Medicine through time - GCSE History

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This is the revision powerpoint I created and used to revise this topic - plus it contains links that are useful.

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Medicine through time - GCSE History

  1. 1. 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/
  2. 2. 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/
  3. 3. Roman Medicine
  4. 4. ROMAN CIVILISATION A knowledge of Roman civilisation will help you to understand Roman medicine.
  5. 5. • 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
  6. 6. • 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
  7. 7. The baths of Caracalla could accommodate up to 1600 bathers
  8. 8. • 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
  9. 9. 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
  10. 10. ROMAN KNOWLEDGE ABOUT THE BODY AND DISEASE
  11. 11. • 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
  12. 12. • 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
  13. 13. Galen as depicted in a book by a 16th-century French surgeon
  14. 14. • 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
  15. 15. • 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
  16. 16. ROMAN SURGERY
  17. 17. • 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
  18. 18. • 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
  19. 19. • 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
  20. 20. ROMAN METHODS OF DIAGNOSIS AND TREATMENT
  21. 21. • 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
  22. 22. • 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
  23. 23. • 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
  24. 24. ROMAN PUBLIC HEALTH
  25. 25. • 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
  26. 26. • 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
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. ROMAN DOCTORS
  31. 31. • 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.
  32. 32. • 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
  33. 33. • 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
  34. 34. • 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
  35. 35. I. What can Pliny tell historians about medicine in Roman times? II. Were doctors in Roman times hated or fêted? Questions
  36. 36. • 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:
  37. 37. •NOW TRY A TEST BITE
  38. 38. Medieval medicine
  39. 39. MEDIEVAL CIVILISATION Some knowledge of Medieval civilisation will help you understand Medieval medicine.
  40. 40. • 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
  41. 41. • 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
  42. 42. • 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
  43. 43. • 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
  44. 44. • 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
  45. 45. • 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
  46. 46. MEDIEVAL MEDICAL KNOWLEDGE
  47. 47. • 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
  48. 48. • 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
  49. 49. • 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
  50. 50. • 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
  51. 51. 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
  52. 52. 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
  53. 53. MEDIEVAL SURGERY
  54. 54. • 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
  55. 55. • 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
  56. 56. • 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
  57. 57. 13th-century artwork of a patient undergoing trephination (surgery to the skull), possibly being performed by a surgeon's apprentice
  58. 58. • 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
  59. 59. I. What does this source tells us about surgery in Medieval times? and Answer Question Now try a Test Bite
  60. 60. MEDIEVAL PUBLIC HEALTH
  61. 61. • 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
  62. 62. • 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
  63. 63. • 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:
  64. 64. 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
  65. 65. I. What does the Alderotti source tell us about health in Medieval times? And answer Questions Now try a Test Bite
  66. 66. MEDIEVAL DOCTORS
  67. 67. • 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
  68. 68. • 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
  69. 69. • 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
  70. 70. 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.
  71. 71. 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
  72. 72. • 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
  73. 73. • 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
  74. 74. • 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
  75. 75. 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
  76. 76. 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
  77. 77. 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
  78. 78. • What can the sources tell historians about the treatment of disease in Medieval times? And answer questions Now try a Test Bite
  79. 79. Renaissance medicine
  80. 80. RENAISSANCE CIVILISATION Some knowledge of Western civilisation at the time of the Renaissance will help you understand the medicine of the Early Modern Age.
  81. 81. • 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
  82. 82. 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
  83. 83. • 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
  84. 84. 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
  85. 85. I. When you have read this famous source about bezoar, can you find evidence that Paré conducted a scientific experiment? Question
  86. 86. RENAISSANCE MEDICAL KNOWLEDGE
  87. 87. • 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:
  88. 88. 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.
  89. 89. • Follower of Vesalius in graveyard, searching for bodies to dissect Vesalius
  90. 90. 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
  91. 91. • 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
  92. 92. • 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 -
  93. 93. 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
  94. 94. 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
  95. 95. • 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
  96. 96. 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
  97. 97. RENAISSANCE SURGERY AND TREATMENT
  98. 98. • 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
  99. 99. • 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
  100. 100. • 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
  101. 101. 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
  102. 102. 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
  103. 103. • 16th-century instruments for grasping gallstones out of a patient, from 'Of Cutting the Stone' by Ambroise Paré
  104. 104. • 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
  105. 105. • 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
  106. 106. • '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
  107. 107. • 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
  108. 108. • 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
  109. 109. 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
  110. 110. 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
  111. 111. RENAISSANCE PUBLIC HEALTH
  112. 112. • 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
  113. 113. • 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
  114. 114. • '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
  115. 115. NOW TRY A TEST BITE
  116. 116. RENAISSANCE DOCTORS
  117. 117. • Medicine in Early Modern times was making some progress - but most people's doctors had little or no training. Introduction
  118. 118. • 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
  119. 119. 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
  120. 120. • 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 • 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 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
  121. 121. 19th-century medicine
  122. 122. 19TH-CENTURY CIVILISATION Some knowledge of 19th-century civilisation will help you understand 19th-century medicine.
  123. 123. • 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
  124. 124. 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
  125. 125. 19TH-CENTURY KNOWLEDGE ABOUT THE BODY AND DISEASE
  126. 126. • 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
  127. 127. • 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
  128. 128. • 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.
  129. 129. • 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
  130. 130. 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
  131. 131. 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. Causes of improvements in physiology and pathology
  132. 132. 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. Causes of improvements in physiology and pathology Now try a Test Bite
  133. 133. 19TH-CENTURY SURGERY
  134. 134. • 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
  135. 135. • 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
  136. 136. Anaesthetics for pain
  137. 137. • 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
  138. 138. • 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
  139. 139. 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
  140. 140. 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. Now try a Test Bite •More causes for improvements in surgery
  141. 141. 19TH-CENTURY METHODS OF DIAGNOSIS AND TREATMENT
  142. 142. • 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
  143. 143. • 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
  144. 144. • 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
  145. 145. 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
  146. 146. • 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
  147. 147. • 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). Now try a Test Bite •Outlandish or alternative cures
  148. 148. 19TH-CENTURY PUBLIC HEALTH
  149. 149. • 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
  150. 150. • 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
  151. 151. • 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
  152. 152. 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
  153. 153. 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. Now try a Test Bite Individual measures
  154. 154. 19TH-CENTURY DOCTORS
  155. 155. • 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
  156. 156. • 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
  157. 157. 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
  158. 158. • 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
  159. 159. 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
  160. 160. • 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. • 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 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:
  161. 161. NOW TRY A TEST BITE
  162. 162. 20th-century medicine
  163. 163. 20TH-CENTURY CIVILISATION Some knowledge of 20th-century civilisation will help you understand 20th-century medicine.
  164. 164. • 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
  165. 165. • 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:
  166. 166. 20TH-CENTURY KNOWLEDGE ABOUT THE BODY AND DISEASE
  167. 167. • 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
  168. 168. • 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
  169. 169. • 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. •Significant developments
  170. 170. • 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 •Significant developments A positronic emission tomograph (PET) scanner
  171. 171. 20TH-CENTURY SURGERY
  172. 172. • In the 20th century success followed success in the surgical treatment of disease, as surgeons grew in knowledge and skill. Introduction
  173. 173. • 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
  174. 174. 20TH-CENTURY METHODS OF DIAGNOSIS AND TREATMENT
  175. 175. • 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
  176. 176. • 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
  177. 177. • 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. Key discoveries in treatments
  178. 178. Key discoveries in treatments Premature baby in an incubator, attached to electrodes that monitor its heartbeat
  179. 179. • 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
  180. 180. 20TH-CENTURY PUBLIC HEALTH
  181. 181. • 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
  182. 182. • 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
  183. 183. • 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. Key steps in the development of the public health policies of today include: Key developments in public health
  184. 184. Key steps in the development of the public health policies of today include: Key developments in public health Walter Elliot, Minister of Agriculture, with two children in 1934, during campaign for free school milk Now try a Test Bite
  185. 185. 20TH-CENTURY DOCTORS
  186. 186. • 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
  187. 187. • 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
  188. 188. • 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
  189. 189. • 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
  190. 190. • 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. As part of your revision, think about the arguments and facts you would use to explain: Answer preparation
  191. 191. • 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 the 20th century affected people's lives. As part of your revision, think about the arguments and facts you would use to explain: Answer preparation

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