Medicine through time - GCSE History

Medicine Through Time
History Revision
Useful links;
•http://www.bbc.co.uk/schools/gcsebitesize/history/shp/
•http://www.bbc.co.uk/schools/gcsebitesize/audio/history/
•http://www.bbc.co.uk/schools/gcsebitesize/history/video/middleages/

Renaissance medicine
http://www.bbc.co.uk/schools/gcsebitesize/history/shp/middleages/
Contents – play all
Roman Medicine
http://www.bbc.co.uk/schools/gcsebitesize/history/shp/ancient/
Medieval Medicine
http://www.bbc.co.uk/schools/gcsebitesize/history/shp/middleages/
19th-century medicine
http://www.bbc.co.uk/schools/gcsebitesize/history/shp/modern/
20th-century medicine
http://www.bbc.co.uk/schools/gcsebitesize/history/shp/modern/
Ancient Medicine
http://www.bbc.co.uk/schools/gcsebitesize/history/shp/ancient/

ROMAN CIVILISATION
A knowledge of Roman civilisation will help you to understand Roman
medicine.

• The Romans preferred prevention to cure, when it came to
health. They put their energies into public health
facilities, rather than following the medical theories that they
knew about from the Greeks. Roman medicine was dominated
by ideas that arose out of the needs of the army.
• Do not, however, make the mistake of thinking that medicine
in Roman times regressed in everything except the area of
public health. The Romans did not continue investigating
Greek theories of disease, but they did advance in more than
one area of medicine.
Introduction

• Roman civilisation developed in a different way from that of
Greece. Instead of a large number of small city-states, the
Romans developed a huge monolithic empire. This was ruled
from Rome by an all-powerful emperor, who imposed his will
through a single system of laws.
• Rome became immensely wealthy, but the Romans were down-
to-earth people, and their wealth flowed into practical
projects, rather than into philosophy and culture.
• Thus the centralised state directed its efforts into amazing
engineering schemes such as those of the baths, aqueducts and
sewers of Rome. The Roman writer Frontinus compared these
favourably to the "idle pyramids [of Egypt] and the useless
buildings of the Greeks."
Overview

The baths of Caracalla could accommodate
up to 1600 bathers

• The Romans were also a warrior race, and they made an
immense investment in their armies, the basis of their power. It
was their observation of the health of their soldiers that led the
Romans to realise the importance of public health. There was a
feeling that medicine was for weaklings, and the Romans did
not put great effort into developing it. Instead, they brought
over doctors from conquered Greece. Although officially
medicine might have been considered unnecessary, these
doctors became very popular.
• The Romans believed in their gods, and in ancient times the
influence they ascribed to these gods was very great.
Overview

I. The need for a healthy army led Romans to
think about public health.
II. The capture of slaves brought Greek doctors
to Rome.
III. The Roman army developed some of the
earliest hospitals.
IV. Anatomical and surgical skill developed as
army doctors treated war wounds.
•The importance of war for Roman medicine

ROMAN KNOWLEDGE ABOUT THE
BODY AND DISEASE

• The Romans did not allow dissection of human
bodies, so they were limited in what they could find
out about human anatomy. They also rejected many
Greek ideas about medicine. These factors slowed
down their progress, but they continued to explore
new ideas about the causes and prevention of
disease.
Introduction

• Roman doctors learned a lot about the human body as
they tended gladiators wounded in the amphitheatres.
However, dissection of humans was forbidden in the
Roman empire, so Roman anatomists such as Galen had to
rely mainly on dissections of animals to further their
knowledge. Galen recommended dissecting monkeys that
walked on two legs, like men.
• He did manage to work a little with the human body, and
described how he had human corpses to dissect when he
found a hanged criminal, and when a flood washed some
bodies out of a cemetery. Despite this, he made various
errors in his analysis of how bodies work.
•
Overview

Galen as depicted in a book by a 16th-century French
surgeon

• Galen's books show a good knowledge of bone structure. He also
studied the lungs, the muscles, the heart and blood and the nervous
system. He conducted experiments on pigs, and when he cut the
spinal cord in different places he realised how thenervous
system takes messages from the brain to the muscles.
• Galen accepted the Greek theory of the four humours as the cause of
disease. However, the Romans did not continue the Greeks'
investigations into disease and rejected Greek ideas, so Roman
knowledge of disease did not progress.
• Roman ideas about disease were muddled. For example:
• Crinas of Massilia thought illness was caused by the stars (astrology).
• Varro blamed creatures too tiny to be seen.
• Columella blamed poisonous vapours in the swamps.
All these ideas survived until the 19th century.
Overview

• Galen based most of his information about anatomy on what he saw
when he dissected the bodies of animals. This led him to make
mistakes. Some of his errors were:
• He thought that muscles attach to the bone in the same way in humans and
in dogs.
• He thought that blood was created in the liver. He realised that it flowed
round the body, but said it was burned up as fuel for the muscles.
• He thought he saw holes through the septum, which allowed the blood to
flow from one side of the heart to the other.
• He made mistakes about the blood vessels in the brain.
• He thought the human jaw-bone was made up of two bones, like a dog's.
• He was mistaken about the shape of the human liver.
NOW TRY A TEST BITE
Anatomical errors in Galen

• The Romans are known to have had some knowledge
of the internal workings of human
bodies, particularly through the work of Galen.
However, historians question whether they
performed internal surgical operations.
Introduction

• Through their work with gladiators and wounded
soldiers, Roman doctors became experts at practical first
aid and external surgery.
• They could do a large number of simple external
operations, such as removing polyps up the nose and goitres
from the neck.
Overview

• We know that the Romans developed new surgical and midwifery
instruments(though they look barbaric to us nowadays). They also
developed the Caesarean section to remove a baby from the womb
(although it is not true that Julius Caesar was born this way). In those
times the mother always died - Roman Caesarean sections were
usually performed to save the baby of a woman who had died during
childbirth.
• We have no evidence that Roman surgeons successfully operated
inside the body. Roman doctors did not have anaesthetics, and had
only herbal antiseptics - so successful surgical operations would have
been extremely difficult for them to perform.
NOW TRY A TEST BITE
Overview

ROMAN METHODS OF DIAGNOSIS
AND TREATMENT

• Some Roman doctors followed aspects of Greek
medical practice, so their emphasis was on
careful observation of symptoms. Some of their cures
were also based on Greek theories. They had their
own practical remedies too, and some people
continued to turn to their gods to heal their
symptoms.
Introduction

• Some Roman doctors (eg Galen) maintained the Greek practice of clinical observation of
people who were sick, and Galen claimed that he never made a mistake in diagnosis or
prognosis. However, medicine failed to progress in this area, as different doctors stuck to
their differing theories of disease. The Roman writer Pliny complained about
the "quarrelsome consultations" of doctors at the bedside of patients.
• The Romans did, however, have a large number of practical, traditional remedies for
disease. Pliny recommended substances such as unwashed wool (for sores), yolk of eggs
(for dysentery) and boiled liver (for sore eyes). The Roman Army doctor Dioscorides
assembled a list of some 600 herbal cures in his 'Herbarium' (a book that was used for the
next 1,000 years).
• Since many of the doctors in Rome were Greeks, who believed that illness was caused by
an imbalance of the four humours, many of their cures tried to rebalance the humours or
restore the natural heat of the patient.
Overview

• Galen advocated the healing power of nature and the use of
opposites - eg hot pepper to cure a cold and (cool) cucumber to
cure a fever.
• doctor using cold cucumber to cure a fever
• Like the Greeks, many ordinary Romans with severe or chronic
diseases still appealed to their gods for a cure. In 293BC the
Romans built an asklepion in Rome, and took there one of the
sacred snakes from Epidaurus.
NOW TRY A TEST BITE
Overview

• Public health is about avoiding the spread of disease within a
particular society - often through providing water to help
people keep clean. The Romans understood that dirty
conditions made people ill, and provided many facilities - such
as public baths, sewers and toilets - to promote public health.
They had every incentive to do this, as they wanted the
soldiers in their army to remain healthy, in order to keep the
empire under control.
Introduction

• The Romans developed the first-ever system of public health.
• Three important factors combined to cause them to create a public health
system. Their suspicion of Greek doctors, their realisation that the army needed
hygienic conditions to keep their soldiers healthy, and their engineering abilities.
• Like the Greeks, the Romans believed in personal health and hygiene - the writer
Juvenal coined the phrase "a healthy mind in a healthy body". The Roman writer
Celsus advised exercises before a meal, and bathing weak parts of the body
(copying Hippocrates's, 'Programme for Health'). Galen prescribed gym exercises
and deep breathing as a way to health.
• Settlements such as army camps, were sited in healthy places (not near swamps).
In other places marshes were drained (Julius Caesar drained the Codetan swamp
near Rome), which reduced malaria.
Overview

Aqueducts
• Rome had nine aqueducts (note the excellent
engineering, including conduits, inverted syphons, bridges and
filter tanks) which brought 222 million gallons of water a day
into the city. They also built many great aqueducts throughout
their empire. In Rome, special commissioners monitored
cleanliness and a fair supply. Most private houses had cisterns
and pipes.
What the Romans built

Baths
• Rome had nine public baths. Many of them were luxurious, 'covered with mirrors buried in glass lined
with marble and silver'. For a fee of one sixteenth of a denarius bathers went from the hot 'caldarium'
to the lukewarm 'tepidarium' and then dipped in the cold 'frigidarium'. Many baths had gymnasia and
massage rooms attached. Government officials called aediles monitored cleanliness and behaviour.
Sewers
• Rome had seven sewers (notably the Cloaca Maxima, which was large enough for a laden wagon to
pass through) flushed by streams, and public latrines (seating up to 60 people). There was a force of
300 slaves who cleaned the streets and latrines at night while people were asleep.
Hospitals
• The Romans built the first real hospitals in order to look after their soldiers. The first hospitals in Rome
were the valetudinaria (free hospitals) for former soldiers.
What the Romans built

I. They needed to keep the army healthy: "I will give you some ideas about how the army can
be kept healthy, by the siting of camps, purity of water, temperature and exercise".
II. They were suspicious of the Greek doctors they had brought to Rome as slaves.
III. They believed in prevention rather than cure.
IV. They objected to paying the doctors (Pliny could not see why they should"pay fees to
profiteers in order to save their lives").
V. They had ideas about disease which encouraged public health measures. (Varro advised
Romans not to build near swamps or drains because "tiny creatures float through the air
and enter the body and cause disease". Columella blamed disease on poisonous vapours
from the swamps. The Water Commissioner Frontinus said that the aqueducts made the city
cleaner and removed the causes of the unhealthy air.)
VI. They had the necessary wealth and power. They were wealthy enough to build the
infrastructure and powerful enough to requisition/pay for the necessary materials and
labour. They had excellent engineering skills - as seen in the Pont du Gard aqueduct in
France.
Why did the Romans want to develop public health?
Answer preparation - Now try a Test Bite

• Doctors in Rome were often Greeks, brought to Rome
as slaves. This meant their status was low for a long
time, although their skills were valued by many
people.

• After the conquest of Greece in 47BC, most doctors in Rome
were Greeks, brought to Rome as slaves. Yet, whilst they flocked
to see these doctors, the Romans were also suspicious of them.
• Pliny, the ancient Roman writer and naturalist, represented
them as vain self-publicists, who tried out their too-clever
theories at the cost of their patients' lives.
Overview

• The most famous Roman doctor was Galen, who came from
Pergamum and had been trained at Alexandria. Galen learned his
trade at a school of gladiators.
• The Romans neglected to develop further the Greeks' ideas about the
nature of disease, and in some ways medicine regressed under their
rule. However, Roman doctors did develop ideas of bad air and tiny
creatures as causes of disease, and these ideas were to have a great
impact on the history of medicine.
• The Romans also developed hospitals, and employed trained military
nurses called medici. They were skilled surgeons, and they built on
the Greeks' knowledge of anatomy and physiology (though not
without errors).
Overview

• I will not mention many famous doctors like Cassius, Calpetanus, Arruntius and Rubrius. Their
annual salaries were a quarter of a million sesterces. When Nero was emperor, people rushed to
Thessalus, who overturned all previous theories and when he walked about in public he was
followed by as big a crowd as an actor or chariot-driver. Next came Crinas of Massilia, who decided
what his patients could eat according to the astrologers' almanacs.
• There is no doubt that these doctors, in their hunt to gain fame by means of some new idea, did not
hesitate to buy it with our lives. Consequently those wretched quarrelsome consultations at the
bedside of patients. Consequently also the gloomy inscription on monuments: "It was the crowd of
doctors that killed me".
• Medicine changes every day and we are swept along on the puffs of the clever brains of the Greeks.
People can live without doctors (though not, of course, without medicine). It was not medicine
which our ancestors hated, but doctors. They refused to pay fees to profiteers in order to save their
lives. Of all the Greek arts, it is only medicine which we serious Romans have not yet practiced.
• Pliny, 'Natural History' (c.AD 50)
[Note how this passage disproves the point Pliny is trying to make.]
Source analysis

I. What can Pliny tell historians about medicine in
Roman times?
II. Were doctors in Roman times hated or fêted?
Questions

• How Roman medicine reflected the ideas and practices of Roman civilisation.
• What caused people to be healthy or unhealthy in Roman times.
• What ideas the Romans had about the causes and treatment of illness and
injuries.
• Who provided medical care in Roman times.
• How much (or whether) medicine changed in Roman times, and what he main
turning points were.
• Why some diagnoses and treatments changed while others remained the same.
• How (or whether) the process of change was influenced by:
• individuals
• the government
• science and technology
• war
• attitudes and beliefs in society
• trade.
• To what extent developments in medical understanding and practice in Roman
times affected people's lives.
Answer preparation
As part of your revision, think about the arguments and facts you would use to explain:

MEDIEVAL CIVILISATION
Some knowledge of Medieval civilisation will help you understand
Medieval medicine.

• The Middle Ages (or Medieval period) were the period in
between the Roman Empire (often said to have ended in
AD476) and the Renaissance(often dated from 1453). The Dark
Ages are the first part of this period, following the collapse of
the Roman Empire (476-1066). The High Middle Ages are the
second part of this period (1066-1453). The Middle Ages were
initially represented (by Renaissance scholars) as a period
of stagnation and ignorance, in between the wonders of the
Romans and the glories of the Renaissance.
Intriduction

• In the 5th century AD, waves of barbarians such as the
Goths, Vandals, Saxons and Vikings invaded western Europe. Europe
disintegrated into a huge number of small fiefdoms, each governed by a local
lord, who protected his peasants - owned by him as 'serfs'. These tiny states
could not afford universities for study, or public health systems.
• Communications were difficult and dangerous, so ideas travelled slowly.
During the Dark Ages, the monasteries alone managed to hang onto learning
and knowledge, and even the ability to read and write. Many of the medical
ideas of the Greeks and Romans were lost at this time, and survived only in
the Muslim cities of the Middle East.
• Similarly, technology was limited, and much of the advanced technical
knowledge of the Romans was lost.
Overview

• Medieval Europeans believed in the Christian God, so politics and
everyday life, as well as medicine, were dominated by the Roman
Catholic Church. Most peasants were extremely superstitious.
• The key aspect of the Middle Ages was the emphasis on authority -
people would believe what they were told against the evidence of
their own eyes, and people who questioned authority risked
execution.
• After 1066, civilisation began to recover. Universities were established
(eg in Paris in 1110, Oxford in 1167). Kings grew more powerful, and
established courts as centres of culture and wealth. Trade and
communications, especially, by sea, developed. Towns grew up, which
created public health problems.
Medieval Beliefs

• In 1258, Baghdad was destroyed by the Mongols, and
much ancient knowledge that had been retained in the east but
lost to the west was carried back to the west by fleeing scholars.
Medieval Beliefs

• the loss of medical knowledge/ bad doctors
• the forbidding by the Church of dissection, and its
encouragement of prayer and superstition)
• the encouragement by the Church of prayer and superstition
• the emphasis on 'authority' rather than on observation and
investigation
• the lack of resources to build public health systems
• social disorder and war, which disrupted communication and
learning
Causes of medical stagnation in the Middle Ages included:
Medical stagnation in the Middle Ages

• forbidding dissection of human corpses
• insisting that people agree with the writings of Galen
• encouraging people to rely on prayers to the saints and
superstition to cure them of disease
• encouraging the belief that disease was a punishment from God
- this led to fatalism and prevented investigation into cures
However, the Church did encourage people to go
on Crusades, meaning that people travelled to the Middle East.
Here they came into contact with Muslim doctors, who were
significantly more skilled than their counterparts in Britain.
The Church played a big part in medical stagnation in the Middle Ages. It
discouraged progress by:
Medical stagnation in the Middle Ages

• Knowledge was hard to come by in Medieval times, especially
during the Dark Ages when barbarian tribes roamed western
Europe. The knowledge gained by the ancient Greeks and
Romans was largely lost to
Europeans, and superstition reigned - although learning was
more advanced in the Muslim Middle East.
Introduction

• Knowledge went into reverse in the west in Medieval times - many of the books
of the Greeks and Romans were lost, and the knowledge they contained was
replaced by mere speculation and superstition.
• Even when universities developed, after 1100 (Montpellier, Bologna and Salerno
had famous medical schools), lectures on anatomy were rudimentary. They
consisted simply of a butcher pointing to the different parts of a body, while the
lecturer read a text by an authority such as Galen.
• Although students did debate the ideas of Galen, any new ideas were judged on
the debating skills of the student, not on scientific proof. The Church said that
Galen's ideas were so correct that there was no need to investigate any further.
• Generally, the Church forbade the dissection of human bodies, so knowledge was
hard to come by - and ignorance led to numerous errors and misunderstandings
on the part of Medieval doctors. For example, the Italian doctor Alderotti
claimed that combing the hair 'comforts the brain'.
Overview

• Although many Medieval doctors continued to believe in the theory
of the four humours, they also said disease was caused by
demons, sin, bad smells, astrology and the stars, stagnant water, the
Jewish people etc.
• Ultimately, they believed that life was controlled by God and his
saints, and a plague such as the Black Death was seen as a
punishment from God. Guy de Chauliac, the Pope's doctor, blamed
the Black Death on a conjunction of Saturn, Jupiter and Mars.
• Things were different only in the Muslim Middle East where, during
the reign of Harun al-Rashid (786-809), the books of Hippocrates
were translated into Arabic. At first, Muslim doctors like al-Razi
('Rhazes known as the Galen of Islam') conserved the ideas of the
Greeks and Romans.
Medieval superstitions and Muslim
knowledge

• Later, Muslim doctors such as Avenzoar and Ibn an Nafis actually
began to challenge errors and to develop new ideas. However
because the Christian Church was at war with Islam, Muslim
ideas spread only slowly to western Europe. The exception was
a book by Ibn Sina (often known as Avicenna) - the 'Canon of
Medicine'.
Medieval superstitions and Muslim
knowledge

A Doctor too emerged as we proceeded.
No one alive could talk as well as he did
On points of medicine and of surgery
For, being grounded in astronomy
He watched his patient's favourable star
And, by his Natural Magic, knew what
are
The lucky hours and planetary degrees
For making charms and effigies.
The cause of every malady you'd got
He knew, and whether dry, cold, moist or
hot;
He knew their seat, their humour and
condition.
He was a perfect practicing physician.
All his apothecaries in a tribe
Were ready with the drugs he would prescribe
And each made money from the other's guile
(They had been friendly for a goodish while)
He was well-versed in Aesculpaius too
And what Hippocrates and Rufus knew
And Disocorides now dead and gone,
Galen and Rhazes, Hali, Serapion.
In blood-red garments, slashed with buish-
grey
And lined with taffeta, he rode his way;
Yet he was rather close as to expenses
And kept the gold he won in pestilences.
Chaucer, 'Canterbury Tales' (c.1387)
Source analysis
A medieval doctor

I. What can Chaucer tell historians about medicine in Medieval
times?
II. Were doctors in Medieval times hated or fêted?
Now try a Test Bite
Questions

• Surgery made some surprising leaps forward in Medieval
times. This was thanks partly to ingenious barber-surgeons on
the battlefield, and partly to the discovery of some
natural anaesthetics and antiseptics.
Introduction

• During the Middle Ages, surgery was left to barber-
surgeons, not to trained doctors.
• It was a time of frequent warfare, and the constant fighting
meant that surgeons' skills were much in demand. Perhaps as a
result, surgery actually progressed in Medieval times. Certainly
Theodoric of Lucca, in the 13th century, wrote how:
• Every day we see new instruments and new methods [to extract
arrows] being invented by clever and ingenious surgeons.
• Theodoric of Lucca
• This is completely different from the normal picture of
stagnation given to us about Medieval medicine.
Progress of Medieval surgery

• Medieval surgeons realised how to use wine as an antiseptic, and they used
natural substances (mandrake root, opium, gall of boar and hemlock) as
anaesthetics.
• Medieval surgeons could therefore do external surgery on problem areas
such as facial ulcers and even eye cataracts. There was
also, surprisingly, some internal surgery undertaken (eg to remove bladder
stones).
• However, they still had no idea that dirt carried disease, and most operations
of Medieval times, if carried out today, would end in a suit for criminal
negligence. Deep wounds still caused death from bleeding, shock and
infection. Some surgeons even believed it was good to cause pus in wounds.
• A medieval surgeon might cure an epileptic patient by trephining the skull to
let the demon out.
Techniques of Medieval surgery

13th-century artwork of a patient undergoing trephination
(surgery to the skull), possibly being performed by a surgeon's
apprentice

• They brought to me a knight with a sore on his leg; and a woman who was feeble-minded.
To the knight I applied a small poultice; and the woman I put on diet to turn her humour
wet.
• Then a French doctor came and said, "This man knows nothing about treating them." He
then said, "Bring me a sharp axe." Then the doctor laid the leg of the knight on a block of
wood and told a man to cut off the leg with the axe, upon which the marrow flowed out
and the patient died on the spot.
• He then examined the woman and said, "There is a devil in her head." He therefore took a
razor, made a deep cross-shaped cut on her head, peeled away the skin until the bone of
the skull was exposed, and rubbed it with salt. The woman also died instantly.
• I asked them if I was needed any more, and when they said not I came home, having
learned of their medicine what I knew not before.
Usama ibn Munqidh, 'Autobiography' (c.1175) (Usama ibn Munqidh was a Muslim doctor)
Source analysis

I. What does this source tells us about surgery in Medieval
times?
and Answer
Question
Now try a Test Bite

• Medieval towns and public places may not have been clean by
modern standards, but Medieval people understood the
connection between clean living and good health.
Occasionally, they even took a bath.
Introduction

• Medieval towns did not have systems of sewers or water
pipes like Rome had. Medieval towns were probably filthy.
Garbage and human waste was thrown into the streets. Houses
were made of wood, mud and dung.
• Rats, lice and fleas flourished in the rushes strewn over the clay
floors of people's houses (often changed only once a year).
Overview

• They had their own version of the
Greek's Programme for Health. The
doctor Alderotti advised people to
stretch their limbs, wash their
face, clean their teeth, exercise etc.
• Guy de Chauliac (the Pope's doctor)
realised the importance of a good
diet, and that a poor diet made
people more vulnerable to the
plague.
• Monasteries developed
comprehensive systems of public
health, including fresh running
water, 'lavers' (wash rooms), flush
'reredorters' (latrines) with running
sewers, clean towels and
a compulsory bath four times a year.
• Nobles took regular baths (perhaps two a
year).
• Towns had bath houses (which were also
restaurants and brothels).
• People realised that a room next to a privy was
unhealthy, and towns paid 'gongfermers' to
clear out the cess pits.
• Medieval kings passed laws requiring people to
keep the streets clean.
• Leaders in Venice realised that sexually
transmitted diseases were
infectious, and ordered checks on the city's
prostitutes.
• During the time of the plague many towns
developed quarantine laws, and boarded up
the houses of infected people. People with
leprosy, likewise, were confined to lazar
houses (a place for people with infectious
diseases).
• During the Middle Ages the first hospitals were
built since Roman times (eg St Bart's in
London).
Overview
However, we can't conclude that Medieval people were personally
filthy, or careless of their health:

Source A - 'The Preservation of Health'
• When you get up in the morning, stretch your limbs, so that the
natural heat is stimulated. Then comb your hair because this
removes dirt and comforts the brain.
• Wash your face with cold water to give your skin a good colour
and to stimulate the natural heat.Clear your nose and your
chest by coughing, and clean your teeth and gums with the bark
of some scented tree.
• Exercise in moderation, because it is good to be tired; it
stimulates the natural heat.
Taddeo Alderotti, 'On the Preservation of Health' (13th century)
(Alderotti was an Italian doctor)
Source analysis

I. What does the Alderotti source tell us about health in
Medieval times?
And answer
Questions
Now try a Test Bite

• Medieval doctors retained some medical knowledge from
the Greek and Roman eras, despite the fact that much
was lost during the Dark Ages. Unfortunately these doctors
accepted the ideas of the ancients without question, and held
many superstitious beliefs. This meant that patients often got
worse, rather than better, under their care.
Introduction

• Schools of medicine were set up in Universities such as Bologna and
Salerno, and there were lectures in anatomy.
• New writings of Muslim doctors (such as Rhazes) became available.
• Doctors debated the best methods of treating disease.
• Padua University (alone) insisted that doctors visited the sick during
their training.
Medieval doctors flattered to deceive, although there were
developments that gave the appearance of progress:
Overview

• The anatomy 'lectures' consisted only of the doctor reading
from a book while a prosector pointed to parts of the body.
• The ancients were held unquestioningly as the true
authorities, any debates was seen merely as an opportunity to
practice the art of arguing.
• Doctors had a terrible reputation. During the Black
Death, "...doctors were useless and indeed shameful as they
dared not visit the sick for fear of becoming infected" wrote Guy
de Chauliac.
These signs, however, were deceiving . For example:
Overview

SOURCE A - PETRARCH
• I know that your bedside is
besieged by doctors, and of course
this fills me with fear. As Pliny
said, in order to gain fame they buy
it with our lives. They learn their
art at our cost, and even our death
brings them experience; only a
doctor can kill without punishment.
Remember what it says on the
gravestones: "I died of too many
doctors".
A letter from the poet Petrarch to
Pope Clement VI (c.1350)
• Medical men are well educated, for I do
not think that an illiterate man can do the
work of a doctor. Even so, at the present
time, ignorant amateurs and even worse
and more horrible worthless and
presumptuous women, grab the
profession and abuse it and make
mistakes and kill people. You need three
qualifications to be a doctor nowadays: to
be able to lie cleverly, to seem honest,
and to be able to kill without caring.
Johannes de Mirfield, 'Flowers of
Bartholomew' (c.1375). (Mirfield, a
monk and a doctor, copied this from a
book written by the Italian surgeon
Bruno of Calabria in 1252)
SOURCE B - JOHANNES DE MIRFIELD
Source analysis
Read the sources below by Petrarch and Mirfield on suspicion of doctors.

I. What do the sources tell us about medieval attitudes to
doctors?
II. What evidence is there in the sources that medieval doctors
accepted authority over their own experience?
And answers
Question

• Many Medieval doctors carried with them
a vademecum (meaning 'Go-with-me') book of diagnoses and
a urine chart. Usually, they examined the colour, smell and taste
of the patient's urine, and made an on-the-spot guess as to
what they might be suffering from. Pictures from the time make
it clear that doctors also did clinical observation, and took their
patient's pulse.
• Other essential doctor's equipment included posies, oranges or
lighted tapers. Since they believed that bad smells carried
disease, they believed that they could protect themselves from
catching the disease by carrying something nice-smelling.
Methods of diagnosis

• Since they still believed in the theory of the four humours, many
of their cures involved balancing the 'humours overflowing'.
They did this by bleeding, applying leeches, or causing purging
or vomiting in their patients. Other ways of balancing the
'natural heat' included the taking of hot baths, drinking a soup
of yellow lentils, or applying water cooled with snow.
• The Medieval English poet Chaucer describes how a doctor was
followed by a 'tribe' of apothecaries (medicine-makers), and it is
known that medieval doctors had access to a huge range
of natural healing herbs and substances. These included red
rose ground fine with 'bamboo juice' for smallpox, and fig
poultices for plague sores.
Methods of treatment

• However, superstition increased throughout the period.
Monarchs thought that by touching patients suffering from the
'King's Evil' (scrofula) they could cure them. Peasants prayed to
St Roch to cure their toothache or the plague, or turned to St
Anthony to cure them of 'St Anthony's Fire' (ergotism).
• During the time of the plague, huge Christian processions were
held, at which people flagellated (whipped) themselves, to try
to show God how sorry they were for their sins.
Methods of treatment

Johannes de Mirfield on a medicinal bath
Mirfield, a monk and a doctor, was regarded as one of the best
doctors of his time.
• Here is a bath which has proved to be of value. Take blind
puppies, gut them, and cut off the feet; then boil in water, and
in this water let the patient bathe himself. Let him get in the
bath for four hours after he has eaten, and whilst in the bath he
should keep his head covered, and his chest completely covered
with the skin of a goat, so he won't catch a sudden chill.
Johannes de Mirfield, 'Flowers of Bartholomew' (c.1375)
Source A -
Source analysis

Guy de Chauliac on reducing swelling
De Chauliac was the Pope's doctor.
• Bleeding and purging, cordials and medicinal powders
can be used. The swellings should be softened with
figs and cooked onions, peeled and mixed with yeast
and butter, then lanced and treated like ulcers.
Guy de Chauliac, 'Surgery '(c.1350)
Source B -
Source analysis

John of Gaddesden on toothache
John of Gaddesden claimed to be an expert doctor, but most of
his cures relied on 'sympathetic' magic, and he clearly knew
little about surgery.
• “When the gospel for Sunday is read during the service of the
Mass, let the man hearing Mass sign his tooth and his head with
the sign of the Holy Cross and say the Lord's Prayer. It will keep
him from pain and cure the tooth, so say trustworthy doctors.”
John of Gaddesden, 'English Rose' (c.1314)
Source C -
Source analysis

• What can the sources tell historians about the treatment of
disease in Medieval times?
And answer
questions
Now try a Test Bite

RENAISSANCE CIVILISATION
Some knowledge of Western civilisation at the time of
the Renaissance will help you understand the medicine of the Early
Modern Age.

• During the 15th century Western civilisation experienced a
process of profound change, which historians call
the Renaissance (meaning 'rebirth'). The beginning of the
Renaissance is often dated from AD 1453, when the fall of
Constantinople drove many scholars with knowledge of Greek
and Roman learning westwards. The period historians call
the Early Modern Age lasted from about 1450 to about 1750.
Introduction

I. Governments - such as that of Henry VIII - were strong and rich. The economy boomed and trade prospered.
People could afford doctors.
II. Artists (such as Michelangelo, Leonardo da Vinci and Titian) revolutionised painting - this led them to study
the body in more detail, and was connected to improved knowledge of anatomy (eg the fabulous
illustrations for 'Fabric of the Human Body' by John Stephen of Calcar, one of Titian's students).
III. There was a revival of learning. Universities established schools of medicine. The Renaissance saw the
beginning of scientific method - which involved conducting an experiment, collecting observations, then
coming to a conclusion. At first, scholars merely claimed that they were renewing the perfection it had
amongst the ancient teachers', but soon they began to conduct experiments which led them to question the
knowledge of the Greeks and Romans. This was vital for the development of medicine.
IV. The invention of the printing press allowed new ideas to spread more quickly around Europe.
V. The discovery of America by Columbus meant that new foods and medicines were brought back from
the New World.
VI. The invention of new weapons (especially gunpowder) led to soldiers getting different sorts of
wounds, which battlefield doctors had to deal with.
In the 15th century AD, there was a 'rebirth' of European civilisation.
Six key changes

• Although the Renaissance saw an improvement in medical
knowledge, particularly of anatomy and physiology, many
people rejected the new ideas.
• Further, doctors still did not manage to use their discoveries to
develop better cures for their patients, because they had still
not discovered the role that germs play in causing disease.
Growth of knowledge

Bezoar is a stone that grows in the stomach of a goat found in the Middle East. It was
thought to be an antidote to poison (the word is Persian, and means 'counterpoison').
The French surgeon-doctor Paré tested this in a crude and cruel scientific experiment. He
gave poison to a condemned criminal, followed by bezoar, and then observed what
happened:
• “Some years ago, a gentleman boasted before King Charles that bezoar was an antidote for
all poisons ... It was an easy matter to make trial of this claim on those condemned to be
hanged [and a criminal] had poison administered to him ...
• An hour after, I found him on the ground on his hands and feet like an animal, with his
tongue hanging out of his mouth, his eyes wild, vomiting, with blood pouring from his
ears, nose and mouth. Eventually he died in great torment, seven hours after I gave him
the poison. I opened his body and found the bottom of the stomach black and dry, as if it
had been burned, whereby I realised that he had been given sublimate of mercury, whose
force the bezoar could not stop. Therefore the king commanded: Burn it!”
Ambrosie Paré, 'Apology and Treatise' (1575)
Source analysis

I. When you have read this famous source about bezoar, can
you find evidence that Paré conducted a scientific
experiment?
Question

• The Early Modern Age was an exciting time for medicine, with
knowledge of the human body progressing in fundamental
ways - although the causes of disease remained a mystery.
Introduction
Knowledge about the body
Two key practitioners moved knowledge forwards in the Early Modern Age:

1536
He discovered the spermatic vessels. He also realised that the famous
doctor Galen could be wrong, when he discovered that the great man
was mistaken about there being two bones in the jaw, and about how
muscles were attached to the bone.
1537
He became professor of medicine at Padua University. He said that
medical students should perform dissections for themselves, stating
that:"... our true book of the human body is man himself."
1543
He published 'Fabric of the Human Body' (with high-quality annotated
illustrations).
Vesalius
The first was Vesalius, whose patron was Charles V of Spain. He trained at Louvain, Paris and
Padua universities, and ransacked cemeteries and gibbets for bones and for bodies to dissect.

• Follower of Vesalius in graveyard, searching for bodies to dissect
Vesalius

The second important practitioner was William Harvey - who
discovered the principle of the circulation of the blood through
the body. He trained at Cambridge and Padua universities, and
became doctor to James I and Charles I of England.
1616
He calculated that it was impossible for the blood to be burned
up in the muscles (as Galen had claimed).
1628
He published 'Anatomical Account of the Motion of the Heart
and Blood', which scientifically proved the principle of the
circulation of the blood. This book marked the end of Galen's
influence on anatomy.
William Harvey

• Paracelsus declared "Galen is a liar and a fake" but still believed
in the four humours. He believed in alchemy, and believed it
was possible to find the elixir of everlasting life.
• Thomas Sydenham insisted that doctors should visit the
sick, rather than the other way round, which showed some
progress in his thinking - but he taught that disease was caused
by 'atmospheres'.
• Nicholas Culpeper believed that illness was caused by the stars.
• Anton van Leeuwenhoek discovered bacteria in 1683, using a
single-lens microscope, but no one realised their significance, or
that they caused disease.
Despite progress in some areas of medicine, Early Modern doctors did
not advance understanding of the causes of disease.
Knowledge about disease

• a terrible sexually transmitted disease which became prevalent
at the time - was thought variously to be a punishment from
heaven, or caused by small worms that floated through the
air, the planet Saturn at certain times, sexual contact between a
man and a sick woman, or contact with the New World.
• Despite the lack of progress in some areas, doctors did come to
realise that the plague was a contagious disease.
•
Syphilis -

Discovering the circulation of blood through time
The discovery of the circulation of the blood is an excellent example of how
knowledge can accumulate over time
Development through time and question

• Use the table to study development through time by
identifying:
• an example of an error that lasted many years
• discoveries that had no effect on the development of knowledge
• examples of ideas that had an effect because they were disseminated
• the effect of education and training
• the 'pathway of knowledge' that led to Harvey's discovery, excluding all
the false starts and people who had no effect
•Questions

I. Galen's idea that the heart pumped out blood to be burned up in the muscles
II. Nafis (Muslim; not known) / da Vinci (lost) / Servetus (burned) / Caesalpino
(not known)
III. Vesalius and Columbo - wrote books read by Harvey
IV. Fabricius was Harvey's tutor - his discovery of valves was vital for Harvey's
discovery
V. start point: Galen - blood passes through the septum and is pumped out to
be burned up in the muscles. Vesalius - blood does not pass through the
septum. Columbo - blood is pumped past the lungs. Fabricius - valves mean
blood can only go one way through the veins. Harvey - blood cannot be
produced fast enough to burn it up - leads to understanding of circulation of
blood
Now try a Test Bite
Answers

RENAISSANCE SURGERY AND
TREATMENT

• Early Modern surgery was a gruesome procedure, but
physicians and surgeons such as Paracelsus and Paré started to
make some progress, and passed their knowledge on.
Introduction

• Ambroise Paré changed people's ideas about surgery. He developed his ideas
during his 20 years as a barber-surgeon, when he accompanied the French
army on its campaigns.
• Despite the unpleasant procedures that were part of medicine in his day, it is
clear from his writings that Paré cared deeply about his patients.
• In 1536 he discovered by chance (when the cautery oil he used to cauterisethe
wounds of his patients ran out) that wounds healed better if they were treated with a
'soothing digestive' (boiled poultice) of yolks and rose oil.
• He used catgut ligatures to tie arteries during amputations instead of cauterising the
wound.
• In 1575 he published his 'Apology and Treatise', which advocated changes to the way
surgeons treated wounds and amputations.
• Paracelsus, a famous German alchemist and surgeon of the period, discovered
that laudanum (a derivative of opium) was a painkiller that could be used to
help his patients. For many years it was used for general pain such as
headaches and period pain (and many people became addicted to it).
Overview

• Now I was at that time a freshwater soldier. I had not yet seen wounds made by gunshot
at the first dressing. It is true that I had read in Jean de Vigo, "Of Wounds in General", first
book, chapter eight [that the doctor should] cauterise them with oil of elder, pouring the
oil as hot as possible, into the wound...
• Eventually my oil ran out and I was forced to use in its place a digestive made of the yolks
of eggs, rose-oil and turpentine. That night I could not sleep, fearing that because of my
lack of cauterisation I would find the wounded dead or poisoned. This made me wake up
very early to visit them. Beyond my hope, I found those for whom I had used the digestive
feeling little pain, their wounds without inflammation, having slept fairly well through the
night. Those to whom I had applied the boiling oil I found feverish, with their wounds very
painful and swollen. Then I decided never more to burn thus cruelly poor men wounded
with gunshot.
• Ambroise Paré, 'Apology and Treatise' (1575)
Paré's discovery that cautery was a bad treatment is an excellent example of discovery by
chance - his account of what happened tells a fascinating tale:
Source analysis

Use the source to explain how Paré made his discovery by
identifying an example of:
I. his process of scientific experiment
II. his ability to overturn an established idea
III. his care for his patients
Questions

I. Paré's discovery was not a scientific experiment, but it had
the same effect as one - he was testing cautery as a way of
healing. His method was to try something different ("I was
forced to use in its place"), he observed the results ("I found
those for whom I had used the digestive. Those to whom I
had applied the boiling oil I found"), and
his conclusion was "never more to burn thus cruelly poor
men wounded with gunshot".
II. "I had read in Jean de Vigo, "Of Wounds in General", first
book, chapter eight..."
III. "That night I could not sleep, fearing that... Beyond my
hope, I found... Then I decided never more to burn thus
cruelly poor men"
Answers

• 16th-century instruments for grasping gallstones out of a
patient, from 'Of Cutting the Stone' by Ambroise Paré

• Methods of diagnosis in the Early Modern Age did not change
from the time of the Middle Ages.
• Doctors were utterly unable to cure infectious disease, and
were powerless in face of diseases such as the plague and
syphilis.
• They did get some new drugs (eg quinine for malaria) from the
New World, but generally treatment was a mixture
of superstition and errors. Charles II was still asked to touch sick
people, as it was said this would cure them of the 'King's Evil'
(scrofula).
Diagnosis and treatment

• Nicholas Culpepper's 'Complete Herbal' (1653) was a
compendium of healing substances, but:
• he advocated the use of opposites
• he advised invoking sympathetic planets
• he claimed that garden rue was an antidote to all poisons (long after
Paré had proved this to be impossible)
• he recommended smoking tobacco (then a novel substance from the
New World) as a wonder-cure that would expel worms, ease
toothache, cure snake bites and kill lice
Early cures - and first knowledge of
vaccination

• 'Cures' for the plague included pieces of paper with the
letters abracadabra written in a triangle; a lucky hare's foot;
posies and perfume; smoking tobacco; sherry; dried toad;
leeches; a potion of rue, wormwood, vinegar and rose-water;
and pressing a plucked chicken against the plague-sores until
the chicken died.
• In 1796, Edward Jenner discovered how vaccination could
prevent disease (he found that infecting people with cowpox
protected them from smallpox) - but nothing came of this since
no one knew why it did so.
Early cures - and first knowledge of
vaccination

• The 'cures' tried by Charles II's doctors after he had had a mild
stroke - which he might have recovered from quickly today -
certainly hastened his death. The following is a modern
description of the treatment of Charles II, summarised from a
description written by his chief physician, Sir Charles Scarburgh:
Source analysis - death of Charles II based
on Scarburgh's description

• When Charles II of England lay dying from a convulsion which attacked him while shaving, the medicos of that
day left no stone unturned in helping him along to the Great Beyond. First, he was bled of a pint of blood.
Then his shoulder was cut and eight ounces more of blood was extracted by cupping.
• Then followed an emetic, a purgative and another purgative. Next, an enema in which they used
antimony, sacred bitters, rock salt, mallow leaves, violet, beet root, camomile flowers, fennel
seed, linseed, cinnamon, cardamom seed, saffron, cochineal and aloes. This enema was repeated. In two
hours, another purgative was given.
• The King's scalp was then shaved, and a blister raised on it. They gave him next sneezing powder of hellebore
root; they sought to strengthen his brain by giving him powder of cowslip flowers. Purgatives were frequently
repeated. He was given drinks of barley water, licorice, sweet almonds, white wine, absinthe, anise
seed, extracts of thistles, rue, mint and angelica. When these did not cure him, they gave him a poultice of
burgundy pitch and pigeon dung, to be applied to his feet. More bleeding, more purging; they added melon
seeds, manna, slippery elm, black cherry water, extracts of flower of lime, lily of the valley, peony, lavender
and dissolved pearls. When these did not do the trick, they went at it with gentian root, nutmeg, quinine and
cloves. When this failed, he was given forty drops of extract of human skull. Then they forced down his throat
a rallying dose of herbs and animal extracts. Then some powdered bezoar stone.
• Alas, after an ill fated night His Serene Majesty was so exhausted that all the physicians became despondent.
And so, more active cordials, and finally pearl julep [a heart tonic] and ammonia, were forced down the royal
patient's throat. Then he died.
• Modern description

I. cures connected to the four humours
II. natural substances.
III. exotic substances
IV. substances from the New World
V. substances that had been discredited
VI. magical substances
VII. poisonous substances
Find references in the source based on Scarburgh to:
questions

I. cures connected to the four humours - bleeding (including
cupping), purgatives, enemas, emetics, blistering, sneezing, a poultice of pitch and
pigeon dung
II. natural substances - antimony, rock salt, mallow leaves, violet, beet root, camomile
flowers, fennel seed, linseed, cinnamon, cardamom
seed, saffron, cochineal, aloes, cowslip flowers, barley water, licorice, sweet
almonds, white wine, absinthe, anise seed, extracts of thistles, rue, mint and
angelica, melon seeds, manna, slippery elm, black cherry water, extracts of flower of
lime, lily of the valley, peony, lavender, gentian root, nutmeg, cloves
III. exotic substances - dissolved pearls
IV. substances from the New World - quinine
V. substances that had been discredited - bezoar
VI. magical substances - extract of human skull, sacred bitters, pearl julep
VII. poisonous substances - hellebore, ammonia
Now try a Test Bite
Answers

• Rats, lice and fleas were a part of people's everyday lives in
Early Modern times, so the need for public health measures
was great - but it took theplague of 1665 to get the authorities
moving.
Introduction

• Early Modern towns were similar to Medieval towns. They did
not have systems of sewers or water pipes. They were
probably filthy. Garbage and human waste was thrown into the
streets.
• Houses were made of wood, mud and horse dung. Rats, lice
and fleas flourished in the rushes that people strewed on the
clay floors of their houses. In 1524 the Renaissance writer
Erasmus gave a description of English houses, which he
described as having floors covered with rushes, which were
renewed only infrequently, and were full of "...spittle and vomit
and urine of dogs and men, beer that has been thrown
out, remnants of fishes and filth unnameable."
Overview

• 'Surgeons' were appointed, who examined the dead to establish the extent of the
plague.
• Bills of Mortality were published, to publicise the course of the disease.
• 'Examiners' and 'searchers' were appointed, who established whether members of a
household had contracted the plague. If so, they then shut up the house for a
month, and its inhabitants had to stay indoors.
• Constables were appointed, who made sure no one left such houses.
• Bodies were buried at night in huge pits, and mourners were not allowed to attend.
• 'Pest houses' were set up, to quarantine sufferers.
• Householders were ordered to collect all waste, which was then removed by 'rakers'.
• Stray pigs, dogs, rabbits and cats were killed.
These measures unfortunately did not stop the spread of the plague, which only ended
when the weather turned cold.
Despite the generally casual attitude to dirt, during the 1665 plague London
did nevertheless establish some public health provisions.
Measures to combat the plague

• Medicine in Early Modern times was making some progress -
but most people's doctors had little or no training.
Introduction

• were well educated and trained
• did 'scientific' research
• were prepared to contradict the accepted authority
• disseminated their findings
• relied on royal support
• had limited success
However, they charged very high fees and only the richest people
could afford them.
The Early Modern Age saw advances in theory, but not in practice. The most
advanced Early Modern physicians were usually town-based, and also:
Early physicians

The medicine available to ordinary people relied on the amount
they could afford. The people they turned to for medical advice
included:
• country doctors - lower fees than town doctors, but not well-
trained
• barber-surgeons - who were paid to perform small operations
• apothecaries (chemists) - no medical training, but sold
medicines and groceries
• quacks - travelling barbers, tooth-pullers, who sold medicines
which were supposed to cure everything
• wise women, neighbours and local 'witches'
Early physicians

• How Early Modern medicine reflected the ideas and practices of early modern times
• What caused people to be healthy or unhealthy in Early Modern times
• What ideas Early Modern people had about the causes and treatment of illness and
injuries
• Who provided medical care in Early Modern times
• How much medicine changed in Early Modern times, and what were the main turning
points
• Why some diagnoses and treatments changed while others remained the same
• individuals
• the government
• war
• trade
• To what extent developments in medical understanding and practice in Early Modern
times affected people's lives
Answer preparation
As part of your revision, think about the arguments and facts you would use to explain:
Test Bite

19TH-CENTURY CIVILISATION
Some knowledge of 19th-century civilisation will help you understand
19th-century medicine.

• During the 18th century there was a quickening in economic
activity in the western world. Historians call this the time of
the Industrial Revolution. The process continued during the
19th century, with an even greater quickening of invention and
scientific discovery.
• Huge progress was made in identifying and preventing many
diseases. People felt that humankind was becoming god-like in
its knowledge and achievements, and that nothing was
impossible except the cure of infectious disease - a problem
that continued to cause much misery.
Introduction

I. A great explosion of industry (and industrial diseases such as dermatitis, lung disease and
'phossy jaw').
II. Urbanisation (and public health problems that included 'filth diseases' such as cholera and
typhus).
III. The growth of empires (and contact with new diseases such as yellow fever).
IV. The growth of immense wealth, based on trade and industry (which created the money to
spend on medical research and public health).
V. Great advances in technology (which led to medical machines such as the electrocardiograph).
VI. Improved communications (allowed medical knowledge to spread - doctors gained information
from all over the world).
VII. The growth of science and research (which led to medical breakthroughs).
VIII. Democracy and socialism (people believed they had the right to good health). The right to
health was one of the 'rights of man' claimed by working people during the French Revolution
(which was why the medical revolution of the 19th century started in France).
IX. New ideas about evolution (Darwin) and genetics (Mendel) - broke the control of the Church
over medicine and medical ethics.
X. Wars were waged on a greater scale (creating mass injuries that were hitherto unknown, and
required new medical and surgical techniques).
Developments in the 19th-century included:
•Ten key developments

19TH-CENTURY KNOWLEDGE
ABOUT THE BODY AND DISEASE

• There was a general atmosphere of scientific research and
advance throughout the 19th century, and this was reflected in
the fast build-up of medical knowledge. Pasteur's discovery
that germs cause disease was a crucial turning point.
•Introduction

• William Beaumont (America: 1822) studied the digestive system of
Alexis St Martin, a Canadian who had an open hole into his stomach.
• Theodor Schwann (Germany: 1839) realised that animal matter was
made up of cells, not 'humours'. This was the vital breakthrough of
knowledge that at last destroyed belief in the old 'humoral' pathology
of the Greeks.
• Henry Gray (Scotland: 1858) wrote 'Gray's Anatomy', which had over
1,000 illustrations. Many people bought a copy to own at home. After
the 1870s, pupils started studying anatomy in schools.
• Starling and Bayliss (England: 1902) discovered the first hormone.
• Casimir Funk (Poland: 1912) discovered the first vitamins, and
realised that some diseases were caused simply by poor diet.
Knowledge about the body increased greatly in the 19th century:
•Knowledge about the body

• Louis Pasteur (France: 1860s) discovered (by using a swan-
necked flask) that germs cause disease. Before he made this
discovery, doctors had noticed bacteria, but they believed it was
the disease that caused the bacteria (the so-called theory of
'spontaneous generation') rather than the other way round.
• One of the spin-offs of Pasteur's discovery was
the pasteurisation of milk, which prevented it from going sour
by killing the germs and sealing it from the air.
Knowledge about disease also increased greatly in the 19th century.
Knowledge about disease
Louis Pasteur, French microbiologist and the
'father' of the germ theory of disease. Image
first published in 1894.

• Robert Koch (Germany: 1878), who discovered how to stain and grow bacteriain a Petri dish (named after his assistant
Julius Petri). He was thus able to find which bacteria caused which diseases:
• septicaemia (1878)
• TB (1882)
• cholera (1883).
• In the same period other bacteria were discovered, including those that caused:
• typhoid (1880s)
• pneumonia (1880s)
• plague (1894)
• Patrick Manson (Britain: 1876) discovered that elephantiasis was caused by a nematode worm, and that mosquitoes
were the vector (carrier). This was abreakthrough discovery, because researchers soon found out that other tropical
diseases were transmitted by vectors such as mosquitoes (malaria and yellow fever) or tsetse flies (sleeping sickness).
• Charles Chamberland (France: 1884) found that there are organisms even smaller than bacteria that also cause disease -
he had discovered viruses.
Other scientists also made crucial discoveries, among them:
•Knowledge about disease

The Industrial Revolution / inventions
• There was a general atmosphere of scientific research and advance.
• Louis Pasteur's first commission was to find a cure for sour
wine, which set him off on his revolutionary course.
• Joseph Jackson Lister (Britain: 1826) invented the multi-lens
microscope, which allowed doctors to see very tiny things accurately.
• Carl Ludwig (Germany: 1847) invented the kymograph, which allowed
more accurate measurement of the pulse.
• Wilhelm Roentgen (Germany: 1895) discovered x-rays.
• Willem Einthoven (Holland: 1900) invented
the electrocardiograph(measured heart activity).
Causes of improvements in physiology
and pathology

Scientific knowledge
• Jan Purkinje (Czechoslovakia: 1836) set up the first university
department of physiology (science of how the body works).
• Louis Pasteur started as a research chemist. He set up a team of
researchers at the Pasteur Institute (1888).
• Robert Koch developed his Postulates of how researchers
should find a disease. These led to four basic procedures - make
sure the germ in question is present in the sick specimen -
grow a culture of that germ - inject it into a healthy specimen -
see if the disease develops.
and pathology

Social factors
• Nationalism - eg the rivalry of Pasteur and Koch. Shibasaburo
Kitasato (Japan) and Alexandre Yersin (France) raced to discover
the plague bacterium in 1894.
• The deaths of his two daughters motivated Louis Pasteur to
redouble his efforts in the fight against disease.
and pathology
Now try a Test Bite

• Before the 19th century operations were horrific procedures, and most
patients died from post-operative shock, infection, or loss of blood. In
some London hospitals the death rate after operations was over 80 per
cent.
• The 19th-century up-turn in surgery actually pre-dated anaesthetics and
antiseptics. Many new ideas were trialled in America (eg Dr Thomas
McDowell performed an ovariotomy in 1809), with some success. One
suggestion is that American surgeons were happier to try out new
techniques on Black slaves.
• The improvements in anaesthetics (to protect patients from pain) and
antiseptics (to protect patients from infection) occurred because surgery
without them was too traumatic, and patients couldn't survive it. New
blood transfusion techniques also saved many lives.
Introduction

• 1842: Crawford W Long (America) used ether as an anaesthetic while
operating on a neck tumour (but did not publish details of his
operation).
• 1845: Horace Wells (America) tried unsuccessfully to demonstrate
that laughing gas would allow him to extract a tooth painlessly.
• 1846: Dr JC Warren (America) removed a tumour from the neck of
Gilbert Abbott using ether.
• 1846: Robert Liston (Britain) removed a leg using ether - 'this Yankee
dodge'.
• 1847: James Simpson (Britain) discovered chloroform.
• 1884: Carl Koller (Germany) discovered that cocaine is a local
anaesthetic.
Anaesthetics for pain

• 1847: Ignaz Semmelweiss (Hungary) cut the death rate in his maternity ward
by making the doctors wash their hands in calcium chloride solution before
treating their patients.
• 1854: Standards of hospital cleanliness and nursing care rose rapidly under
the influence of Florence Nightingale.
• 1865: Joseph Lister (Scotland) - basing his ideas on Pasteur's Germ Theory
cut the death rate among his patients from 46 to 15 per cent by spraying
instruments and bandages with a 1-in-20 solution of carbolic acid.
• 1890: Beginnings of aseptic surgery - surgeons started boiling their
instruments to sterilise them - WS Halstead (America) started using rubber
gloves when operating - German surgeons started to use face masks.
•For infection - antiseptics

• 1901: Karl Landsteiner (Austria) - discovered blood groups.
Transfusions had been tried before but usually killed the patient
because of clotting. Matching blood groups stopped this
happening.
• 1913: Richard Lewisohn discovered that sodium citrate stopped
blood clotting during an operation.
• 1938: The National Blood Transfusion Service was set up in
Britain.
•For blood loss - blood transfusions

The number of operations grew hugely through the century, and
surgeons became skilled at internal operations (1880s: first
appendectomy; 1896: first open-heart surgery) and even tried
(unsuccessfully) to transplant organs such as thyroid glands and
testicles. Various factors pushed the process along:
• The Industrial Revolution / inventions
• Wilhelm Roentgen discovered x-rays - helped internal surgery.
• Public demonstrations (eg of anaesthesia) allowed knowledge of new
procedures to spread.
•More causes for improvements in surgery

Scientific knowledge
• The scientist Humphrey Davy had first discovered that laughing gaswas an anaesthetic when working
on the properties of gases in 1800.
• Joseph Lister lectured in King's College London, and published his findings in 'The Lancet'.
Social factors
• Queen Victoria gave birth to her children under anaesthesia (after which the general public's fear of
anaesthesia lessened). Edward VII's appendectomy helped reduce fear of operations.
War
• The needs of army surgeons treating soldiers injured in battle (often requiring amputations)
stimulated advance.
• The Crimean War led to the development of nursing (Florence Nightingale at Scutari).
• World War One led directly to the development of the National Blood Transfusion Service.
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•More causes for improvements in surgery

19TH-CENTURY METHODS OF
DIAGNOSIS AND TREATMENT

• The search to combat disease gained enormous momentum in
the 19th century. Instruments such as the stethoscope and
machines such as the electrocardiogram were invented, and
research into inoculation began to bear fruit.
•Introduction

• René Laennec (France: 1816) invented the stethoscope and started the practice of
'auscultation' (listening to the patient's chest).
• Pierre Louis (France: 1834) argued that symptoms were irrelevant, and that what was
happening inside the body was much more important when it came to diagnosing illness.
As a result, doctors made diagnoses on the basis of a full clinical examination of the 'signs'
made by the disease on the body.
• Carl Ruge (Germany: 1878) developed the technique of biopsy (removing cells to
determine if they were cancerous).
• Doctors used machines to measure the functions of the body precisely:
• Carl Ludwig (Germany: 1847) invented the kymograph (which measured the pulse).
• Wilhelm Roentgen (Germany: 1895) discovered x-rays.
• Willem Einthoven (Holland: 1900) invented the electrocardiograph (which measures heart activity).
Methods of diagnosis changed massively during the course of the 19th
century
•Diagnosis

• The search for new ways to cure disease also gained
momentum in the 19th century, and included the discovery of
how inoculation could prevent disease.
• Charles Chamberland (France: 1880) discovered by chance
(when he left bacteria exposed to air) that injecting chickens
with an attenuated (weakened) form of chicken cholera gave
them immunity to the disease (ie he discovered the principle of
inoculation).
•Treatment - inoculation, magic bullets
Charles Chamberland, with chicken

That realisation was the start of an important chain of events.
• Louis Pasteur developed an effective inoculation against
anthrax (1881), and rabies (1885).
• Albert Calmette and Camille Guérin (France: 1906) developed
the BCG injection against TB.
• Emil von Behring (Germany: 1913) developed an anti-toxin
against diphtheria.
Treatment - inoculation, magic bullets

• Paul Ehrlich (Germany: 1890s) reasoned that, if certain dyes could
stain bacteria, perhaps certain chemicals could kill them. He set up a
private laboratory and a team of scientists. By 1914 they had
discovered several 'magic bullets' - compounds that would have a
specific attraction to disease-causing microorganisms in the body, and
that would target and kill them. These were methylene blue (for
malaria), trypan red (for sleeping sickness) and Salvarsan (for syphilis)
- although Salvarsan was more effective than the other two.
• Most vaccines, however (eg one developed by Robert Koch against TB
in 1891), were not successful. And against acute infectious
disease, doctors were largely powerless. They carried, as one medical
historian wrote, 'a box of blanks'. So people looked elsewhere for
their cures - sometimes in strange places.
Magic Bullets

• A home medicine encyclopaedia of 1910 recommended cures
that included electrical shocks, injection with animal
hormones, and a range of harmful substances including
cocaine, mercury, creosote and strychnine.
• Other alternative medical treatments included mesmerism
(hypnotism), homeopathy (taking tiny doses of poisons), 'health
reform' (a religious movement which recommended a healthy
lifestyle - it was run by John Kellogg whose brother invented
cornflakes) and Christian Science (which taught that disease
only existed in the mind).
• Travelling 'quacks' sold patent medicines (such as Lily the
Pink's medicinal compound).
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•Outlandish or alternative cures

• Public health provision was completely transformed as the
19th century progressed. Overcrowding, dirt, poverty and
disease went hand in hand at the century's start, but by the
1900s energetic social reformers had comprehensively turned
things round.
Introduction

• In the early 19th century, the growing towns of Britain were
characterised byovercrowding, poor housing, bad water and
disease.
• In 1842, Edwin Chadwick argued that disease was the main
reason for poverty, and that preventing disease would reduce
the poor rates.
• In 1848, a cholera epidemic terrified the government into doing
something about prevention of disease - through both public
and individual health measures.
•Overview

• At first the government tried - as the Romans had done - to
prevent illness among the population by public sanitation
measures.
• The first public health measures were based upon the idea
that miasmas (bad smells) caused disease. Although the idea
was wrong, the measures against the miasmas involved a
greater focus on cleanliness, and this improved public health.
•Public measures
Florence Nightingale, English hospital
reformer, who publicised the 'miasma' theory
of disease while campaigning for cleaner
hospitals

Further measures included:
• In 1848 the first Public Health Act caused the setting up of a Board of
Health, and gave towns the right to appoint a Medical Officer of
Health.
• In 1853 vaccination against smallpox was made compulsory.
• In 1854 improvements in hospital hygiene were introduced (thanks in
large part to Florence Nightingale).
• In 1875 a Public Health Act enforced laws about slum
clearance, provision of sewers and clean water, and the removal of
nuisances.
The benefits of these measures soon became clear, and by the late
19th century local councils were competing with each other to
provide the best public health.
•Public measures

When the Boer War revealed that half the population were unfit
for military service, the government accepted that it had to pass
laws to improve the situation of the individual poor:
• 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.
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Individual measures

• The 19th century was a time of great change for doctors. They
started the century able to do very little for their patients, and
ended it with a far greater understanding of disease, how to
prevent it, and how to help patients through it.
Introduction

• The 19th century saw great advances in the practice of medicine.
• In 1800, the doctor may have been a friend of the rich, but many
doctors themselves were poor. They could do little to heal
disease, and their main role was to provide comfort and reassurance.
As the century progressed, however, so did the role of doctors.
• 1803 Thomas Percival wrote the first book on medical behaviour.
• 1823 The first issue of the the medical journal the 'Lancet' was
published.
• 1832 The British Medical Association was formed.
• By 1900, doctors and surgeons occupied a highly respected place in
society. They provided treatment increasingly through hospital
provision, and in certain situations were able to heal their patients
with surgery.
•Overview

In the 18th century, the place of women in medicine was mostly limited to
nursing. However, as the 19th century progressed, women began to play a
greater part in medicine, and some of their names are familiar to historians
to this day.
• Elizabeth Blackwell: gained a medical degree in America (1849) and set up
the New York Infirmary for Poor Women before returning to England, where
she was accepted onto the Medical Register in 1858.
• Elizabeth Garrett: acquired a licence from the Society of Apothecaries (1865)
then set up the Dispensary for Women.
• Sophia Jex-Blake: studied medicine at Edinburgh University (1869), but had
to take her degree in Switzerland and get her licence to practise medicine in
Ireland. In 1874 she founded the London School of Medicine for Women.
•Women doctors in the 19th century

• These women were, however, the exceptions. Most male
doctors were opposed to women doctors, and each time a
woman found a loophole that allowed her to progress in her
career, the medical profession changed the rules to stop it
happening again. In 1911 there were only 495 women on the
Medical Register in Britain.
•Women doctors in the 19th century
19th-century engraving of Elizabeth Garrett
Anderson before the Faculty of Medicine, Paris

To familiarise yourself with the achievements of 19th-century medicine:
• Make a series of spider diagrams showing the five key
achievements for each of the key areas of 19th-century medicine (ie
knowledge about the body and disease / surgery / methods, diagnosis
and treatment / public health / doctors). This will give you a list of 25
achievements.
• Look back at the ten characteristics of the 19th century in the
'civilisation' unit, and work out which of them are reflected in each of
the achievements you have identified.
• Taking an overview of the 25 key achievements, decide on five over-
arching aspects of 19th-century medicine.
• Find five failures of 19th-century medicine.
•Revision tip

• How 19th-century medicine reflected the ideas and practices of 19th-century
society.
• What caused people to be healthy or unhealthy in the 19th century.
• What ideas people had about the causes and treatment of illness and injuries in
the 19th century.
• Who provided medical care in the 19th century.
• How much medicine changed in the 19th century, and what the main turning
points were.
• Why some diagnoses and treatments changed, while others remained the same.
• individuals
• the government
• war
• trade
• To what extent developments in medical understanding and practice in the 19th
century affected people's lives.
•Answer preparation
As part of your revision, think about the arguments and facts you would use
to explain:

20TH-CENTURY CIVILISATION
Some knowledge of 20th-century civilisation will help you understand
20th-century medicine.

• During the 20th century the pace of change, which had
quickened during the Industrial Revolution, speeded up even
more. There was an on going explosion of invention and
scientific discovery. Huge progress was made in curing disease
and manipulating the body.
• The feeling of the 20th century is summed up in the 'Can do'
motto of the US Navy construction engineers during the
Second World War: 'The difficult we do immediately. The
impossible takes a little longer.'
Introduction

• There was a great explosion of
scientific understanding and
technological innovation.
• Many societies became
hugely rich, though wealth was still
unequally shared.
• There was
considerable urbanisation(explosive
growth of cities).
• Communications technology made the
world seem smaller and more
cosmopolitan. This allowed medical
ideas to spread rapidly, but also
allowed diseases such as SARS to
spread.
• There was more time for leisure, less
time spent on work.
• People became less religious - so more
inclined to look for medical solutions
even to spiritual and psychological
problems.
• Many societies were democratic, and
thought the duty of the state was to
care for its citizens - hence demands
for a welfare state.
• American military and economic
power, and American values, were
dominant.
• Stress due to terrorism, the
undermining of traditional values
and the rapid pace of life took a great
toll on people's general health.
• Wars, epidemics and famines killed
more people in the 20th century
than they had in the whole of the
rest of history.
All these factors affected medicine in
both negative and positive ways.
Never the less, most people in
2000, when compared with their
grandparents, were
taller, heavier, healthier and lived
longer.
•Developments in 20th-century
Here's a list of some of the many developments and changes that took
place during that century:

20TH-CENTURY KNOWLEDGE
ABOUT THE BODY AND DISEASE

• Knowledge about the body and disease increased greatly in
the 20th century. Developments ranged from the discovery of
the cause of diabetes to the creation of 'test-tube' babies for
previously infertile couples.
Introduction

• 1896: Walter Cannon (America) used a barium meal with x-rays to track the passage of
food through the digestive system.
• 1910: Henry Dale (Britain) discovered the chemical histamine, which is produced by the
body during an allergic reaction. This allowed him to understand allergic response and
surgical shock.
• 1921: Frederick Banting and Charles Best discovered insulin, which breaks down sugar in
the bloodstream. Thus he found the cause of diabetes.
• 1923: Edgar Allen (America) discovered oestrogen (the hormone that powers femaleness).
In 1935 Ernst Laqueur isolated testosterone, the hormone that creates maleness.
• 1931: The invention of the electron microscope allowed doctors to see bacteria and
viruses for the first time.
• 1951: The Mexican company Syntex developed norethisterone, which prevents ovulation -
leading to production of the first contraceptive pills.
•Significant developments

• 1953: Francis Crick and James Watson (Britain) discovered DNA.
• 1953: Leroy Stevens (America) discovered stem cells.
• 1970s: Patrick Steptoe (Britain) developed IVF fertility
treatment; in 1978 Louise Brown became the first 'test-tube'
baby.
• 1970s: Endoscopes - fibre optic cables with a light source -
enabled doctors to 'see' inside the body.
• 1972: Geoffrey Hounsfield (Britain) invented the CAT
scanner, which uses x-ray images from a number of angles to
build up a 3D image of the inside of the body.
• 1980s: MRI scans were developed to monitor the electrical
activity of the brain.

• 1986: In the Visible Human project undertaken in the US, the bodies of two
criminals (a male and a female) were frozen, cut into 1mm
slices, stained, photographed and stored as 3-d images on the internet.
• 1990s: The Human Genome project undertaken in the US mapped all the
genes in the human body - 40,000 of them. Humans share their gene make-
up with much of the natural world, leading scientists to joke that because of
the genes we share, human beings are 60 per cent banana! In 1997 Scottish
researchers bredDolly, the first cloned sheep.
• 2002: Gunther von Hagens (Germany) performed live dissections on TV.
Now try a Test Bite
A positronic emission tomograph (PET) scanner

• In the 20th century success followed success in the surgical
treatment of disease, as surgeons grew in knowledge and skill.
Introduction

• 1890s: Victor Horsley (British): first specialist
neuro-surgeon.
• 1940s: Archibald McIndoe (British) learned
how to rebuild surgically the faces of airmen
(the 'Guinea Pigs') burned in the war - this was
very early plastic surgery. In 2002, nearly 7
million cosmetic surgical procedures were
performed in the US alone.
• 1950: William Bigelow (Canadian) performed
the first open-heart surgery to repair a 'hole' in
a baby's heart, using hypothermia.
• 1952: First kidney transplant (America).
• 1962: Surgeons at Massachusetts General
Hospital re-attached the arm of a 12-year-old
boy.
• 1967: Christiaan Barnard (South Africa)
performed the first heart transplant - the
patient lived for 18 days. (In 2002, there were
2,154 heart transplant operations performed in
the US - 87 per cent of the patients lived for at
least a year.)
• 1970s: The development of plastic lenses
allowedc ataract surgery. Since 1991 laser eye
surgery has obviated the need for glasses.
• 1970: Roy Calne (Britain) developed the use of
the immunosuppressant
drug cyclosporine, which prevents the body
'rejecting' grafts and transplanted organs.
• 1972: John Charnley (Britain) developed hip
replacements.
• 1986: Davina Thompson (Britain) became the
first heart, lungs and liver transplant patient.
• 1990s: Increasing use of keyhole surgery, using
endoscopes and ultrasound scanning, allowed
minimally invasive surgery.
• 2002: Specialists at Massachusetts General
Hospital, watching digital x-rays transmitted by
satellite, helped the medical officer at a
research station from the South Pole operate
on a damaged knee.
•
Key developments in surgery
Key steps in the development of the surgery through the 20th century
include;
Christian Barnaard,
South African heart surgeon
Now try a Test Bite

20TH-CENTURY METHODS OF
DIAGNOSIS AND TREATMENT

• Methods of diagnosis changed massively during the 20th
century. X-rays, CAT scans, MRI imaging, ultrasound
scans, endoscopy etc, together with histology and
biopsies, started to allow accurate and exact diagnoses of
most illnesses as the century progressed. Treatments had to
keep up with all the information, so new drugs and procedures
were constantly being developed
Introduction

• The list of treatments that finally started to help people cure disease and
health problems is a long one. Here are some of the main discoveries:
• The discovery of vitamins allowed doctors to prescribe vitamin
supplements, which cured beriberi, rickets, pernicious anaemia and pellagra.
• In 1921 Banting and Best developed insulin. They could not cure
diabetes, but they were able to alleviate its results. Today, doctors use
hormone treatments to correct thyroid problems, help children
grow, improve sexual performance and shrink cancers.
• In 1932, the German scientist Gerhard Domagk discovered that a coal tar
product (a sulphonamide called prontosil) killed streptococci bacteria. Other
sulphonamides were discovered which could cure pneumonia, meningitis
and acne.
Key discoveries in treatments

• During the Second World War, Florey and Chain learned how to mass-produce penicillin - discovered
(by chance) in 1928 by the Scottish bacteriologist Alexander Fleming - the first antibiotic.
Now, doctors could effectively cure acute infectious disease (although misuse of antibiotics has led to
the development of drug-resistant strains of killer diseases such as TB and the MRSA hospital
superbug).
• The work of Peter Medawar (1950s: Britain) on immuno-suppressants led to the development of anti-
histamine, which prevents allergies and operative shock.
• After the 1950s, doctors (through contraception) were able to prevent pregnancy, and after the
1970s (through IVF) to help childless women become pregnant (although side effects of the
contraceptive pill are thromboses, migraine and jaundice). In 2005, a 66-year-old Romanian woman
gave birth to twins.
• In the 1950s, doctors used the drug thalidomide to treat morning sickness during pregnancy. It
caused terrible deformities in babies, but today is used in the treatment of AIDS, leprosy and some
cancers.
• In 1952, the Danish surgeon Christian Hamburger used large doses ofhormones and surgical
operations to change the sex of George Jorgenson, an American army vet, who returned to the US as
Christine.
• In 1954, Joseph Salk (America) discovered a polio vaccine, which helped eradicate polio from the
western world in the 20th century, and which may make it extinct worldwide early in the 21st
century.
• Doctors started using technology - such as incubators and pacemakers - to help patients. In
2002, American surgeons implanted electrodes connected to a miniature computer into the visual
cortex of a blind man. Using a video camera mounted on his glasses, he was able to 'see' well enough
to drive a car.

Premature baby in an incubator, attached to
electrodes that monitor its heartbeat

• Modern doctors believe that stem cells and genetic
engineering will allow doctors to cure or prevent most diseases
in the 21st century. In 1999, however, a healthy young man who
volunteered for gene therapy to cure a congenital liver
complaint died of a toxic response.
• Doctors are still not able to cure viral infections such as AIDS
and the common cold, and cancer is still a killer disease.
• Now try a Test Bite
Looking to the future

• In the 20th century, the government accepted the need to care
for all its citizens 'from the cradle to the grave', and there was
a greater focus than ever before on the health of the nation.
Introduction

• 1918: After the First World War, the British Prime Minister Lloyd George promised the
soldiers returning from the battlegrounds of Europe 'homes fit for heroes'. The
government set itself a target of building half-a-million decent homes by 1933.
• 1919: A Ministry of Health was set up to look after sanitation, health care and disease, as
well as the training of doctors, nurses and dentists, and maternity and children's welfare.
• 1921: Local authorities were required to set up TB sanatoria.
• 1934: Although the economic depression of the 1930s caused government to cut back on
spending, it passed the Free School Milk Act and encouraged local councils to give poor
children free school meals.
• 1942: During the Second World War, the need to give people something to fight for led the
government to commission up the Beveridge Report. Beveridge recommended a Welfare
State, which would provide social security, free health care, free education, council
housing and full employment.
Key steps in the development of the public health policies of today include:
Key developments in public health

• 1946: The New Towns Act planned new towns such as Stevenage and
Newton Aycliffe to replace the inner-city slums. The Town and Country
Planning Act of 1947 set a target of 300,000 new homes a year, and
identified 'green belts' where housing would not be allowed to continue to
swallow up the countryside.
• 5 July 1948: The 'appointed day' for the start of the National Health Service.
• 1956: The Clean Air Act imposed smokeless zones in cities and reduced
smog.
• 1980: The Black Report stated that huge inequalities in health still existed
between the rich and the poor in Britain.
• Recently: Worries about the cost of the National Health Service have grown.

Walter Elliot, Minister of Agriculture, with two
children in 1934, during campaign for free
school milk
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• Doctors changed almost beyond recognition during the 20th
century. In the early years your doctor was usually a man, with
a limited range of medicines and techniques. By the end of the
century doctors were as likely to be women as men, with a
whole arsenal of pills and treatments to help make you better.
Introduction

• At the beginning of the century local doctors still visited the sick in
their homes, usually carrying their sturdy Gladstone bag. Doctors
could do little to cure disease, although they had learned some ways
of preventing it, and some new techniques of caring for patients.
• The modernisation of medicine changed the role of the doctor. Sixty
per cent of new doctors are now women. Familiar illnesses, previously
dangerous, can often be treated by a course of pills.
• Many other diseases now call for the use of expensive technology so,
by the end of the century, most medicine was delivered in hospitals
(in America in 2002 only 2 per cent of doctor-patient contact took
place in the home).
Advances in the practice of medicine
Surgeon scrubbing hands prior to performing
an operation

• Towards the end of the century, confidence in doctors began to wane.
A survey in America in 1974 found that 2.4 million unnecessary
operations were performed every year, at a cost of $4billion a year. In
Britain in the 2000s, a number of scandals (eg that of the GP Harold
Shipman, who murdered his elderly patients) reduced confidence.
• One in five Britons prefer alternative healthcare to conventional
medicine, and many more are looking after their own health by
visiting a gym or attending self-help health groups.
• Even so, a National Health Service survey in 2002 found that 82 per
cent of the population had visited a doctor at least once during the
year, and that 90 per cent of those people were satisfied with their
treatment.
Public confidence in doctors

• Make a series of spidergrams showing the five key
achievements for each of the key areas of 20th-century
medicine (ie knowledge about the body and disease / surgery /
methods, diagnosis and treatment / public health / doctors).
This will give you a list of 25 achievements.
• Look back at the ten characteristics of the western world in the
20th century in the 'civilisation' unit, and work out which of
them are reflected in each of the achievements you have
identified.
• Taking an overview of the 25 key achievements, decide on five
over arching aspects of 20th-century medicine.
• Find five failures of 20th-century medicine.
To familiarise yourself with the achievements of 20th-century
medicine:
Revision tip

• How 20th-century medicine reflected the ideas and practices of
society of the time.
• What caused people to be healthy or unhealthy.
• What ideas people had about the causes and treatment of
illness and injuries.
• Who provided medical care.
• How much medicine changed during the 20th century, and what
the main turning points were.
to explain:
Answer preparation

• Why some diagnoses and treatments changed, while others
remained the same.
• individuals
• the government
• war
• trade
• To what extent developments in medical understanding and
practice in the 20th century affected people's lives.
to explain:
Answer preparation

Medicine through time - GCSE History

Medicine through time - GCSE History

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