Medicine Through Time Revision Guide

Transcription

1 Medicine Through Time Revision Guide Oasis Academy Isle of Sheppey History Department

2 The cult of Asclepios Philosophers looked for rational explanations 1. Asclepios was the Greek God of healing with his daughters Panacea and Hygeia. Temples were built, dedicated to them. 2. People would go there to rest, exercise and eat a healthy diet (natural treatment) but they would believed they would be healed in the night by the Gods (supernatural treatment) 3. People did get better. This may be because of rest, or because they believed they would! Greek philosophers also looked for rational explanations for disease! Hippocrates: The Founding Father of Modern Medicine? Encouraged doctors to look for natural treatments rather than praying to Gods. Created the Hippocratic Oath doctors swear to work for the patients, not just to become wealthy. Encouraged observation and recording of illnesses and treatments. Could be used to help diagnose other patients in the future The theory of the Four Humours. Important as logical and believed until the Renaissance! The Hippocratic Collection first detailed list of symptoms and treatments. How were patients treated? 1. Careful observation could work out what was wrong and then plan treatment. Timeline 2. Rest and Exercise doctors believed that best way to get well was to restore the balance of the Four Humours. This meant resting or changing their diet. 1798: 3. Vomiting Edward Jenner and Purging developed if still a not vaccine well could for smallpox be made to vomit to try and make the bodies Humours balanced. 4. Prayer many still believed in the power of prayer! 5. Herbal Remedies women would still treat families.

3 The Roman Army Practical approaches Leads to Public Health 1. The Roman Empire was bigger than the Greek or Egyptian empire. They needed a big, healthy army to be successful with this. 2. When the army camped near swamps and marshes they became ill. 3. Even though they did not know about germs they realised there was a link between dirty water and disease. 1. The government paid for aqueducts to carry good water into cities, public baths, toilets and sewers to remove waste, 2. They also built roads for travel which increased communication. Believed in Hippocrates method of observation and the theory of the four humours. Built on the theory of the four humours with the treatment of opposites. This involved using an opposite treatment to the problem. For example, if a man has a cold, should give him a fiery pepper to balance his humours. Galen proved that the brain controls speech through a famous experiment on a pig. Before this, they thought the body was controlled by the heart! Galen s reputation lasted over 1400 years! Galen Galen also said that every organ in the body had a special role to play and were designed by God. These ideas fitted in with the Christian belief that God created human beings. Factors that influenced medicine in the Ancient World 1. War The Roman armies spread knowledge through the countries they conquered (including Britain!) The army was needed to stay fit and healthy so they had specialist doctors and surgeons 2. Individuals Hippocrates and Galen 3. Religion In all times religion banned dissection. In all time periods they believed Gods made you better such as Asklepius. 4. Education The Greeks were great thinkers, they encouraged logical thinking and natural solutions to causes of illness. The Greeks developed writing. 5. Trade and Communication as trade increased, there was an exchange of ideas across Europe and Africa. 6. Government the Romans introduced public health into the towns.

4 What do we mean by The Dark Ages? 1. By AD 400, the Roman Empire was being invaded by warriors from northern Europe. The Empire collapsed and the Roman Army left Britain. a. With this came the collapse of the public health systems that had been put into place as there wasn t a central government to maintain it and invading tribes destroyed it. b. Due to war, travel was dangerous so ideas travelled slowly. c. Many of the medical ideas of the Greeks and Romans were lost in Britain. d. The Christian Church became a big part of British life. The church stopped dissection and encouraged the belief that disease was a punishment from God. 2. This led to the idea that medicine stagnated (didn t get better), or even got worse! The Lack of Public Health The Growing Power of the Church 1. The Roman Catholic Church grew in this period: a. Churches each village had its church and priest who told people what to believe and how to behave. b. Conservatism the pope and bishops were afraid that new ideas would challenge the power of the Church. Every new idea was checked to make sure it didn t challenge the bible. c. Education the church controlled this. Priests and monks were often the only people who could read. The church also sometimes banned booked they didn t want people to read. d. Superstition The Greeks had looked for rational explanations. The church taught the opposite. They said that God and the Devil controlled their lives.

5 Galen Returns to Western Europe 1. The works of Galen and Hippocrates were rediscovered in the libraries of the Arabic world. 2. The Europeans came into contact with the Arabists during the crusades, this made Europeans aware of the scientific knowledge of the Arabs. 3. By about 1100, versions of the works of Galen and Hippocrates came back to Britain. 4. About the same time, university medical schools in Europe were set up by the church. Anyone who wanted to be a doctor had to train here. They taught the ideas of Galen (which are wrong) but also taught the need to observe and record patient s disease. Who could treat you in the Medieval Period? 1. Trained doctors were very expensive and the poor could not afford to pay. These were therefore limited to the rich. 2. Most of the medicine practiced amongst the ordinary people was provided by the monasteries and local women. 3. The Christian Church also set up hospitals to care for the poor and sick. However, only 10% cared for the sick, whereas 47% housed the poor and elderly and provided no medical care. 4. Apothecaries sold drugs and medicine and sometimes advised on their use. Many were quack doctors What diagnosis and treatments were available? 1. Doctors would use urine charts to diagnose patients, they test the colour, smell and even taste of the urine. 2. They still believed in the theory of opposites and so would use methods such as bleeding to balance the humours. 3. There was a huge selection of herbal remedies. Many of these have been proven to work e.g. onion and garlic kill bacteria. 4. There were also supernatural treatments available, such as charms and The King s Evil or Touch (when the king would touch a person that was suffering with the disease scrofula to cure them) And what about surgery? 1. Surgery was seen as a job for low-paid assistants and untrained barber-surgeons (the local barber). 2. Surgical treatments were still few and simple, as pain, bleeding and infection made major surgery very risky.

6 And what about surgery?

7 What was the Black Death? 1. In 1348, a ship brought the Black Death to England. Over 40% (nearly half!) of the population died during the plague. The Black Death killed both rich and poor alike, swiftly and painfully. The dead were quickly buried in large communal graves. 2. There were two kinds of plague: Bubonic Plague Pneumonic Plague What did they believe caused the black death and disease? 1. There were also a group of people called the flagellants who whipped themselves to try and rid themselves of their sins. They believed this would protect them from the Black Death. 2. Some people even thought it was sent as a punishment for naughty children!

8 How did they attempt to treat the Black Death and why did medical ideas get worse? Attack foreigners and people of a different religion. Twenty thousand Jews were burned to death in Strasbourg in Sit next to a blazing fire (as the Pope did right through the hot summer of 1348) In 1348 the Archbishop of Canterbury wrote: Terrible is God to the sons of men he uses plagues, miserable famines, wars and other sufferings to drive out their sins In 1365 a French doctor wrote: many people have been killed by the plague, especially those stuffed with bad humours. As Galen says, the body does not become sick unless it contains evil humours You should carry a bunch of herbs and hold it to your nostrils at all times. Avoid stagnate water, slaughter houses and rubbish tips. The evil planets of Mars and Saturn have moved closer together. This has turned the air bad. If we breath in the bad air we will catch the plague You should avoid overeating and avoid having a bath. These cause the pores of the skin to open which the poisonous air can enter. Not all advice was bad "You are to make sure that all the human excrement and other filth lying in the street of the city is removed. You are to cause the city to be cleaned from all bad smells so that no more people will die from such smells Letter from King Edward III to the Lord Mayor of London 1349.

9 How did the Church help the sick? 1. Looking after the sick was an important part of the Christian Church and 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 in 1123 By 1400 there were over 500 hospitals in England, although many only had 5 or 6 beds Many hospital treated specific illnesses such as lepers, poor travellers, the sick, the elderly People believed God was punishing them for their sins so joined in prayers. Nursing care was provided by nuns who had a good knowledge of herbs and other remedies How were some Abbeys like Canterbury designed to help the sick?

10 Who else could you go to if you were sick? If you could afford to pay, you would go to see a local physician However most illnesses were taken to the women of the household. Women treated the vast majority of the illnesses in the Middle Ages Mothers and wives had a wide range of remedies at their fingertips, although sometimes the wise woman was called in. Women also acted as midwives. In some towns, midwives had to be apprenticed and gain licenses working as apprentices. Women could also qualify as surgeons by working a apprentices. However women were not allowed to become physicians and were certainly not allowed to attend university How did they try to stay healthy? This book was very popular and sold in towns and carried around the country by peddlars Bleeding was the most common way of trying to avoid illness. In some monasteries they were bled between 7 and 12 times a year to avoid illness. On occasion, this was carried out until the monk was on the point of unconsciousness, which means he lost 3 or 4 pints of blood. Some careless surgeons bled their patients to death!

11 How did they treat the sick? 1. Diagnosing the illness 2. Timing the treatment 3. Use of bleeding chart 4. Home remedies Were all herbal treatments good? Certainly not! To cure an abscess in the throat, take a fat cat, flay it well and draw out the guts. Take the grease of a hedgehog, the fat of a bear, resins, fenugreek, sage, honeysuckle, gum and wax and crumble this and stuff the cat with it. Then roast the cat and gather the dripping to use and apply on the patient.

12 Arab Medicine 1. It is important to remember that medicine has changed in different places in different times. 2. The Arab world did not have the problems that came with the collapse of the Roman empire and so the ideas of Galen and Hippocrates were kept safe, and built upon! Similarities between Arab and European Medicine 1. Both used the medical ideas of Galen and Hippocrates 2. Both were strongly influenced by religion e.g. both religions said should care for the sick, both banned dissection. 3. Neither had a cure for the Black Death. Differences between Arab and European Medicine 1. Arab medicine had more good libraries. 2. They also had more hospitals, which were there to care for the sick. 3. The medical ideas were not lost and were built on instead. Factors that influenced medicine in the Medieval Period 1. War Armies took trained doctors to war so they gained experience on the battlefield. However war also made travel dangerous and caused the collapse of the public health system. 2. Religion The Christian church set up universities for doctors to train in. It also built hospitals. They also housed booked in the monasteries. However, the universities did not teach the doctors to look for new ideas as they said Galen s ideas were correct. 3. Communications The Crusades led to an exchange of ideas with Arab doctors. 4. Government There were some laws to force towns and cities to clean up. However, these were not enforced and the King had not money to pay for improvements.

13 Renaissance Man born-again Roman? 1. The Renaissance gets its name from the rebirth in interest of the classical period. 2. The Royal Society (a famous scientific society), was founded in this period (1660). The Renaissance saw science begin to replace explanations of superstition, astrology and religion. 3. Renaissance Man is important as people at the time thought that a well-educated person should have a good knowledge of science and art. Artists like Michelangelo and Da Vinci would have studied both. They would attend dissections resulting in wonderful drawings. 4. The return of the works of Galen and Hippocrates renewed a belief in the four humours, treatment of opposites and various herbal remedies. An illustration by Da Vinci The Renaissance also led to new ideas 1. Within this period, there was a break away from the Roman Catholic Church, which we call the Reformation. Different groups of Christians went different ways, encouraging debate. 2. This led to the questioning of old ideas, even those of Galen and Hippocrates! Printing one of the greatest inventions of all time 1. Johann Gutenburg introduced printing to Europe in This invention helped medicine progress! William Caxton set up the first British printing press in 1476 in Westminster Abbey. 2. Making a single copy by hand could take weeks, months, even years to complete by a copyist. Books were therefore very rare before printing. New ideas could not be spread easily as they just weren t written down anywhere! 3. The printing press changed this, and was a big factor in helping new ideas spread within the Renaissance.

14 Vesalius wrote anatomy books with accurate diagrams 1. Vesalius was born in 1514 and studied medicine in Paris and Italy. He was allowed to perform dissections but couldn t look closely at the skeleton. He was so dedicated he stole the body of a criminal from the gallows. 2. He became professor of surgery at Padua in Italy where he performed more dissections. He wrote books on his observations including The Fabric of the Human Body in His illustrations were carefully labelled and he used his powers of observation to point out some of Galen s mistakes. a. Galen thought that blood passed through the septum of the heart through little holes. Vesalius proved there were no holes in the Septum. b. Galen believed that human jaw bones were made of two pieces. Vesalius proved it was three parts, not seven as Galen said c. The breastbone has three What was the importance of Vesalius? Many doctors refused to accept that Galen was wrong Nobody was healthier as a result of Vesalius Vesalius insistence on enquiry began to change attitudes Doctors realised there was more to be learned His book spread knowledge and the way forward for medicine Pare was forced to improvise and so improved 1. Pare was a barber surgeon born in Surgery was still a low status profession. He first worked for a public hospital and then became an army surgeon. 2. At the time the wound left by amputation was sealed by burning the end with a red hot iron, known as cauterisation. This was very painful. 3. Pare invented the method of tying off vessels with thread, known as ligatures. This was less painful, but may have caused infection as they did not yet know about germs. 4. Gunshot wounds were, at the time, treated by pouring boiling oil into the wound. 5. During one battle, Pare ran out of oil and resorted to an ointment of his own using egg yolk, oil of roses and turpentine. To his surprise, these patients recovered better than the ones scalded with oil. 6. He received opposition to his ideas from doctors who didn t want to listen to a lowly surgeon. However, when he became surgeon to the King of France and gained the King s support, people started listening to his ideas.

15 1. Pare also introduced the use of ligatures to stop bleeding silk threads tied around individual blood vessels. 2. He also designed and arranged the making of false limbs for wounded soldiers and included What was the importance of Pare? Stopping bleeding with ligatures was slow; using a cautery iron was faster especially in the chaos of war Ligatures were dangerous as the threads carried infection Pare s discoveries were small scale they had no anaesthetics or antiseptics to cure infections Pare s work became widely known through his book Pare encouraged surgeons to think for themselves. He showed improvements were possible as healthier as a result of Vesalius Harvey discovered the circulation of the blood 1. William Harvey was born in 1578 and studied medicine in Padua in Italy. He then worked in London as a doctor and lecturer to James I and Charles I. 2. He realised he could observe living animal hearts in action and his findings would also apply to humans. He chose cold-blooded animals so the heart beat was slow. 3. In 1628, he published a book showing that blood was going around and around and NOT being used up and remade like Galen thought. He also proved the difference between arteries and veins. 4. He proved that blood was not produced in the liver as Galen had said 5. He calculated that the amount of blood going into the arteries each hour was three times the weight of a man

16 What was the importance of Harvey? 1. Although Harvey s discovery was useful for knowledge of anatomy and for challenging Galen, it did not radically change surgery. Bleeding continued to be performed and blood transfusions were not generally successful until the discovery of blood groups in Doctors could not make blood transfusions until they discovered blood groups in Harvey s discovery was only gradually accepted and some ignored his theory 1. Harvey s discovery laid the foundations for future investigations of blood and physiology (how the body works 2. Surgery could not develop until Harvey s understanding of the blood system 3. Harvey proved Vesalius correct about the importance of dissection What were quack doctors? 1. Quacks were healers with no medical training 2. They arrived in a town with a fanfare of drum and trumpet and accompanied by a clown and chattering monkey to draw the crowds 3. They were there to make as much money as possible and concocted as many lies as they could to sell medicines 4. Some did very well indeed. Joanna Stephens claimed to have a remedy to solve bladder stones without needing surgery. Parliament paid her 5000 to buy it in the 1700 s!

17 Did hospitals help the sick? 1. When Henry VIII closed the monasteries, many medieval hospitals attached to them disappeared. 2. Some were taken over by town councils, especially the almshouses that looked after the elderly 3. During the 1700 s, many new hospitals opened paid for by local people, charities and town councils. 11 new hospitals were opened in London and 46 in the rest of Britain for example 4. Most hospitals looked after the poor 5. A bezoar stone from the stomach of goat like animals was used to cure poisons 6. St Bartholomew s hospital in London had 3 surgeons, 3 physicians and 15 nurses. Physicians had been trained at university, but nurses trained in the hospitals 7. Patients were given herbal remedies by the nurses or bled. Simple surgery was carried out such as settings fractures and some amputations were performed Who else could you go to if you were sick? 1. Women still played a major part in everyday medicine. The first person to treat nearly all sicknesses was the wife or mother 2. An apothecary sold and mixed medicines that had been prescribed by physicians 3. Between , over 92,000 people visited King Charles II believing if he touched them, they would be cured from the skin disease scrofula 4. They were not supposed to treat or prescribe medicines, but many did for a small fee 5. New ingredients were tried from abroad a. A bezoar stone from the stomach of goat like animals was claimed to cure all poisons b. Rhubarb from Asia was used to purge the bowels c. The bark of a cinchona tree was imported from South America to treat fever d. Tobacco was recommended for toothache, wounds and protection from plague e. A suggestion for curing malaria was to take the hair and nails of the patient, cut them small and either give them to birds in a roasted egg or put them in a hole in an oak tree. Stop up the hole with a peg of the same tree

18 The Great Plague of London, The Black Death returned in 1665, killing around 100,000 people in London. 2. Some efforts were made to control the disease, such as every house with the disease was painted with a red cross, and every person buried must be in a grave at least six feet deep. 3. These measures showed that people realised that the disease was spread through people but they still didn t understand about germs. 4. Doctors, chemists and priests were more likely to get the disease than most, because the sick went to them for help. 5. The Great Fire of London, in 1666, effectively sterilized large parts of London, killing the plague bacteria. What changed? 1. The discoveries made by Harvey and Vesalius were important as they proved to doctors that Galen was wrong and that careful dissection and experimentation were the way to new ideas. 2. Pare s use of bandaging wounds and using ointment instead of boling oil helped patients survive as other surgeons could see it working. However his use of ligatures slowed down surgery, causing problems with bleeding, and also helped spread infection as these were not sterilised. 3. In 1492, America was discovered. This brought a wide range of new knowledge to Europe What stayed the same? 1. The discoveries of Harvey and Vesalius did not make anyone healthier at the time. Life expectancy did not increase much. They hadn t discovered new and better ways of treating illnesses. 2. Treatments: Herbal remedies were still widely used. It is important to remember that a number of these worked. Surgery only improved a little. 3. Treatments from the Four Humours were still widely used; this had not yet been disproved. 4. Superstitious treatments were still widely used, including charms and the famous King s Evil, this included the king touching someone with the skin-disease, Scrofula, in order to cure them. 5. Trained doctors and surgeons could still treat those who could pay. The poor had to rely on family, wise women and travelling quacks. What factors affected this? 1. Experiment: People were willing to challenge old ideas. By experimenting they could prove they were correct. 2. Wars: Public health was made worse. 3. Education: literacy was increasing and there were more schools. 4. Printing: helped with the spread of ideas. 6. Ancient learning: renewed interest in the writings of Greek/Roman thinkers. 7. Art: more realistic artwork. 8. Machinery: there were improvements in clocks, watches and pumps. 9. Wealth: Money to spend on luxuries and education.

19 Lady Montagu introduces inoculation from Turkey 1. Smallpox was a big killer in the 18 th century. If you survived the disease you were left badly scarred. 2. Lady Montagu learnt about inoculation in Turkey and introduced it to Britain. This was when pus from a sore of someone with mild smallpox was given in a small cut to the person being inoculated. After a mild reaction, they were immune to smallpox. 3. Unfortunately inoculation sometimes led to full blown smallpox and death. 4. However, as people feared smallpox, they took the risk. Doctors were made rich from this. Jenner was interested in milkmaids 1. Jenner (b. 1749) was a country doctor. He heard that milkmaids didn t get smallpox, but they did catch the much milder cowpox. 2. Using his skills of experimentation and observation, he found that this was true. 3. In 1796, he tested his theory on a boy called James Phipps. He injected him with pus from a milkmaid called Sarah Nelmes who had cowpox from a cow called Blossom. Jenner then injected him with smallpox but he didn t catch the disease. 4. The Latin for the word cow, vacca, gives us the word vaccination. Jenner became famous, but not everyone was happy 1. In 1840, vaccination was made free for infants, and compulsory in (The first time any government had forced a medical treatment on the entire population) 2. Jenner was given 30,000 by the Government in 1802 and 1807 to develop his work 3. Some people opposed the vaccination. Reasons were varied and include: a. Doctors who were making money out of inoculation didn t want to lose their income. b. Jenner couldn t explain why it worked and some people didn t believe a disease that came from cows could protect you. They thought you would turn into a cow! c. Vaccination was seen as dangerous. Not all doctors were careful with the dosages. d. Some people did not like government forcing medicine upon them. Continuity and change in doctors and treatments 1. Doctors: From the 1750s ordinary people were able to call on the services of a local doctor or general practitioner after they trained in an apprenticeship. They would often waive the fees of the poor who were unable to pay. 2. But the cost of medicine was a problem. Dispensaries began to appear. These were created to provide the poor with cheap medicine. 3. Many illnesses were still treated in the home using common sense and herbal treatments. 4. There was also a rise in Patent Medicines which claimed to cure all. There were some dangerous ingredients in a number of these.

20 Could you see a woman doctor in the 1850s? 1. No! Due to a number of changes, the role of women in medicine had gradually reduced: a. In the middle ages, the Church allowed only men to train as physician. b. By 1700, surgeons also had to have a university degree. As women could not go to university, they were unable to become surgeons. c. With the introduction of medical forceps. Midwifery also was taken over by men. d. In 1852, there was the Medical Registration Act which required all doctors to belong to one of the College of Physicians, Surgeons or Apothecaries. All of these were closed to women. 2. Some women did fight to overcome this. Elizabeth Garrett was the first woman to qualify as a doctor in Britain. 3. Women still played a major role as healers in the home, and as nurses. In the 1850s, female nurses went to work in the Crimea. This was the first time women were used as army nurses. The Lady with the Lamp changed nursing 1. Florence Nightingale became a nurse despite opposition from her family. 2. When the Crimean War broke out in March 1854, horror stories emerged about the hospitals that were treating the wounded British soldiers. 3. The secretary of war, who was a friend of the Nightingale family, asked Florence to go and sort out the nursing care in the hospitals over there. Florence took 38 hand-picked nurses and made changes such as bringing in good food and boiling the sheets. The death rate in Scutari hospital was 42% before she arrived, and 2% afterwards. 4. When she returned, she set up the Nightingale School of Nursing and wrote her book Notes on Nursing which became the standard textbook. 5. Men were not admitted onto the Royal College of Nurses until Mary Seacole also nursed in the Crimea 1. Mary Seacole learnt nursing from her mother, who ran a boarding house for invalid soldiers in Jamaica. She came to England to volunteer for the Crimea. 2. She was rejected, probably due to racism, but raised money to make her own way. 3. She nursed soldiers on the battlefield and was loved by many. However, when she returned to England she was unable to find any work and went bankrupt.

21 Pasteur was the first to suggest that germs cause disease 1. Micro-organisms had been seen through 18 th century microscopes but scientists thought that they were caused by disease and appeared because of illness. This was the theory of spontaneous generation. Instead of blaming the micro-organisms, they blamed bad smells or miasmas. 2. Louis Pasteur was employed in 1857 to find out why alcohol was going bad in a brewing company. His answer was to blame germs in the air. Pasteur proved this and showed how to kill these germs by boiling the liquid. 3. In 1861, he published his Germ Theory 4. Pasteur was a scientist, not a doctor, and he carried out his early experiments with beer, wine and silkworms. Robert Koch used dyes to link germs to human disease 1. Koch began to study different microbes (germs) to see which microbe caused what disease. He developed a solid medium to colour microbes, and dyeing techniques to colour them. 2. He managed to identify the anthrax microbe in 1875, linking germs to human disease. 3. He went on to identify the germs causing TB and Cholera and won the Nobel Peace Prize in 1905 Pasteur, rival of Koch, finds chicken cholera vaccination 1. Pasteur (French) and Koch (German) were rivals at this this point. France had lost a war to Germany in and it bothered Pasteur that Koch appeared to be getting ahead on the medical front. 2. Pasteur joined the race to find cures for anthrax and chicken cholera. Both he and Koch had been given large teams to help them. 3. In the summer of 1879, some chicken cholera solution was accidentally left out over the holiday. On the return of the team, this was injected into a number of chickens. The chickens survived, they then tried with some new cholera, but the chickens still lived. 4. They worked out that the cholera had been weakened by its time out in the open, and that this weakened cholera had made the chickens immune (like Jenner s vaccination)! 5. The cure for anthrax followed in 1881, then rabies in 1882.

22 What is DNA? 1. DNA stands for deoxyribonucleic 2. Inside every cell of your body are several identical strings of DNA 3. DNA is like a long list of instructions like a computer program that operate every cell in your body 4. These instructions are grouped together into sets of instructions called genes 5. Each gene has a different function. Some decide your eye colour, how much hair you have, whether you will develop a disease 6. Everyone s DNA is different! How was DNA discovered? 1. DNA took a series of discoveries over a long period of time 2. In 1953 two scientists in Cambridge, Francis Crick and James Watson discovered the structure of DNA 3. They proved DNA structure was present in every human cell and showed how it passed on information from parents to children. 4. In 1986, the Human Genome Project began to compile a complete map of human DNA and was completed 15 years later! Why is DNA so important? 1. Gene Therapy uses genes from healthy people to cure the sick which are known as stem cells eg. Re-growing cells to restore movement to paralysis, or blindness 2. Customised drugs to cure one person s particular health problems 3. Genetic engineering will help choose the nature of the child, their gender, appearance and intellectual ability. 4. Genetic Screening or testing to identify illnesses people could suffer from and preventing them eg. Checking for Down s Syndrome 5.

23 The problems of surgery in the 1800s 1. There were 3 main problems with surgery at this time: a. Pain b. Infection c. Bleeding Simpson, solvent abuse and the rise in anaesthetics 1. The use of natural drugs like alcohol and opium to reduce pain had been around for a while. But these were not very effective and could make the patient ill. 2. Laughing Gas was introduced by Humphry Davy in 1799, but it did not work on all patients. 3. Ether was introduced in the 1840s but this was an irritant and also fairly explosive. 4. In 1847, James Simpson was testing some drugs and discovered that chloroform was an effective anaesthetic. It then started to be used in surgery. New anaesthetics were not necessarily a good thing 1. Some people objected to its usage on religious grounds. Others were afraid of the dangers of an overdose (Remember Hannah Greener died when removing a toenail) 2. Surgeons could perform more complicated surgery. As infection and bleeding were still a problem, this actually led to more deaths. 3. It was hard to get the balance right; some patients were paralysed by the drug, whereas others could still feel the pain. Joseph Lister and the fight against infection 1. Lister s background helped him with his discoveries as his father developed better microscopes and he had the best medical training. 2. In 1867 Lister read Pasteur s work on bacteria. He thought that bacteria might be causing the infections. He used carbolic spray to kill these bacteria. This was antiseptic surgery. 3. Why was Lister s work important? a. In the short term, more of his patients survived. The percentage of his patients who died after operations fell from 46 per cent to 15 per cent. His ideas spread and were used by other doctors, although at first many doctors did not believe in Lister s discovery. b. Other doctors built on his ideas. Hospitals and operating theatres became much cleaner places. All medical instruments were sterilised effectively. The whole room was sterile. All germs were killed. This was called aseptic surgery. Longer and more complicated operations became possible as the danger of infection was reduced.

24 The Industrial Revolution was bad for your health 1. Crowding was not a problem in the medieval period. Within a town there would be gardens for growing vegetables and keeping pigs and chickens. 2. Industry changed this. The spaces filled up with factories and poor quality housing. 3. People didn t believe the government could tell people what to do with their land. The government believed in leaving things alone (Laissez-Faire) 4. Sewage was put into rivers, overflowing cesspits and even into the streets. Smoke from factories was also dangerous. 5. Diseases like smallpox and typhus were also common. Cholera the coming! 1. Cholera reached Britain from the East in Cholera spreads when infected sewage gets into drinking water. It causes extreme diarrhoea that sufferers often die from loss of water and minerals. Both rich and poor people caught the disease. 3. People didn t know what caused cholera. It broke out in 1848, 1854, and Chadwick and the beginning of public health reforms 1. Chadwick published a Report on the Sanitary Condition of the Labouring Population of Great Britain in He said that improving public health would save money rather than cost money. The report which used statistics to describe death rates shocked some of the upper classes. 2. However, the first Public Health Act was passed in 1848, after the next outbreak of cholera. 3. This led to the Central and local Health Boards. The local boards had to be approved by the local taxpayers. The central board was dismantled in 1854.

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26 Chadwick How important was he The 1860s and 70s saw the defeat of laissez-faire 1. Chadwick and Snow were finally proved right when Pasteur discovered germs in Another cholera outbreak in 1866, and the Great Stink led to government acting. This is when the Thames smelt so bad that MPs had to leave the house of Parliament. They knew change was needed! 3. The second Public Health Act was brought in This was more effective than the first one because it forced local councils to act on public health. This included towns providing proper drainage and sewers. 4. Victorian Engineering helped this by producing improvements such as brick-lined sewers and steam-driven water pumps. Factors that led to change 1. Rapid growth of towns increased dangers of disease and made people realise they had to work together to improve health. 2. Government s attitude changed in 1875 began to force councils to improve public health. 3. Many huge engineering projects such as building of canals and railways led to advances in technology which would help with public health. 4. Scientific knowledge was improving such as the discovery of germs. 5. People s attitudes to sickness changed. The wealthy wanted reforms that would improve everyone s health. 6. The different Cholera epidemics-this made the public scared because loads of people died. This made the government take action and take on board Chadwick s suggestions.

27 The Great Clean up Other changes The Public Health Act 1875 made it compulsory to improve sewers and drainage, provide fresh water and appoint medical officers! Also it said: 4. Improve housing standards 5. Stop polluting the rivers 6. Shorten working hours for women/children 7. Do not add bad ingredients to food 8. Make education compulsory How far did the reforms help? Flushing toilets were invented! I am Joseph Bazalgette I designed and built London sewers system after the Great Stink! In 1853 the tax was taken off soap! By 1900 towns were healthier with better public health facilities. People started to live longer BUT 1. Poverty was still causing ill health. 2. People who could not get help from friends had to give up their homes and go live in workhouses. 3. Charles Booth and Seebohm Rowntree wrote a report. In it said that many families did not have enough money to pay for housing, clothes and food. 4. The sick, elderly and unemployed received no help! 5. Many men got rejected from fighting in the Boer war because they were still unfit. Against this background of poverty, the Liberals under David Lloyd George pushed through a series of social welfare reforms which included: In 1906 local councils were told to provide free school meals for poor children. In 1907 school medical examinations were ordered for all children (among these examinations were those of the 'nitty nurse'). In 1908 Old-age pensions were introduced. In 1911 National Insurance (free medical treatment for workers who fell ill) was introduced.

28 The First World War 1. During the First World War, more people were killed and wounded than in any previous war. New and deadly weapons were used for the first time, such as shrapnel bombs and high-explosive shells. They caused terrible injuries that surgeons had never seen before. 2. However, this caused a number of improvements in medicine and health: a. Surgery improved they had opportunities to experiment with new techniques. These included developing new techniques to repair broken bones, and to perform skin grafts (the start of plastic surgery). b. X-rays were discovered before the war. During the war, they were used to find bullets and shrapnel lodged in the body. Governments paid for more and more X-ray machines to be made. c. Blood transfusion was used effectively for the first time after blood types were discovered in Methods of storing blood and transporting it were improved. d. The poor health recruits to the army made the government very worried about their living conditions at home. The soldiers who fought in the war were promised homes fit for heroes when they returned. This caused unhealthy slum houses to be knocked down. The Second World War The Second World War improved medicine by: a. Further improvements in blood transfusions. Including better ways to store blood and the introduction of donations of blood from civilians. b. Rationing was introduced to improve some people s diet and healthy eating was encouraged through government posters. c. Penicillin was developed the first antibiotic. d. Further improvements in the use of skin grafts and in the treatment of burns by surgeons. e. 1.5 million children were moved from the cities into the countryside for their safety. This showed how much difference there was between the rich and the poor. The government became more serious about fighting poverty. f. The government improved what services the poor people could access. In 1942, William Beveridge, a civil servant, put forward the idea of a free national health service for all.

29 Improvement 1 National Insurance 1. At the beginning of the twentieth century the poor and unemployed could not afford to get help if they were sick. 2. The first step towards helping them came in 1911 when the Liberal Gov. passed the National Insurance Act. The aim was to give workers the chance to get medical help and sick pay if they could not work because they were ill. They did this by paying into a sickness fund. 3. However, it only applied to people in work. The unemployed, long-term sick and the elderly could not pay into the scheme, so they could not get help. Improvement 2 Better Housing 1. In 1900, poor housing was still a major cause of ill health. Many didn t have fresh water or toilets. 2. The first big step came with the Housing Act in The Housing Act said that local councils had to provide good homes for working people to rent. A quarter of a million houses were built under this scheme. 3. The next step was to clear the overcrowded, filthy slums. This began in the 1930s. Tens of thousands of slum houses were cleared and 700,000 new homes were built. 4. Even so, the last of the slums did not disappear until the 1960s. Improvement 3 National Health Service 1. WW2, in which people of all classes worked closely together, led to a call for a fairer health service that would help everyone. 2. As a result, William Beveridge (a leading civil servant), put forward a plan in 1942 to reform medical services. 3. After the war, this plan led to the creation of the NHS in The key point was that all services were free. 4. Doctors, dentists and nurses were to be paid by the government instead of by their patients. This was the biggest step forward in improving the health of people in Britain.

30 Why was infant mortality so high in 1900? 1. Housing many people lived in overcrowded, poor-quality housing. These houses were damp, dirty and had no toilets. 2. Disease infectious diseases spread rapidly, because vaccines had not been developed for some of the most common killer diseases. 3. Medical care many parents could not afford this. 4. Diet parents and babies had poor diets. 5. Education there were not enough trained midwives to help and advise new mothers. Some patents did not know how to keep their babies healthy. Why has infant mortality fallen? 1. Scientists developed new vaccines. Government started to make sure that these were given to children e.g. in 1940, it was made compulsory to have the diphtheria vaccination. This reduced deaths from 300 per million to less than 10 per million. 2. In 1902, the gov. said that all midwives had to be trained. 3. In 1906 the gov. started to provide school meals so that children of poorer families could get some good food. 4. In 1909, the gov. banned overcrowded back to back housing and enforced building regulations. 5. In 1919 local councils started clinics for mothers to be. They appointed health visitors to visit families and advise on health and hygiene. 6. In 1948, the NHS was set up. It provided free medical treatment and medicine for everyone. What kills people today? 1. There are still big killers in today s society, these include: a. Cancer b. Heart disease caused by people being overweight. c. Lung disease caused by people smoking. d. Aids e. Malaria 2. It is important to note that different diseases affect different people in the world. Some countries still suffer from the same infectious diseases that have not been in Britain for a long while!

31 Fleming discovered penicillin the first antibiotic 1. The discovery of penicillin is a good example of a chance finding helping science. 2. Alexander Fleming was searching for a cure for infections. In 1928 he went to clean up some culture dishes which had bacteria growing in them. By chance, the penicillin bacteria had blown in through the window. He noticed that not one the infectious bacteria grew near the penicillin. He had found the first antibiotic. 3. Fleming was unable to take his work further as he did not have enough money or government support. Florey and Chain developed this further 1. Florey and Chain, two scientists from Oxford University, experimented on penicillin. They found a method to take and test penicillin and grew the penicillin in any container they could. 2. They tried it on the first human in February Although the patient s health did improve, there was not enough penicillin to cure him and he eventually died. 3. However, although the patient died, the trial showed how powerful penicillin could be if it could be grown in huge amounts. 4. In December 1941, America joined the war and the American government gave $80 million to find a way to mass-produce penicillin. 5. In 1943, scientists used penicillin to treat wounded British soldiers for the first time. By June 1944, there was enough penicillin to treat all the casualties from D-Day. How was penicillin developed? 1. War the need to fight infection. 2. Chance that penicillin came in through the window. 3. Individual Genius Fleming, Florey and Chain were awarded the Nobel Prize in Government Gave money to fund research. What treatments were there? 1. At the beginning of the century, the people had to rely on cheap, easy-to find remedies. Most people cared for their family when they were sick. 2. However, with improvements due to war, technology, science, governments and individual genius, the medicine available has risen dramatically. This includes vaccinations, access to hospital for all and the new surgeries we see today!