Medicine Through Time Summary

Medicine in c1350
1. The Four Humours
  1. Ancient Greeks
    1. Believed people became ill if mix was unbalanced
    2. Greeks tried to put balance right to cure people
    3. Thought everyone had a mix of four humours in their body
    4. Hippocrates
      1. Ancient Greek doctor
        His ideas were very influential in Roman times and beyond
        Most of his treatments were based on diet, exercise and rest - also used bleeding and purging - get rid of excess humour
      2. Wrote the Hippocratic Oath - doctors swore to respect life and prevent harm
      3. Clinical Observation
        Studying symptoms, making notes, comparing with similar cases, then diagnosing and treating
  2. Romans
    1. Galen developed the Four Humours even further
      1. Galen
        Developed Hippocrates' ideas mainly - bloodletting/purging to prevent illness
        Developed a Theory of Opposites
        Carried out dissections on dead bodies (mainly animals) - drew diagrams to explain human anatomy
        Galen and many others were convinced his ideas were right - dominated medicine for over 1500 years
    2. Theory of Opposites 2nd Century AD
      1. Believed in treating illness with 'opposite' of their symptoms
      2. For example, if you had phlegm (linked to water and cold), you should eat hot peppers
2. The Christian Church
  1. Belief that God made people ill because he was displeased with them
    1. This held back medical research, people didn't believe there was a rational explanation for disease
      1. The Church discouraged dissection, people did not approve of people challenging ideas and authority
  2. On the other hand, the Church taught people to follow Jesus' example and care for sick
    1. Galen's theory fitted Christian beliefs
1750-1900
1. Breakthroughs
  1. Edward Jenner
    1. Cowpox prevented smallpox - 1796
    2. By 1804 - 12000= vaccinated
    3. 1840 - Government began paying for vaccinations
    4. There was opposition to Jenner and he couldn't find link to why vaccination worked - didn't lead to other vaccinations
  2. Pasteur - published Germ Theory in 1861
    1. Microbes in air caused decay
  3. Robert Koch
    1. Linked bacteria to disease
    2. Identified specific microbe that caused anthrax and microbes that cause TB and cholera
    3. Chemical dyes stained bacteria - easier to see under microscope
  4. Koch and Pasteur important - published ideas, use other's findings
    1. Took time so prevention was not immediately possible
      1. Causes of some diseases were still unkown
2. Professionalising medicine
  1. Elizabeth Garrett Anderson
    1. Women - not allowed to be doctors
      1. Elizabeth went to medical lectures until she was forced to stop
    2. Society of Apothecaries did not bar women and she passed exam in 1865
    3. Was certified but Society changed it so women couldn't qualify
    4. Set up medical pratice in London and gained medical degree in Paris
    5. Set an important precedent - 1876 - women allowed to go to university and get degrees
  2. Florence Nightingale
    1. Little traning for nursing - wasn't repsectable job
      1. Attended first nurses' training school - Kaiserwerth Hospital, Germany
    2. Asked to lead team of nurses at military hospital in Scutari during Crimean War (1854-56)
    3. Believed miasma caused disease, so emphasised hygiene, fresh air, good supplies
      1. This lowered death rates from 42% to 2%
    4. Her work widely reported in Britain - published books on nursing and set up training school for nurses/midwives
3. Improvements in medical training
  1. Teaching hospitals developed - students could observe doctors
  2. Students dissected bodies - human anatomy
    1. More emphasis on studying microbes and disease through microscopes - following Pasteur
      1. Improved tech - thermometers and stethoscopes to help diagnose illness - training
4. Treatment 1750-1900
  1. People still used herbal remedies - had less plants so more reliant on apothecaries
  2. Pills - made by hand until William Brockedon invented machine that standardised dosage and increased production speed - 1844
  3. Money could be made from patent medicines - encouraged growth of pharmaceutical industry
  4. Companines financed chemical research to produce and sell their own brands of medicine
  5. By 1900 - government brought in regulations to prevent harmful ingredients being used in medicines
  6. New understanding of causes of disease had little impact on prevention or treatment until 20th century
1900 - Present Day
1. James Watson and Francis Crick
  1. Studied structure of DNA together at the Medical Research Council
    1. Their work helped to improve our understanding of genetic conditions
      1. Analysed X-ray crystallography by Maurice Wilkins and Rosalind Franklin - worked out the double helix structure of DNA - 1953
        New Possibilities - Structure of DNA and Human Genome Project
        improved vaccines
        better insulin for diabetics
        new techniques for skin grafts
        better understanding of conditions like Down's Syndrome
        discovery that stem cells can be grown into different cells
2. Causes of Disease since 1900
  1. Scientists built on research and findings of earlier years
    1. People created more vaccines based on techniques of Pasteur and Koch
      1. Knowledge of how microbes causse disease improved - led to cures like 'magic bullets'
3. Treatment since 1900
  1. Magic bullets
    1. Koch discovered different chemical dyes stained specific microbes
    2. Behring discovered antitoxins - only attack the microbe causing a disease
    3. Paul Ehrlich - searched for a 'magic bullet'
      1. 'magic bullet' - a chemical compound that would attack and kill the microbe causing a specific disease
        Team worked for many years - tested many compunds of Salvarsan to cure syphilis
        1909- Dr Hata found they rejected a compound that worked (Salvarsan 606)
        1932 - Domagk developed second magic bullet - Protonsil, cured some types of blood poisoning
        Other scientists found that sulphonamide in Prontosil cured pneumonia, scarlet fever and meningitis
  2. Penicilin
    1. 1928 - Alexander Fleming - noticed bacteria in Petri dish was killed by a penicillium mould
      1. He tested it on other bacteria - discovered mould produced an excellent antibiotic (penicilin)
        Years on - Florey and Chain continued Fleming's research on penicilin
        Effective on mice, so they tested it on humans - Penicilin killed bacteria which killed the infection
        Mould had to be grown in large quantities to be effective - 1941, Florey asked US drug companies for help, they refused
        When US joined war, antibiotics were needed so US offered funding
4. Health care since 1900
  1. Until 1948 - still done by women in family with herbal or folk remedies
    1. Doctors charged for each visit - mainly used by wealthy
      1. Most cities had infirmies, fever houses and asylums - offering free basic care for poor
        Run by local authorities and charities
  2. Government action
    1. 1902 - Midwives Act: midwives to be trained and registered
      1. 1911 - National Insurance Act: employees, employers and government paid for medical fees for employees
        1919 - Nursing Act: set up General Nursing Council to promote high standards of care
        1919 - Ministry of Health set up: government gained overview of health care across UK
        1938 - 3000 died from diptheria in UK: led to free immunisation programme in 1940
5. NHS 1948
  1. What led to the setting up?
    1. Increase in vote - women won vote in 1918
      1. Government more concerned about how the poor could get health care
    2. WWII highlighted inequality, people wanted change
    3. 1942 - Beveridge Report identified disease as 1/5 major problems in Britain
    4. Accepted by 20th century - government should involve itslef in people's lives
    5. National Emergency Medicine Service gave free treatment in WWII proving government control over health care worked
  2. Good
    1. Taxes funded; seeing GP, hospital care and operations, health visitors for pregnant and young, treament by dentists and opticians, ambulances and emergency treament and health care for elderly
  3. Bad
    1. Cost of running was much higher than expected
    2. People living longer - expensive care for elderly
    3. lack of nationawide availability for some drugs and treatments
    4. long waiting lists - private medical insurance grew
Treating the sick c1350
1. Physicians - medically trained at university, diagnosed illnesses and gave treatments, or sent patients to apothecary or barber surgeon
2. Barber surgeons - no training, carried out bloodletting, pulling teeth and lancing boils, did basic surgery - amputating limbs (very low success rate), cost less than physician
3. Monks and nuns - ran hospitals using Church donations, cared for poor and elderly - not people with common diseases, this was free
4. Housewife physicians - usually village 'wise woman' or lady of manor who treated diseases, dealt with childbirth and common injuries, mixed plant and herb remedies, were cheapest and most accessible option
5. Apothecaries - received training but no medical qualifications, mixed medicines and ointments based on own knowledge, cost money but less than physician
The Black Death
1. Bubonic plague, carried by fleas living on black rats
2. 'Causes': Religion, Astrology, Miasma, Volcanoes, Four Humours, Outsiders
  1. How people tried avoiding: Flagellants - walked in church praying and whipping each other, praying and fasting, clearing up rubbish in streets, smelling toilets to overcome plague, lighting a fire in a room, carrying herbs and spices around, not letting unknown enter the town
    1. Symptoms: Swelling of the lymph glands into large lumps filled with pus (knwon as buboes), fever and chills, headache, vomiting, diarrhoea and abdominal pain
      1. Treatments: Paying and holding lucky charms, cutting open buboes to drain the pus, holding bread against buboe and burying it, eating cool things and taking cold baths
The Renaissance
1. New ideas about anatomy
  1. Vesalius proved that Galen was wrong
  2. Vesalius drew the muscles, nerves, organs and skeletons of human body
  3. 1543 - Published The Fabric of the Human Body
    1. Others could learn about human anatomy
2. New Ideas about blood
  1. William Harvey discovered that Galen's ideas about blood were wrong
    1. 1628 - Harvey published An Anatomical Account of the Motion of the Heart and Blood in Animals
  2. Harvey discovered that veins carry only blood, which was pumped through body by heart
3. Technology
  1. Better microscope lenses helped discover bacteria
  2. Invention of mechanical pumps helped people understand that the human body worked like a machine
  3. Printing press - invented in mid-15th century, allowed ideas and discoveries to be published and widely circulated
  4. Impact on medicine
    1. Causes of disease still not understood
    2. Harvey's and Vesalius' ideas slow to be accepted
    3. Medical teaching still based mainly on Galen's theories
    4. Old treatment methods still used

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