they gained a lot of experience in a wide range of injuries
and sometimes had to improvise new techniques. In this
way, war can be said to accelerate their training.
• New developments – explosive weapons meant people
suffered deep wounds that caused infection. Surgeons
found that cutting away infected tissue and soaking the
wound in salt was the best way. Before WW1, most
surgeons stayed away from working on the brain – too
complicated. Surgeons did know that they needed to try
something.
• Harold Gillies asked for permissions to set up a plastic
surgery unit in the British army. He began to work on ways
of reconstructing facial injuries and paid attention to the
attempt to create a normal appearance. He developed a
new techniques of pedicle tubes. A narrow layer of skin was
lifted up from the body and stitched into a tube at one end.
The other end was still attached to the body and this meant
blood continued to circulate and helped healthy skin to
develop. When the tube had grown long enough, the free
end was attached to the new site. Once the skin graft was
in place, the pedicle tube could be cut free at the base.
• Prosthetic limbs – between 1914 and 1921 over 41,000
men in the British armed forces lost a limb. Advances
meant that the use of light metal alloys and new
mechanisms, but there were long waiting lists for these to
be fitted and patients then needed training to use them
properly.
Communications
Journals – development of surgery depended on effective
communication of findings, evidence and techniques. Surgeons
had to convince others that their new methods were worth trying.
Reports of new discoveries in medical journals, such as the one
produce by the Royal College of Surgeons were important
because:
Most surgeons read the same journals
Journals only published information that they though was based
on good science.
Pasteur published his germ theory that microbes in the air
caused decay and infection, and Lister applied this idea to his
attempts to reduce infection. Lister was able to build on Pasteur's
work and communication helped surgery advance.
Overcoming obstacles – journals also communicated problems
with new techniques and criticisms of new ideas. The spread of
ideas was an automatic process. Ideas were initially rejected or
only accepted gradually. Remember when Semmelweiss tried to
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improve hygiene, he was unsuccessful.
Lister’s ideas were
accepted more readily because Pasteur had published his germ
theory.
Some of the developments would probably have happened
anyway. Ether had been such a breakthrough in surgery that
when people realised the problems in using it they didn’t want to
abandon anaesthetics but find a better one. Nevertheless,
communication was not always effective. The spread of new
ideas was sometimes restricted when people protected their new
ideas from being copied.
Newspapers – Public were interested in the developments of
surgery. Newspapers reported on anaesthetics, Queen Victoria
use of chloroform. These make useful sources for historians, but
opinion was also important. Remember religious factors on using
anaesthetics. The Lancet paper was very critical of the Queen
having chloroform.