Secondary



Medicine Through Time

Medicine in Prehistoric Times

What do we mean by prehistoric?

• ‘Prehistory’ is used to describe the period before history was recorded, starting around 500,000 years ago

• ‘Prehistoric medicine’ means medicine used before the invention of writing

• Prehistoric people were nomads – they did not settle down in one place, they were hunter-gatherers and they had only primitive technology

The Nature of the Evidence

Because there is no written evidence from prehistoric times the evidence we do have about prehistoric medicine comes from the remains of human bodies and the remains of the things these people made.

1. Disease

Skeletons show that prehistoric people suffered from some of the same diseases that people suffer from today, e.g. bone cancer.

2. Medicine

Prehistoric cave paintings show images of a man with antlers on his head which some historians believe to be a medicine man.

3. Surgery

Trephining: trephining or trepanning is a surgical procedure still in use today which involves cutting out a piece of a person’s skull. Evidence of trephining has been found in prehistoric skulls from all over the world.

There are different theories as to why prehistoric people would have used trephining:

• To cure conditions like headaches or epilepsy

• To let evil spirits out of the body

• These two theories could work together: the use of trephining to remove evil spirits which were causing headaches or epilepsy

The regrowth of the bone found on some of these trephinned skulls proves that the patient did sometimes survive the operation. They could, therefore, be used as evidence that prehistoric people performed surgery successfully.

Problems with the Evidence

There are a number of problems with prehistoric evidence:

• No written evidence exists so we cannot be sure exactly what prehistoric people thought about the cause or treatment of illness

• Only skeletons remain so we cannot find out about diseases found in the flesh or organs

• Although evidence of trephining exists, we cannot be sure why it was used

• Cave paintings might appear to show ‘medicine men’, but they do not prove that they, or their practices, actually existed

Medicine Men

Because prehistoric evidence is so limited, historians have looked to other groups of people in the world with cultural similarities to the prehistoric people to understand more about prehistoric medicine. One such group of people are the Australian Aborigines of the nineteenth century. Aborigines had ideas about medicine that prehistoric people might have had too:

• They believed that some physical problems had common-sense cures, such as setting broken bones with mud or clay.

• If something didn’t have an obvious physical explanation it was attributed to spirits which had either left or entered the patient’s body and made them sick. Medicine men would use spiritual cures such as pointing bones to extract evil spirits and magic crystals to trap them.

It is possible that prehistoric people shared similar medical beliefs to the Aborigines and believed in both physical and spiritual explanation for disease and methods of treatment. This is, however, only a theory, as the lack of evidence from prehistoric times means we can never really be certain what people believed.

|Tasks |

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|a. Complete the table below using the text above to help you. |

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|What evidence exists? |

|What are the problems with the evidence? |

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|Disease |

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|Medicine |

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|Surgery |

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|b. Explain why it is difficult to prove what prehistoric people thought caused illness. |

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|( Once you have finished tick off the checklist at the top of the chapter so you know you have covered everything. |

Medicine in Ancient Egypt

Egyptian Civilisation

• Lasted from around 3000–30 BC

• Strong central state

• The first great, stable civilisation

• Organised government, laws and religion

• The development of writing and calculation was achieved by the Egyptians

The Impact of Egyptian Civilisation on Medicine

• As a well-organised society developed so did hygiene, seen in bathing and the use of toilets.

• Different roles for people in society emerged; medicine became a profession as doctors developed from priesthood. Fathers would train their sons or daughters in their profession.

• Religion had a huge impact on Egyptian medical belief. Mummification increased knowledge of anatomy and religious belief encouraged cleanliness.

• The development of writing meant medical books with instructions on treating illness started to be used, and medical knowledge could now be passed on.

• The development of calculation meant medicine could be measured (in units called ‘ro’) and standardised.

• Observation of the irrigation system of the River Nile led to what historians call the ‘Channel Theory’: Egyptians believed that illness could be caused by different channels in the body becoming blocked, like the irrigation channels of the Nile. The channels or vessels carried vital fluids around the body just like the irrigation channel of the Nile gave fields the water vital to their health.

The Co-existence of Spiritual and Natural Beliefs and Treatments

Thanks to the development of writing in Ancient Egypt the written records left by Egyptians provide far more evidence of what they believed caused illnesses and how illness should be treated than in prehistoric times.

Supernatural and spiritual ideas continued to play a big part in Egyptian medical belief but natural theories about the cause and treatment of disease also started to be used.

|Spiritual |Natural |

|• Egyptians believed that there were many different gods who controlled|• Gods had the power to cause illness but Egyptian medical books, such as the |

|different aspects of an individual’s life, including health |Papyrus Edwin Smith, show that natural treatments were used to treat ailments |

|• Sekhmet, the warrior goddess, was thought to cause and cure disease |including: |

| |( Mending broken bones |

| |( Stitching and bandaging wounds |

| |• Archaeologists have found Egyptian stone carvings showing surgical instruments |

| |which would have been used for simple external surgery |

|• The Papyrus Ebers, written around 1550 BC, was a medical book which |• Herbs and minerals were used to make medicinal drugs to help these magical cures |

|included specific spells and prayers to say to the gods in order to |and drive evil spirits out of the body |

|help remedies work | |

|• Egyptians believed that channels in the body became blocked due to |• Attempts to unblock channels in the body led to natural, practical treatments |

|the evil spirit ‘Wehedu’ |including: |

|• Amulets were worn to protect against the evil spirits which caused |( Vomiting |

|illness |( Bleeding |

|• One of the most popular protective amulets was the ‘Eye of Horus’ |( Purging |

Developments in the Understanding of Physiology,

Anatomy and the Causes of Disease

Physiology and Disease

The ‘Channel Theory’ of physiology that was based upon vessels in the body carrying vital fluids which could become blocked was a breakthrough in understanding the causes of disease because now disease was seen to have a physical as well as spiritual origin, and therefore needed physical as well as spiritual treatment.

Egyptians developed empirical methods (based on facts and observation rather than theory) in the search to cure disease rather than always looking for spiritual explanations.

Anatomy

The mummification process advanced the Egyptians’ understanding of anatomy. Embalming dead bodies in order to preserve them involved cutting out the organs that would rot inside the body, and provided Egyptians with knowledge of their location. However, further dissection of the body and therefore understanding of anatomy was limited by the religious belief that their bodies would be needed in the afterlife.

The papyri that archaeologists have discovered, such as the Papyrus Edwin Smith, suggest that Egyptians had a good enough understanding of human anatomy to perform minor surgical procedures.

Egyptian Hygiene

Cleanliness was important in Ancient Egypt for religious reasons rather

than because any connection was made between dirt, germs and disease.

Herodotus, the Greek historian who visited Egypt in around 450 BC and

recounted his tales in The Histories, provided a vivid account of Egyptian personal hygiene which included:

Archaeologists have discovered Egyptian toilets and baths, but a toilet drainage system does not appear to have been developed during this period. There was not a public health system as we know it today with facilities such as sewers provided by the government for public use.

|Tasks |

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|a. Complete the table of ailments below and explain whether Egyptian doctors would have |

|used spiritual treatments, natural treatments, or a combination of both: |

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|Ailment |

|Spiritual Treatment |

|Natural Treatment |

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|A broken leg |

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|An open wound |

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|A blocked channel |

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|b. Briefly describe the impact of religion on Egyptian hygiene. |

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|c. Explain why the River Nile had an important influence on Egyptian medicine. |

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|( Once you have finished tick off the checklist at the top of the chapter so you know you have covered everything. |

Medicine in Ancient Greece

What were the key characteristics of Greek civilisation?

• Organised into ‘city-states’ ruled by different governments which colonised land around the Mediterranean Sea; Ancient Greeks therefore came from other places than Greece itself.

• City-states were powerful and wealthy and people developed an interest in culture and philosophy.

• Rational thinking developed around 450 BC as an outcome of Greek philosophy and started to be applied to medicine. Consequently rational and supernatural medical belief existed at the same time.

Asclepios and Temple Medicine

Asclepios, or Asclepius, was the Greek god of medicine and healing and represents the supernatural tradition of medicine in Ancient Greece.

The Myth

Asclepios was the son of Apollo and two of his daughters were Hygieia and Panacea. He learnt the art of healing over his life and became so skilled in medicine and surgery that he could bring the dead back to life.

The Cult

Asclepios began to be worshipped as a god in the fifth century BC and temples called ‘asclepions’ were built for his worship. People would visit the temples, stay overnight and offer gifts and pray to Asclepios in the hope that he or his daughters would visit and cure them. Many people reported success after their visit.

Visiting an asclepion was a popular way of treating illness all the way through the Ancient Greek and Roman period. People could appeal to the gods if doctors couldn’t cure them.

The Four Humours: Theory and Treatment

The Theory

Greek philosophers believed that the human body was made up of four humours:

• Blood

• Phlegm

• Yellow bile

• Black bile

Each of these humours was connected to a season. The type of symptoms were linked to that season, as were the humours that caused the illness.

The theory held that these humours needed to be in perfect balance for a person to be healthy and was hugely influential in the history of medicine; it survived up until the nineteenth century. They thought that if the humour of the season was too high, there might be a problem. They also based this around the four elements. They thought that the elements could tell them the following information to help diagnose the patient:

• Too much fire = choleric (bad temper and angry)

• Too much air = sanguine (hopeful and full of courage)

• Too much water = phlegmatic (showing little emotion)

• Too much earth = melancholic (restless and sad)

Development of the Theory

Treatment

Doctors attempted to rebalance the humours by various methods. A change in diet and exercise was the first prescription by a doctor, to try and chock the humours back into balance. They would then increase the opposite humour, so for instance with a fever, which is hot and dry, they would increase the phlegm to counter it. This was done by ordering a cold bath. They would then try to release the high humour. One such treatment was bleeding to lower the level. Bleeding would be used in the case of fever because it can also be hot and wet, which were believed to be the qualities of blood.

Hippocrates and the Clinical Method of Observation

Hippocrates represents the rational tradition of medicine in Ancient Greece.

Hippocrates (c. 460 – c. 370 BC)

• Ancient Greek physician

• Believed that all diseases had natural causes and should be treated with physical rather than supernatural cures

• This was a crucial breakthrough in the history of medicine: doctors now looked for the natural, rather than supernatural, basis of disease

• Medical texts called ‘Hippocratic books’ written by Hippocrates or his disciples emphasised that when looking to treat an illness the focus should be on the patient – clinical observation

• His ‘Hippocratic Oath’ laid down the ethical guidelines for doctors for centuries to come

Clinical Observation

• The careful study and noting down of a patient’s symptoms so that the course of a disease could be worked out and then applied to other cases.

• Treatment would only begin once the doctor was sure of the illness. Natural remedies would then be used; surgery was a last resort.

Health and Hygiene

Like the Egyptians, the Greeks did not have a public health system like today with running water and sewers, but they did attempt to stay healthy by:

• Washing

• Exercising

• Eating properly

Keeping healthy was based on the theory of the four humours, and so to keep the body in balance Greeks were advised that everything should be in moderation.

The Developments at Alexandria

Alexandria in Egypt was founded in c. 331 BC by Alexander the Great who built the famous ‘Great Library’ there which attracted the greatest Greek scholars.

Anatomy

The dissection of human bodies was crucial to understanding anatomy, and was permitted at Alexandria after Aristotle and Plato agreed that the body wouldn’t be needed in the afterlife. At Alexandria Herophilus discovered the brain’s connection to the nervous system and Erasistratus realised that blood moves inside veins.

Surgery

The discoveries about anatomy at Alexandria helped surgeons understand the human body better, but without anaesthetics and with only herbal antiseptics surgery remained dangerous. However, due to the wars of the city-states, doctors were well-trained in first aid and could perform external surgical procedures like the Egyptians.

|Tasks |

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|a. Imagine you are ill and seeking a cure in Ancient Greece. Describe what might happen to you in the two situations below. |

|Visiting a Greek doctor |

|Visiting an asclepion |

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|_________________________________________ |

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|b. Briefly describe clinical observation. |

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|c. Explain why there were advances in the knowledge of anatomy in the Ancient Greek period. |

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|( Once you have finished tick off the checklist at the top of the chapter so you know you have covered everything. |

Medicine in Ancient Rome

What were the key characteristics of Roman civilisation?

• One large centralised empire ruled by an emperor

• Rome was at the centre of the empire and was extremely rich

• The empire had a powerful army to keep it in order which needed to be kept healthy

• The wealth of Rome and the need for a strong army led to development of public health facilities

• Roman people were more practical than the philosophical Greeks and were great builders and engineers

Roman Medicine and Greek Ideas and Doctors

When the Romans conquered Greece they brought over Greek doctors to treat them. Because medicine was associated with the Greeks, and because the Greeks were often slaves, the Romans had a very low opinion of doctors.

The Romans continued some aspects of Ancient Greek medicine, but they also made developments of their own.

|Greek Ideas |Roman Ideas |

|• Belief in the healing power of gods |• Set up the first hospitals and employed public doctors and nurses who were skilled in |

|• In 293 BC an asclepion was built in Rome |surgery and advanced knowledge of anatomy and physiology |

| |• Like the Greeks, the Romans could perform external surgery successfully and became experts|

| |at this, but there is no evidence they performed internal operations |

|• The Greek doctors that the Romans brought over continued to |• The Romans looked down upon and rejected Greek theories about the causes of disease when |

|use the theory of the four humours |they could have developed them and made more progress |

|• Some Roman doctors like Galen continued the clinical |• The Romans observed the environment surrounding illness which led them to develop |

|observation of patients |important theories about disease being related to cleanliness and ‘bad air’ |

| |• This helped lead to the creation of the public health system |

The Romans and Public Health

The Romans focused more on preventing disease than curing it. Observation of their environment, like houses that were built near swamps, led them to discover that unhygienic living conditions could cause illnesses. The empire needed a healthy population to pick its army from and the Romans had the engineering skills to create the first public health system to do this. It included:

Galen’s Ideas about Physiology, Anatomy and Treatment

Galen (AD 129 – c. 200)

• The most famous of Roman doctors

• Born around AD 129 in the Greek city of Pergamum, Galen trained as a doctor at Alexandria

• He worked as a gladiators’ doctor and gained some knowledge of the human body through this job

Physiology and Anatomy

• Dissection of human bodies was forbidden in the Roman Empire due to religion, and was now forbidden in Alexandria too.

• Galen had to make do with dissecting animals instead to try and understand anatomy better. He thought that monkeys were the best animals to dissect because of their close resemblance to humans.

• Unfortunately Galen’s dissection of animals led him to make wrong assumptions that the human body worked in the same way. Some of his mistakes included thinking that there was a network of blood vessels in the brain in humans like there is in some animals, that blood was made in the liver, and that there were holes in the septum of the heart which led blood flow through.

• Galen’s theories were not always wrong – his experiments on pigs led him to discover the importance of the spinal cord in the nervous system – but he had a huge influence on medicine in the Middle Ages and his errors were not discovered until over 1,000 years later!

Treatment

• Galen stressed the importance of the clinical observation of patients that Hippocrates had developed

• He based his treatments around the theory of the four humours and tried to balance the humours by using opposites as cures

|Tasks |

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|a. How did the development of the Roman Empire affect medicine? Fill in the table below. |

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|Features of the Roman Empire |

|Effect on medicine |

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|The empire needed a strong, healthy army |

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|Roman people were practical and good builders |

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|Rome was extremely wealthy |

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|Greek doctors were slaves |

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|b. Briefly describe the elements of the Roman public health system. |

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|c. Explain why religion hindered medical progress in Ancient Rome. |

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|( Once you have finished tick off the checklist at the top of the chapter so you know you have covered everything. |

Medicine in the Middle Ages

The Collapse of the Roman Empire

• The Roman Empire ended around AD 476 after barbarians like the Vikings and the Saxons invaded Europe.

• Places that were once under the control of the empire, like Britain, no longer had the centralised government of Rome to provide public health facilities for their people.

• Instead, Europe was divided into small, poor states.

• The medical progress made by the Greeks and Romans was lost in the transition. Only very educated people could read and technology was far less advanced than it had been in Roman times.

• The Middle Ages, or Medieval period, from around AD 476–1430, was looked back on in the Renaissance as a period of regression. The question is whether any medical progress was made or not.

The Impact of Christianity and Islam on Medicine

Unlike the Roman Empire of the West, the Islamic Empire which started in the Middle East did not collapse. Muslim doctors like Rhazes and Avicenna translated Greek and Roman medical texts and developed medical ideas of their own. The Roman Catholic Church did preserve some medical knowledge, but it also stopped medicine from progressing in many ways.

|Religion |Progress |No Progress |

|Christianity |• Some monasteries had libraries with Greek and Roman medical texts |• Christianity usually did not permit the dissection of |

|(Roman Catholic)|• Set up hospitals and medical schools |human bodies |

| |• Monks treated the sick |• Belief in supernatural causes and cures for disease, and |

| | |the importance of these above anything else |

| | |• The Church supported Galen’s theories |

|Islam |• Muslims believed that learning was important and translated and built upon |• Islam did not permit the dissection of human bodies |

| |Greek and Roman medical texts |• Appealing to the Muslim god Allah was encouraged to cure |

| |• Continued to use clinical observation |disease |

| |• Muslim doctors understood the importance of hygiene | |

| |• Set up hospitals | |

Christians came into contact with the Islamic medical texts as they fought wars with the Muslims called the Crusades, but the medical progress the Muslims had made spread slowly.

The Reasons for the Acceptance of Galenic Medicine

Galen’s theories continued to dominate understanding of medicine in the Middle Ages because:

• Universities and medical schools which started to be set up in around 1000 used Galen’s works as a basis for their textbooks.

• Galen would be read out in anatomy lectures while someone pointed to the parts of a dissected body that was being described. It would be difficult to discover Galen’s mistakes in this way.

• Galen’s ideas could be debated but any students who did notice his errors would be told they were wrong.

• The Church supported Galenic theory because Galen thought the human body was designed by a ‘creator’ which for the Christian Church meant the Christian God.

Supernatural Beliefs and Treatments

Medieval people were superstitious and continued to believe in supernatural causes and cures for disease. The Roman Catholic Church dominated medieval Europeans’ lives and taught that illness had a spiritual rather than physical origin. It encouraged people to pray to saints or go on a pilgrimage to a saint’s shrine to cure their illnesses. Kings and queens were also thought to have a magical touch which could cure skin diseases called ‘scrofula’ or the ‘King’s Evil’.

The Black Death came to Europe in 1347–1349 and is estimated to have killed around a third of Europe’s population. One explanation for its arrival was that it was a punishment from God for people’s sins. ‘Flagellants’ whipped themselves as a punishment in the hope that God would stop the plague.

There were also natural theories about the cause of disease.

These included:

• The theory of the four humours

• Astrology and the planets

• Bad air

Developments in Surgery

The Middle Ages did see some developments in the field of surgery. There were two types of surgeons: small numbers of professionally trained surgeons and lots of unlicensed ‘barber surgeons’.

• The wars of the Middle Ages developed surgeons’ skills in external surgery

• Some surgeons used wine as an antiseptic and natural drugs as anaesthetics

But problems remained. Surgeons knew little about anatomy, did not realise that dirt could cause disease, and their practice of cauterisation led to fatal infections.

Living Conditions: Health and Hygiene

A public health system like the Romans had did not exist in the Middle Ages. People understood that keeping clean would help them stay healthy, but they found it difficult to without running water and sewers. The problems were:

• Clean running water was available for the rich only

• People chucked their rubbish and sewage onto the streets and into rivers

• Laws passed to keep the streets clean were hard to enforce

Public health was not all bad in the Middle Ages. Towns had public baths. Monasteries were rich and had fresh water and sewer systems. Monks would wash in rooms called ‘lavers’ and have clean towels to dry themselves with.

Hospitals

Hospitals, like St Bartholomew’s in London, were set up by the Church for the first time since the Roman period. They had better water and sewage systems than the average medieval home. Some hospitals would treat the sick and others would just provide a clean environment where people would hopefully recover.

Caring for the Ill

There were different types of people you could

go to if you were ill, including trained (and expensive) doctors, local healers, apothecaries (pharmacists) and monks. Doctors looked at the colour of, smelt and tasted urine to diagnose the disease against a urine chart. All of these people might give supernatural and/or natural treatments. Treatments included:

• Bleeding and purging to rebalance the humours

• Using the ‘opposite’ of the illness to treat it

• Healing herbs

• Charms and prayer

Domestic Medicine, Childbirth and the Role of Women

Women were involved in medicine as doctors and local healers. The medical schools set up during the Middle Ages seem to have trained women as doctors, but their role was probably confined to treating other women and acting as midwives. ‘Wise women’, local healers, were important because most people couldn’t afford to use the trained doctors, but professional medicine was increasingly carried out by men.

|Tasks |

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|a. Did medical understanding in the Middle Ages progress from Roman times or not? Decide for a) disease, b) anatomy and c) surgery and fill in what you |

|think below. |

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|b. Briefly describe public health in the Middle Ages. |

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|c. Explain why the collapse of the Roman Empire affected medicine in the Middle Ages. |

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|( Once you have finished tick off the checklist at the top of the chapter so you know you have covered everything. |

The Medical Renaissance

What do we mean by the ‘Medical Renaissance’?

• Between about 1430 and 1750 Europe experienced great change which has been named the Renaissance.

• Renaissance means ‘rebirth’. During this time scholars revisited the Ancient Greek and Roman texts and learnt from them.

• They realised the importance of the Greek ideas about the close observation of nature.

• The Renaissance had important consequences for medicine:

⇨ The renewed emphasis on learning meant more medical schools were created.

⇨ Medical theory was based on close and careful observations.

⇨ Renaissance artists produced accurate illustrations of the human anatomy through their observations.

⇨ The arrival of the printing press in 1454 meant medical books could be printed and spread around quickly.

Four key people made some very important medical discoveries during this period: Vesalius, Paré, Harvey and Jenner.

Vesalius and Anatomy

|Who was he? |Why is he important? |

|• Andreas Vesalius (1514–1564) came from a long line of doctors. |• Because he dissected human bodies himself he was able to realise when Galen|

| |was wrong, e.g. about the jawbone or the liver. |

|• From 1528–1537 he studied medicine at Leuven University in Belgium and the | |

|University of Paris. |• He could also prove when Hippocrates or Galen had been right because of his|

| |own scientifically based observations of the human body. |

|• He studied Galen’s theories and developed an interest in finding skeletons | |

|to learn about anatomy. |• His book, The Fabric of the Human Body, was a textbook of human anatomy and|

| |was important because: |

|• In 1537 he became the professor of medicine at Padua University in Italy |⇨ It contained descriptions and accurate illustrations of the entire human |

|and taught anatomy. |body. |

| |⇨ It discussed how dissection should be practised (doing it yourself). |

|• He did his own dissections and then published drawings of them. |⇨ It corrected some of Galen’s mistakes |

| |⇨ Because it was a book its ideas could be spread quickly. |

|• In 1543 his most important book, The Fabric of the Human Body, was | |

|published. | |

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|• Soon after this he became Charles V’s imperial physician. | |

Paré and Surgery

|Who was he? |Why is he important? |

|• Ambroise Paré (1510–1590) was the most famous surgeon of the Medical |• When he was treating soldiers in the army he discovered by chance a new way|

|Renaissance. |to treat gunshot wounds: an ointment of egg yolks, rose oil and turpentine |

| |rather than cauterisation or boiling oil (which he had run out of). |

|• In 1533 he trained as a barber-surgeon in Paris. |Cauterisation was extremely painful and often people died from the shock. Now|

| |ointments could be used instead. |

|• In 1537 he became a military surgeon to the French army. | |

| |• He stopped using cauterisation for amputations too, instead tying the veins|

|• In 1545 he published his discoveries in his book The Method of Treating |and arteries to stop the bleeding. |

|Wounds. | |

| |• He proved that the bezoar stone didn’t cure the effects of poison with an |

|• In 1552 he became King Henry II’s royal surgeon. |experiment on a thieving cook. The cook was given poison and then some of the|

| |stone. He died. |

|• In 1575 a collection of his works was published. | |

| |• Paré tested theories and if something didn’t work, he would stop using it. |

|• In 1585 The Apology and Treatise of Ambroise Paré was published which | |

|justified his treatments and encouraged others to practise them. | |

Harvey and Physiology

|Who was he? |Why is he important? |

|• William Harvey (1578–1657) was an English physician. |• Harvey disproved Galen’s theory about blood and discovered that it |

| |circulated. |

|• From 1598–1602 he studied medicine at Padua University where he was taught | |

|by Fabricius, a famous Italian anatomist. |• He did his own experiments rather than relying on what people in the past |

| |had discovered. |

|• Fabricius showed Harvey how Galen had mistaken the septum in the heart to | |

|have holes in it and told him the new theories. |• Unlike Galen, he realised that animal hearts and human hearts are different|

| |but understood that animal hearts were still useful to gain understanding. |

|• In 1604 he joined the Royal College of Physicians in London. | |

| |• By vivisecting (cutting something up while it’s alive) animals he |

|• In 1616 he began lecturing on anatomy at the Royal College. |discovered that the heart pumps blood around the body. |

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|• From 1618 he became James I and the Charles I’s physician. |• He realised that the heart was pumping out lots of blood, too much for it |

| |to be remade and replaced like Galen thought. It must have been circulating |

|• In 1628 his book An Anatomical Treatise on the Motion of the Heart was |instead. |

|published which told of his discovery that blood circulates around the body. | |

| |• Fabricius had found valves in the veins and Harvey built on this: he found |

| |that valves would only let blood go one way. Blood came out of the heart |

| |though the arteries and in through the veins. |

The Impact of Developments on Medical Treatment

Despite the fact that Vesalius, Paré and Harvey made such important discoveries, medical treatment actually changed very little. Doctors still didn’t understand what actually caused disease, so the same treatments used in the Middle Ages carried on, for example:

• Purging and bleeding were still used to rebalance the humours even though Harvey’s discovery of the circulation of the blood showed that this didn’t make sense. If blood goes round and round the body and is not constantly remade then how could someone have too much of it at one time?

• Bezoar stone was still used to reverse the effects of poison even though Paré proved it didn’t work.

• Healing herbs and now also chemical cures were still used as some doctors believed the body was made of chemicals.

• Supernatural cures like prayer, spells and magical potions. Charles II touched the sick to cure them.

If people couldn’t cure their illnesses themselves they would go to a doctor, local healer / wise person or apothecary. As in the Middle Ages there were lots more local healers than fully qualified doctors. Only the very rich could afford the best trained doctors who were usually found in towns and used scientific methods like Paré or Harvey.

The Medical Profession and Women

Well-educated, licensed doctors like William Harvey came from the Royal College of Physicians after it was founded in 1518. They wanted to dominate medicine even though there was only a small number of them. They targeted the untrained local healers and women in particular who they believed did not have the intellect required to practise medicine safely, although they had no evidence that this was the case.

The Medical Profession and Quacks

During the eighteenth century the medical profession started to become more organised. More hospitals were set up and surgeons who had earlier been rather looked down upon by licensed physicians organised their own official company. Along with the increase in professional practitioners came the increase in ‘quack’ doctors. Quack doctors were untrained and tried to sell usually useless, and sometimes dangerous, cures. ‘Quack’ meant shouting; quacks would often sell their cures by shouting about them in markets.

Jenner and Vaccination

Disease was still a mystery in the Medical Renaissance. Science moved forward; Anton van Leeuwenhoek invented the microscope and discovered bacteria in 1683, but people didn’t realise how important his discovery actually was. Diseases like the plague and syphilis had devastating effects. When the Great Plague of London struck in 1665 there were different theories about its cause just like there had been about the Black Death, including ‘bad air’ and punishment from God. Smallpox was the big killer of the eighteenth century.

|Who was he? |Why is he important? |

|• Edward Jenner (1749–1823) was a doctor from the Gloucestershire countryside|• Jenner developed the smallpox vaccine |

|• At 14 he was a surgeon’s apprentice |• The importance of observation that he learnt from Hunter led Jenner to his |

|• In 1770 he studied at St George’s Hospital in London under the famous |crucial discovery |

|surgeon John Hunter |• He saw that the milkmaids who had cowpox didn’t catch smallpox and devised |

|• John Hunter taught Jenner the importance of careful observation and |a theory that cowpox could therefore be used as a vaccine |

|scientific method |• He tested this out himself by injecting a young boy with a small amount of |

|• By 1773 he was an established physician |cowpox |

|• In 1796 Jenner conducted his vital experiment which proved that cowpox |• When he recovered from the mild cowpox, Jenner injected him with some |

|could be used as a vaccine against smallpox |smallpox to see if he would get the disease |

| |• When he didn’t Jenner knew he had created the very first vaccination |

Jenner’s discovery was groundbreaking and would go on to save countless numbers of lives in the future, but not everyone accepted it at the time. Some doctors were sceptical of Jenner and thought that they would lose out on their business of inoculation. No one actually understood why it worked. Despite this the smallpox vaccination was made compulsory for children in 1853.

|Tasks |

| |

|a. Match the key people below to their discoveries and think about which discovery you think was the most important. |

| |

|Vesalius |

| |

|Discovered the circulation of the blood |

| |

|Paré |

| |

|Discovered a vaccine for smallpox could be made from cowpox |

| |

|Harvey |

| |

|Discovered ointments were more effective at treating wounds than cauterisation |

| |

|Jenner |

| |

|Discovered that Galen had made anatomical mistakes |

| |

| |

|b. Briefly describe what a quack doctor was. |

| |

|c. Explain why the Renaissance had an impact on medicine. |

| |

|( Once you have finished tick off the checklist at the top of the chapter so you know you have covered everything. |

Medicine in the Nineteenth and Twentieth Centuries: Fighting Disease

The Industrial Revolution

Historians call the changes which started in the late eighteenth century and carried on through the nineteenth century the Industrial Revolution. These changes included:

• Population growth

• Increase in industry and factories

• Urbanisation (bigger towns)

• Advances in science and technology

• Better communications

The Industrial Revolution had effects on medicine which included:

• Public health problems and infectious diseases

• Medical progress: advances in science and technology led to important developments

• Better communications meant medical ideas could be spread easily

The Medical Revolution: the nineteenth and twentieth centuries saw medical progress like nothing before.

Pasteur and Germ Theory

The leading figure in the discovery of the cause of disease was Louis Pasteur.

|Who was he? |Why is he important? |

|• Louis Pasteur (1822–1895) was a French chemist |• Pasteur discovered that germs cause disease |

|• In 1849 he became Professor of Chemistry at Strasbourg University |• He was commissioned to find a way to stop wine souring and discovered |

|• In 1854 he took the same job at Lille University |‘pasteurisation’: that bacteria sours some liquids and can be removed by |

|• In 1864 he discovered what is now called ‘pasteurisation’ |boiling and then cooling. He realised that the bacteria was coming from the |

|• From 1865–1867 he studied a silkworm disease |air |

|• In 1867 he made the connection between germs and disease |• When he studied silkworms he discovered that the bacteria in the dirt was |

|• In 1877 he turned his attention to anthrax |causing disease |

|• In the 1880s he developed vaccines for cholera, anthrax and rabies |• Before this doctors thought that germs were caused by disease, known as |

| |‘spontaneous generation’ |

| |• Pasteur proved that it actually worked the other way round |

Koch and Bacteriology

|Who was he? |Why is he important? |

|• Robert Koch (1843–1910) was a German physician |• Koch discovered which germs cause which diseases |

|• In 1862 he studied medicine at Gottingen University |• Along with Pasteur, Koch is considered the founder of bacteriology |

|• In 1872 he became District Medical Officer in Wollstein and studied|• By studying the blood of animals which had anthrax against those which didn’t he |

|anthrax |found out which microbe was causing it |

|• In 1875 he discovered the germ (or ‘microbe’) that caused anthrax |• He discovered how to stain microbes so they were visible |

|• In 1882 he discovered the microbe that causes tuberculosis (TB) |• He also discovered how to grow bacteria, called a ‘culture’, so he could find out |

|• In 1883 he discovered the microbe that causes cholera |which germs caused particular diseases |

| |• Koch’s discoveries were made possible thanks to new technology: industrial dyes |

| |and improved microscopes |

Developments in Vaccines

Opposition to Vaccination

There was opposition to vaccination in Britain since Jenner developed the first one, and this continued throughout the nineteenth century. Some people were unhappy that it had become compulsory and thought that it should be their choice, especially when smallpox epidemics continued despite the vaccine.

There were protests, riots and anti-vaccination books and companies. It ended in the 1898 Vaccination Act which let parents choose whether to vaccinate their children.

Chicken Cholera Vaccine

• Pasteur studied chicken cholera in 1880

• He was interested in making more discoveries not just to advance medicine but for France: France was at war with Germany and therefore Koch was his rival

• Charles Chamberland on Pasteur’s team found out by chance that if chickens were injected with an attenuated (weakened) culture of chicken cholera it made them immune

• He had left the culture exposed to the air and the germs had been weakened – now they would not kill but instead give immunity

Anthrax Vaccine

• Pasteur applied the chicken cholera theory to anthrax and his team created a weak anthrax culture

• He proved that it worked in a public experiment on sheep after being criticised by a French journalist

Rabies Vaccine

• Pasteur turned to rabies in 1882

• He made vaccines from the spines of animals infected with rabies

• He tested it when, by chance, a boy with rabies was brought to him, and it was successful

Tuberculosis Vaccine

• Koch discovered the microbe that causes TB but couldn’t make a successful vaccine. An injection was later created in 1906.

Developments in Drugs

Now Pasteur and Koch had greatly increased understanding about the cause of disease the next step was to make drugs which could actually kill the bacteria that was creating the problems.

Ehrlich and Magic Bullets

The German bacteriologist Gerhard Domagk (1895–1964) continued Ehrlich’s work into dyes which killed microbes. He discovered a dye which could stop blood poisoning. Later it was discovered that the active ingredient in the dye could be used to cure other diseases too, including pneumonia.

The Development of Penicillin

Fleming’s discovery that mould had an active ingredient in it which could kill or stop bacteria growing, which he called ‘penicillin’, was to change medicine forever. Penicillin was the very first antibiotic and would be used to fight against lots of different diseases and save millions of lives.

Fleming

|Who was he? |Why is he important? |

|• Alexander Fleming (1881–1955) was a Scottish doctor and bacteriologist |• Fleming discovered that penicillin could be used as an antibiotic |

|• In 1901 he studied medicine at St Mary’s Hospital, London |• Joseph Lister, who discovered carbolic acid was a good antiseptic, had |

|• After graduating he became an assistant bacteriologist |realised that mould (‘penicillium’) weakened germs in the nineteenth century |

|• During the First World War he worked in battlefield hospitals in France |• Fleming saw the need for a substance that would kill bacteria when he |

|• In 1928 he was elected Professor of Bacteriology at St Mary’s and |treated the deep wounds of soldiers during the war |

|discovered the antibiotic properties of mould |• His discovery of what he later called penicillin was by chance: as he went |

|• In 1929 and 1931 his findings were published |to clean his culture dishes he saw that the mould on one had stopped the |

| |germs around it from growing |

The next step was to turn penicillin into a drug which could be used to treat humans. Two important people achieved this: Howard Florey and Ernst Chain.

• Florey headed a team of biochemists, which included Chain

• Chain discovered how to isolate penicillin and make it concentrated

• They could now make pure powdered penicillin

• Penicillin started to be mass produced with funds from the American and British governments to treat soldiers wounded in the Second World War and then the general public

• Since this point more and more antibiotics have been made to treat different diseases

The Battle against Infectious and Non-infectious Diseases

The development of vaccines and drugs has not meant the end of disease for us today. This is because:

• The reliance on, and misuse of, antibiotics has led to drug-resistant bacteria and new strains of TB and hospital ‘superbugs’ like MRSA.

• Some drugs might cure an illness but have other dangerous side effects, like the drug thalidomide which pregnant women took to ease morning sickness but caused deformities in babies.

• Doctors cannot cure new diseases like AIDS because they do not know what causes it. Cancer still kills many people today because a cure has not been found.

Genetic engineering in the future might provide the answer to the diseases still with us today.

Hospitals and Caring for the Ill

After 1850 nursing started to become a respectable job. Nurses started to be trained, and two key women, Nightingale and Seacole, raised nurses’ profiles.

Before this nurses had a bad reputation and hospitals were often in a bad state.

Nightingale

|Who was she? |Why is she important? |

|• Florence Nightingale (1820–1910) was an English nurse from a wealthy family|• Nightingale helped nursing become a respected profession and she was a |

|• In 1851 she trained as a nurse in Germany |heroine of the Crimean War |

|• In 1853 she became a superintendent at a London hospital |• Conditions were very bad in the Scutari hospital before she arrived |

|• In 1854 she went to Scutari hospital in Turkey to treat soldiers wounded in|• She and her team dramatically decreased the death rate there |

|the Crimean War where she headed a team of nurses |• Her Notes on Nursing laid out her methods for everyone else to use |

|• In 1856 she returned to England |• Her school trained nurses to a high standard |

|• In 1859 she published her theories in Notes on Nursing | |

|• In 1860 the Nightingale School of Nursing was set up in London | |

Seacole

|Who was she? |Why is she important? |

|• Mary Seacole (1805–1881) was a mixed race nurse from Jamaica |• Seacole was, like Nightingale, a heroine of the Crimean War, but |

|• She learnt her nursing skills by helping in her mother’s boarding house for|Nightingale didn’t want her on her nursing team |

|invalid soldiers |• Despite the racism she was a victim of, Seacole was undeterred and set up a|

|• In 1854 she went to England and asked the War Office to send her to the |medical hostel in the Crimea and treated soldiers on the battlefields |

|Crimea to nurse, but she was rejected due to her race |• Unlike Nightingale she was forgotten for almost a century after her death, |

|• She funded a trip there herself |but now her bravery and dedication have been rediscovered |

|• In 1856 she returned to England bankrupt | |

|• In 1857 the press organised a music festival to help her | |

|• In the same year she published her memoirs, The Wonderful Adventures of Mrs| |

|Seacole in Many Lands | |

|Tasks |

| |

|a. Match the key people below to their discoveries and think about which discovery you think was the most important. |

| |

|Pasteur |

| |

|Discovered the microbes that cause particular diseases |

| |

|Koch |

| |

|Discovered that penicillin could be used as an antibiotic |

| |

|Fleming |

| |

|Discovered that germs cause disease |

| |

| |

|b. Briefly describe why Florence Nightingale is a famous name. |

| |

|c. Explain why vaccination was opposed in the nineteenth century. |

| |

|( Once you have finished tick off the checklist at the top of the chapter so you know you have covered everything. |

Medicine in the Nineteenth and Twentieth Centuries: Surgery

What changed?

Before the nineteenth century operations were more likely to end up in the patient dying than surviving. There were no anaesthetics to stop the pain, no antiseptics to stop infection, and the operating theatres were dirty. It was during this period that things started to change.

Developments in Anaesthetics

The lack of anaesthetics before the nineteenth century meant surgeons avoided complicated internal operations because they just weren’t possible to carry out. The 1840s saw different people try to find an anaesthetic which would solve this problem:

• 1842: American doctor Crawford Long discovered ether

• 1845: American dentist Horace Wells discovered nitrous oxide (laughing gas) could be used

• 1846: American surgeon John Warren used ether in an operation and British surgeon Robert Liston amputated a leg using ether

Simpson

|Who was he? |Why is he important? |

|• James Simpson (1811–1870) was a Scottish doctor |• Simpson discovered that chloroform could be used as an anaesthetic |

|• In 1832 he graduated from Edinburgh University |• He didn’t like to use ether because it irritated patients’ lungs |

|• In 1840 he was made Professor of Midwifery at Edinburgh University |• He discovered chloroform whilst he was testing different chemicals with his|

|• He was also Queen Victoria’s physician |friends: it knocked them unconscious after they inhaled it |

|• In 1847 he discovered the anaesthetic properties of chloroform |• He first used chloroform to help with the pain of childbirth |

Just like with vaccination, there was opposition to the first anaesthetics too. People worried that surgeons hadn’t had enough practice using them, or that pain should be a part of childbirth because it was God’s punishment to women. Wider acceptance of anaesthetics came when Queen Victoria used chloroform during the birth of Prince Leopold in 1853. John Snow (who discovered the cause of cholera) was the anaesthetist.

Since then more chemicals that can be used as anaesthetics have been discovered including cocaine in 1884 and novocaine in 1905.

Developments in Antiseptics

The development of antiseptics came a bit later than anaesthetics. Surgeons may have been able to stop patients’ pain but infection was still a big problem, and people started to find ways to stop it.

• 1847: Hungarian doctor Ignaz Semmelweiss told doctors to wash their hands in a chloride solution before treating patients. This stopped the spread of puerperal fever after childbirth.

• 1850s: Nightingale and Seacole improved hygiene in hospitals.

Lister

|Who was he? |Why is he important? |

|• Joseph Lister (1827–1912) was an English surgeon |• Lister discovered the first antiseptic: carbolic acid |

|• In 1852 he graduated in medicine from University College London |• While at Glasgow he read Pasteur’s germ theory of disease and realised that|

|• In 1856 he became an assistant surgeon at the Edinburgh Royal Infirmary |infection was caused by germs |

|• In 1861 he became Professor of Surgery at the Glasgow Royal Infirmary |• Carbolic acid was used as a disinfectant at sewages |

|• In 1867 he discovered that carbolic acid could be used as an antiseptic |• He used carbolic acid to spray surgeons’ hands, surgical tools and bandages|

| |• His discovery cut the death rate from amputations massively – from 46% to |

| |15% |

In the 1890s aseptic surgery began – surgery under sterile conditions to stop the risk of infection – which included the use of surgical gloves and gowns.

Developments in Blood Transfusion

Blood transfusions – transferring blood from one person to another – have been attempted for hundreds of years, but when Harvey discovered the circulation of the blood in the seventeenth century successful experiments started: transfusions between animals and transfusions between animals and humans.

Transfusions were controversial and were banned in 1679, so there was no progress for over 100 years. But then in:

• 1818: British doctor James Blundell performed the first successful human blood transfusion.

• 1860: J Neudorfer discovered a way to stop blood clotting.

• 1900: Austrian doctor Karl Landsteiner discovered blood groups. Understanding that only compatible blood groups could be transferred came next.

• 1938: In Britain the National Blood Transfusion Service was set up so people could donate blood.

Modern Surgery

By the twentieth century surgery was the safest it had ever been. Anaesthetics meant invasive internal procedures could now be carried out, and antiseptics meant the risk of infection was now very small. Better understanding about blood meant transfusions could be performed safely. Surgeons became more skilful than ever before.

Transplanting Organs

Organs started to be transplanted to cure diseases in the twentieth century. The key stages include:

Plastic Surgery

War made it necessary for surgeons to attempt heart surgery and it also led to the rise of plastic surgery. The First and Second World War saw new weapons and therefore new injuries. The key developments in plastic surgery were:

• 1917: Harold Gillies helped set up a hospital in London to treat the facial wounds of soldiers fighting in the First World War. Gillies and his team used skin grafts to improve the appearance of the patients.

• 1940s: Gillies’ cousin, Archibald McIndoe, had helped Gillies in the First World War. He set up his own plastic surgery unit in Sussex during the Second World War and treated thousands of airmen with disfiguring burns.

Today plastic surgery is used for all sorts of reasons, from the medical to the purely cosmetic. In 2005 the first partial face transplant was carried out in France, and in 2010 Spanish doctors performed the first full face transplant, but there are still concerns about how ethical it is to perform surgery simply to improve someone’s appearance.

Technology

The big developments in technology throughout the nineteenth and twentieth centuries helped move surgery even further forward.

• Microscopes: The electron microscope was invented in 1931 which uses electricity to magnify things, like bacteria.

• X-rays: Discovered in 1895, x-rays meant surgeons could see the problem inside the body before they started surgery.

• Endoscopes: The first endoscope was developed in 1806. Endoscopes often have a long tube so that surgeons only have to make a small incision (called ‘keyhole surgery’) to see inside the body.

• Ultrasounds: Developed in the mid-twentieth century an ultrasound beams sound waves into the body and uses the echoes which are returned to create an image of the inner structure of the body.

• Lasers: Discovered in 1958, lasers are used in surgery to make very precise cuts, improve the appearance of facial skin, and now even to correct eyesight.

Lots of different machines have also been created to help surgeons, including electrocardiographs which measure the patient’s heartbeat.

|Tasks |

| |

|a. Who do you think is more important in the history of medicine, Simpson or Lister? Fill in their discoveries and the consequences of their discoveries |

|below and then decide. |

| |

|Simpson |

|Lister |

| |

|• Discovery: |

| |

| |

| |

|• Consequences: |

| |

| |

| |

| |

| |

|• Discovery: |

| |

| |

| |

|• Consequences: |

| |

| |

|b. Briefly describe how technology has improved modern surgery. |

| |

|c. Explain why war was an important factor in the development of heart transplants and plastic surgery in the twentieth century. |

| |

|( Once you have finished tick off the checklist at the top of the chapter so you know you have covered everything. |

Medicine in the Nineteenth and Twentieth Centuries: Public Health

The Impact of Industrialisation on Living Conditions, Health and Hygiene

• In the nineteenth century more and more factories started to be set up and towns developed around them as people moved to be near their work.

• Poor quality housing was made quickly for all the new workers and houses were very overcrowded – some might have five or more families in.

• Hygiene was bad: houses were built near drains full of sewage and people chucked their waste into streams because the government didn’t provide a system to dispose of it. Water was unclean.

• Health was poor: with such unhygienic conditions and so many people living in such close proximity diseases spread very quickly, including typhus, typhoid and tuberculosis.

In 1832 a cholera epidemic hit Britain, killing more than 20,000 people. No one had any idea what the cause of it was. The miasma theory of bad and poisonous air was used to explain it just like it had been in the 1348 Black Death. Although this explanation was wrong, the theory that miasma was the cause meant cleanliness needed to be improved. This terrible epidemic scared the government into doing something about the bad living conditions in towns.

The Development of Public Health Systems

Edwin Chadwick (1800–1890):

• Chadwick was an English social reformer

• After the 1832 cholera epidemic Chadwick investigated the Poor Laws of Britain, laws which were created to support the poor

• He published his report in 1842, entitled Report on the Sanitary Conditions of the Labouring Population of Great Britain

• The report made it clear how bad the living conditions of the working class really were

• He believed that improved public health would also save the government money: people would get ill less and not need the poor relief that the Poor Laws provided

• Chadwick and the supporters of public health reform wanted parliament to supply fresh water and provide sewage facilities

• In 1847 a Public Health Bill was introduced, but it had a lot of opposition from MPs who didn’t think it was the government’s responsibility (this is called ‘laissez-faire’ – the theory that the government shouldn’t interfere)

The 1848 Public Health Act

Another cholera epidemic hit in 1848 which put more pressure on the government to take action.

• Parliament passed the first Public Health Act which set up a Central Board of Health in London and Local Boards of Health in some towns to improve water supply and sewage disposal

• However these health boards were optional, and there were still many opponents who believed in laissez-faire

• It was ended in 1854

After the end of the 1848 Act there were some changes that persuaded the government they needed to take charge of public health. These were:

• More cholera outbreaks in 1854 and 1866

• Snow’s discovery that water, not air, was causing cholera in 1848

• Pasteur’s discovery that germs caused disease in 1864

Snow

|Who was he? |Why is he important? |

|• John Snow (1813–1858) was a British doctor |• He discovered that disease was transmitted through water rather than air |

|• At 14 he became a surgeon’s apprentice |(miasma) |

|• In 1836 he studied medicine at London |• When cholera struck in 1848, Snow found that people drinking water coming |

|• In 1838 he became a member of the Royal College of Surgeons |from the Thames were catching cholera |

|• In 1848 he investigated cholera in London and discovered it was transmitted|• During another outbreak in 1854 his theory was confirmed when he deduced |

|through water |that people drinking from a local water pump in Soho were dying of cholera |

|• In 1854 he discovered a water pump in Soho was causing the outbreak there |• Once the pump was disabled by taking off the handle the cholera went too |

Snow’s discovery led to:

• The Local Government Board was created in 1871 to oversee public health measures

• The 1872 Public Health Act which appointed medical officers to local areas

• The 1875 Public Health Act which made local authorities responsible for public health

• The 1875 Artisans’ and Labourers’ Dwellings Act which gave local authorities permission to rebuild and demolish poor housing

The Reforms of the Liberal Governments, 1906–1914

The laws passed in the 1870s were a start, but the problem of poverty and illness still remained. Social

researchers like Charles Booth and Seebohm Rowntree published inquiries about the living conditions of the poor in London and York and found that many people were living below the poverty line. In 1902 it was revealed that nearly half of the men fighting in the Boer War had diseases caused by their bad diet. The Liberal government realised that to tackle illness it would have to tackle poverty first, and introduced a number of reforms:

1906: Local authorities had to provide free school meals for poor children

1907: School medical examinations were introduced

1908: The Old Age Pensions Act was passed which gave small pensions to people over 70 earning under a certain amount

1911: The National Insurance Act was introduced and had two parts:

• Part 1: Dealt with health – low earning workers could take paid sick leave if they contributed some of their salary to insure themselves. The employer and the government then contributed to their insurance too. Free medical treatment was also available.

• Part 2: Dealt with unemployment – low earning workers, employers and the government contributed to a fund so that if the worker was unemployed s/he could claim unemployment benefit.

There was opposition to some of these reforms. The House of Lords didn’t want to pay a tax which the then Chancellor of the Exchequer David Lloyd George introduced to fund the pensions, insurance businesses thought the Insurance Act would make them lose out, and doctors wanted to remain independent rather than be controlled by the government.

In 1919 a Ministry of Health looked after all health matters, and the then Prime Minister Lloyd George promised better quality housing for soldiers returning from the First World War. By 1939 health care was provided by a mix of public and private companies.

The National Health Service

Introduction

The Second World War started to change people’s minds that the government should provide more health care because:

• Children: food rationing meant it was even more important that children were fed well, so more milk and free school meals were given out. Town evacuees were often considered to be in a bad state by the people they stayed with in the country.

• Hospitals: the government had to provide free treatment in hospitals after Britain was bombed which people agreed worked well.

In 1942 the Beveridge Report was published by the economist William Beveridge. Beveridge recommended that a welfare state should be set up to get rid of the five ‘giant evils’ in society which were squalor, ignorance, want, idleness and disease.

The Labour Party started to implement Beveridge’s welfare state when they came in power in 1945.

The Minister of Health Aneurin Bevan introduced the National Health Service which came into effect in 1948.

The NHS:

• Made healthcare free for everyone

• Made hospitals come under the government’s control

• Originally gave doctors a fixed salary but after opposition from the British Medical Association to the government’s increased control gave doctors fees for every registered patient

Impact

• The NHS was popular with people from the start

• There was a decrease in diseases like TB

• It had a particularly big impact on women as it focused on women’s and children’s health and it vastly reduced the number of women dying in childbirth

• Doctors now worked as a team rather than as individuals

The Continuing Debate about the Provision of Healthcare

Since the NHS began in 1948 it has become more and more expensive to run due to:

• Population increase – there are more people to treat and people are living longer

• New treatments which often cost a lot of money

Debate has revolved around how to pay for it. Hospitals have to prioritise treatments according to how important they are, which means sometimes people have to wait for much longer than they would at a private hospital. However in 2002 Gordon Brown, then Chancellor of the Exchequer, increased spending on the NHS from National Insurance contributions which has since reduced the waiting lists.

There has also been debate about whether or not the kind of conventional medicine offered by the NHS is the best kind, with an increase in ‘alternative’ medicine now available like homeopathy and hypnotherapy.

|Tasks |

| |

|a. The lead up to the implementation of the NHS in 1948 started over 100 years earlier. Fill in the table below with what happened on the dates given. |

| |

|Date |

|What happened? |

| |

|1832 |

| |

| |

|1842 |

| |

| |

|1848 |

| |

| |

|1854 |

| |

| |

|1864 |

| |

| |

|1875 |

| |

| |

|1908 |

| |

| |

|1911 |

| |

| |

|1942 |

| |

| |

|1948 |

| |

| |

| |

|b. Briefly describe the ways in which the NHS changed healthcare when it was introduced in 1948. |

| |

|c. Explain why the Industrial Revolution had a negative effect on public health in the nineteenth century. |

| |

|( Once you have finished tick off the checklist at the top of the chapter so you know you have covered everything. |

The Key Questions

Now you have revised the five periods in depth – Prehistoric, Ancient (Egypt, Greece and Rome), the Middle Ages, the Medical Renaissance and the nineteenth and twentieth centuries – the next step is to look at what continued and changed throughout the history of medicine. There are five key questions to help you do this:

1) What caused people to be healthy or unhealthy?

2) Who provided medical care?

3) What caused diagnoses and treatments to remain the same or to change?

4) How far did new ideas and treatments affect the majority of the population?

|Period |What Caused People to be Healthy or Unhealthy? |

|Prehistoric |Unhealthy: |

| |• Skeletons show evidence of diseases like bone cancer and broken bones |

| |• There was no public health system to help prevent disease |

|Ancient Egypt |Healthy: |

| |• Herodotus saw that Ancient Egyptians kept clean for religious reasons which helped keep them healthy |

| |Unhealthy: |

| |• Medical books like the Papyrus Ebers and the Papyrus Edwin Smith show the treatment of disease and illnesses like we have today |

| |• There was no public health system to help prevent disease |

|Ancient Greece |Healthy: |

| |• Washing, exercising and eating a good diet helped keep Ancient Greeks healthy |

| |Unhealthy: |

| |• The Hippocratic books talk about treating illnesses which we have today |

| |• There was no public health system to help prevent disease |

|Ancient Rome |Healthy: |

| |• The Romans developed the first public health system with clean running water and sewers to keep the population healthy |

| |Unhealthy: |

| |• Diseases and illnesses like earlier but also the impact of war: soldiers fighting for the Roman Empire were wounded |

|The Middle Ages |Healthy: |

| |• People knew that hygiene was important and tried to stay clean although it was difficult |

| |• Monasteries and hospitals had clean water and sewers and took care of the ill |

| |Unhealthy: |

| |• The Roman public health system collapsed with the fall of the Roman Empire |

| |• In 1347–1349 the Black Death killed a third of Europe’s population |

|The Medical Renaissance |Healthy: |

| |• Understanding of hygiene and hospitals |

| |• Jenner developed the smallpox vaccine, tested it and found it worked in 1796 |

| |Unhealthy: |

| |• Diseases like syphilis, the plague and smallpox |

|The Nineteenth and |Healthy: |

|Twentieth Centuries |• Vaccination protected against diseases like cholera, anthrax, rabies and TB |

| |Unhealthy: |

| |• The impact of the Industrial Revolution: bad living conditions, bad public health (no clean water or sewers) and infectious diseases like cholera |

5) What ideas did people have about the causes and treatment of illness and injuries?

|Period |Who Provided Medical Care? |

|Prehistoric |• Possibly ‘medicine men’ if we look to nineteenth-century Australian Aborigines for clues |

|Ancient Egypt |• Doctors developed from priesthood and surgeons trained their sons or daughters in their skill |

|Ancient Greece |• Doctors and surgeons |

| |• The most famous Greek doctor Hippocrates laid down the ‘Hippocratic Oath’ which was a guideline for doctors to stick to |

|Ancient Rome |• Doctors were brought over from Greece after the Romans conquered it |

| |• These Greek doctors were slaves and were badly thought of by the Romans |

| |• Galen was the most famous Roman doctor |

|The Middle Ages |• There was more of a choice in the Middle Ages including trained surgeons, unlicensed barber surgeons, trained doctors, local healers, apothecaries and monks |

| |• Most people couldn’t afford expensive doctors’ fees |

| |• Many local healers were women but professional medicine was increasingly dominated by men |

|The Medical |• As in the Middle Ages there were a range of people providing medical care but trained doctors were too expensive for most people | |

|Renaissance |• During this period medicine became ‘professionalised’: organisations like the Royal College of Physicians and the Royal College of | |

| |Surgeons were set up and women were pushed out of medicine | |

| |• Quack doctors increased selling bogus cures | |

|The Nineteenth and |• Nurses like Florence Nightingale and Mary Seacole provided care to soldiers in the Crimean War and Nightingale’s school of nursing | |

|Twentieth Centuries |built in 1860 meant nurses were trained to a higher standard than before | |

| |• The introduction of the NHS in 1948 meant that the government would now provide all medical care – the problem that trained doctors’ | |

| |fees were too high was no longer a problem | |

|Period |What Caused Diagnoses and Treatments to Remain the Same or to Change? |

|Prehistoric |Remain the same: |

| |• It is likely that prehistoric people didn’t know what caused illnesses they couldn’t see, so they continued to use supernatural treatments |

|Ancient Egypt |Remain the same: |

| |• Religion: Ancient Egyptians continued to use supernatural treatments because they believed that evil spirits caused disease and the gods could cure it |

| |• Simple external surgery continued to be used but not invasive surgery because there were no anaesthetics or very effective antiseptics. Religion forbade dissection as it was thought bodies were needed in |

| |the afterlife, so surgeons only had limited understanding of the body. |

| |Change: |

| |• They believed the body could become blocked like the River Nile, so practised vomiting, bleeding and purging |

|Ancient Greece |Remain the same: |

| |• Religion: Ancient Greeks thought gods could cure illness too and would visit asclepions |

| |• Simple external surgery continued but without anaesthetics or very effective antiseptics invasive surgery remained dangerous, even though the Greeks knew more about the body because dissection was permitted|

| |at Alexandria |

| |• Vomiting, bleeding and purging continued but for new reasons |

| |Change: |

| |• Greek philosophers believed the body was made up of four humour which needed to be in balance so treatments were based on removing the excess humour (by vomiting, bleeding and purging) |

| |• Hippocrates believed that all illnesses had natural causes and should be treated with natural remedies |

|Ancient Rome |Remain the same: |

| |• Religion: Romans believed that the gods had the power to cure and built an asclepion in Rome |

| |• Diagnosis and treatment continued to be based on the theory of the four humours because it was supported by Galen |

| |• Simple external surgery continued which the Romans became skilled in thanks to their wars, but there were still no anaesthetics or effective antiseptics to make invasive surgery safer. Surgery also couldn’t|

| |progress because religion forbade dissection which meant that some of Galen’s wrong theories about the body were accepted |

| |Change: |

| |• The Romans developed the first theories about miasma (bad air) causing disease which helped lead to the creation of the public health system to improve living conditions |

| |• War also led to the public health system – Rome needed healthy soldiers |

|The Middle Ages |Remain the same: |

| |• Religion: The Roman Catholic Church taught that illness had a spiritual origin and that God and the saints should be appealed to |

| |• Treatment based on the theory of the four humours continued because the Church supported it |

| |• Simple external rather than invasive surgery continued because of the lack of effective anaesthetics and antiseptics, and religion forbade dissection which meant knowledge about the body couldn’t develop |

| |Change: |

| |• The collapse of the Roman Empire led to the collapse of the public health system too |

|The Medical |Remain the same: |

|Renaissance |• Despite the discoveries of Vesalius, Paré and Harvey, diagnosis and treatment remained the same as it had been in the Middle Ages |

|The Nineteenth and |Change: |

|Twentieth Centuries |• Society gradually became secularised – religion had less of an influence on medicine than before and diagnosis and treatment were based on natural rather than supernatural theories |

| |• When Pasteur discovered that germs were causing disease in 1864 and Koch discovered which germs were causing which diseases, drugs (Ehrlich) and antibiotics (Fleming) were discovered which could fight |

| |bacteria |

| |• Invasive surgery was now possible thanks to the development of anaesthetics (Simpson) and antiseptics (Lister) and dissection was no longer forbidden so surgeons had a far better understanding of the body |

| |• Harvey’s discovery that blood circulates in 1628 led to the development of blood transfusions in the nineteenth century |

| |• War drove the progress forward in heart transplants and plastic surgery |

| |• Technology has improved medical treatment greatly |

|Period |How Far did New Ideas and Treatments Affect the Majority of the Population? |

|Prehistoric |• Lack of evidence means it is difficult to know |

|Ancient Egypt |• Medical ideas and treatments were based on religion so probably applied to most of the population |

|Ancient Greece |• Asclepions were open to anybody. New ideas about the four humours were used by many doctors but might not have reached the whole Greek population. |

| |• Hippocrates’ theory that disease had natural causes would have been used by his followers but not all doctors. |

|Ancient Rome |• The public health system, including hospitals, was set up for the whole population to use | |

|The Middle Ages |• There weren’t many new ideas or treatments in the Middle Ages, but people fighting in wars might have benefited from the | |

| |discovery of basic antiseptics and anaesthetics that some surgeons discovered | |

|The Medical Renaissance |• New ideas didn’t affect treatments | |

|The Nineteenth and Twentieth Centuries |• The discovery that germs caused disease meant drugs and antibiotics eventually became available for everyone | |

| |• The development of anaesthetics and antiseptics meant invasive surgery became much safer for everyone | |

| |• The NHS (1948) meant the entire population could be treated for free | |

|Period |What Ideas did People have about the Causes and Treatment of Illness and Injuries? |

|Prehistoric |Causes: |

| |• If we look to the Australian Aborigines to understand prehistoric medicine it seems likely that people would have believed in spiritual causes of illness as well as physical causes |

| |Treatments: |

| |• Trephining might have been used to let evil spirits out of the body to cure conditions like headaches or epilepsy |

| |• Injuries with an obvious physical cause, like broken bones, might have been set with mud or clay |

|Ancient Egypt |Causes: |

| |• Ancient Egyptians believed in natural and supernatural causes of illness |

| |• Supernatural causes included gods and evil spirits |

| |• Natural causes included the ‘Channel Theory’ |

| |Treatments: |

| |• Treatments were both natural and supernatural |

| |• Supernatural treatments included praying to gods, saying spells and wearing amulets |

| |• Natural treatments included mending broken bones, stitching and bandaging wounds, herbal remedies and vomiting, bleeding and purging to unblock the channels in the body |

|Ancient Greece |Causes: |

| |• Ancient Greeks also believed in natural and supernatural causes of illness |

| |• Supernatural causes focused on gods |

| |• Natural causes were based on the theory of the four humours |

| |Treatments: |

| |• Treatments were both natural and supernatural |

| |• Supernatural treatments involved visiting an asclepion to be cured by the gods |

| |• Natural treatments involved attempts to rebalance the humours by vomiting, bleeding and purging |

|Ancient Rome |Causes: |

| |• Ancient Romans believed in natural and supernatural causes of illness too |

| |• Supernatural causes focused on gods |

| |• The theory of the four humours continued to be used |

| |Treatments: |

| |• Treatments were both natural and supernatural |

| |• An asclepion was built in Rome in 293 BC |

| |• ‘Opposites’ were used as cures once Galen updated the theory of the four humours |

|The Middle Ages |Causes: |

| |• The Church taught that supernatural causes of illness were more important than natural/physical causes – that God had sent disease as a punishment |

| |• There were natural theories too including the four humours, astrology and miasma |

| |Treatments: |

| |• Treatments were both natural and supernatural |

| |• Supernatural treatments included prayer, pilgrimage, being touched by a king or queen and flagellation |

| |• Natural treatments included attempts to rebalance the humours by vomiting, bleeding and purging, the use of ‘opposites’ and healing herbs |

|The Medical |Causes: |

|Renaissance |• People had the same ideas about the cause of disease as they did in the Middle Ages, including the supernatural theory that God was causing disease and the natural theories of the four humours, astrology and |

| |miasma |

| |Treatments: |

| |• Treatments were supernatural and natural as in the Middle Ages |

|The Nineteenth |Causes: |

|and Twentieth |• After Pasteur’s germ theory (1864) people knew that germs were causing disease |

|Centuries |Treatments: |

| |• Treatments were now natural rather than supernatural |

| |• Chemical drugs and antibiotics were used to treat diseases |

| |• Surgery was improved by anaesthetics and antiseptics – blood transfusions, organs transplants and plastic surgery could now be carried out safely |

-----------------------

Use this revision guide to help you learn the key facts that you will need for your exams…

If you have any questions

then don’t be afraid to ask

a teacher!

|By the end of this chapter you should be able to | |

|understand: | |

|The evidence that prehistoric people suffered from | |

|disease, used medicine and practised surgery | |

|The value and problems of prehistoric evidence | |

|The beliefs and treatments of medicine men | |

(

Learning Objectives

(

A skull showing evidence of trephining from around 3500 BC

|By the end of this chapter you should be able to understand: | |

|The development of Egyptian civilisation and its impact on medicine| |

|The co-existence in Egyptian society of spiritual and natural | |

|beliefs and treatments | |

|Developments in the understanding of physiology, anatomy and the | |

|causes of disease | |

|Egyptian hygiene | |

(

Learning Objectives

(

The Edwin Smith papyrus, written around 1600 BC

Supernatural: something which is unexplainable by the natural world or natural law, such as spells or miracles

Key Term

The ‘Wedjat Eye’ or the ‘Eye of Horus’, 500–300 BC

Public health: facilities to keep people healthy and prevent disease

Key Term

Priests washing four times a day in cold water and shaving their

bodies

to get

rid of

lice

Drinking out of

bronze cups

which are

cleaned

every

day

Wearing clean linen clothes

Learning Objectives

(

(

|By the end of this chapter you should be able to | |

|understand: | |

|Asclepios and temple medicine | |

|The theory of the four humours and resulting treatments | |

|Hippocrates and the clinical method of observation | |

|Health and hygiene | |

|Developments in knowledge of anatomy and surgery at | |

|Alexandria | |

Image of a man having his arm bandaged, taken from a Greek drinking goblet

BLACK BILE

COLD

DRY

WET

HOT

Blood

Spring

Autumn

Summer

Winter

Earth

Fire

Water

Air

Phlegm

Yellow Bile

Black Bile

Pythagoras in c. 500 BC:

Had the idea of the ‘balance of opposites’ and taught that balanced bodies are healthy bodies.

Hippocratic books:

Taught that the body was made up of different elements and disease occurred when these elements were unbalanced.

Aristotle (384–322 BC):

Taught that the body was made up of four humours and connected them with the seasons. Too much of one humour in someone’s body could be due to the season.

Rational: based on the use of common sense and logic

Key Term

|By the end of this chapter you should be able to | |

|understand: | |

|Roman medicine and Greek ideas and doctors | |

|The Romans and public health | |

|Galen’s ideas about physiology, anatomy and treatment | |

(

Learning Objectives

(

A physician attending to a wounded Roman soldier,

from the Pillar of Trajan in Rome

The Romans conquered Greece in 47 BC

Key Event

An Ancient Roman latrine in Ostia Antica, Rome

Aqueducts

Built in Rome and in other parts of the empire aqueducts brought fresh, clean water into the towns.

Sewers and Toilets

Roman toilets, or ‘latrines’, were built above a stream of water which would flush the waste away.

Public Baths

Roman baths were cheap so anyone could use the facilities found in them which included a hot bath (the caldarium) a warm bath (the tepidarium) and a cold bath (the frigidarium).

Hospitals

The first hospitals were set up for soldiers and then for the rest of the population.

The First Roman Public Health System

A fifteenth-century Zodiac Man showing the different sites for bloodletting

|By the end of this chapter you should be able to understand: | |

|The impact of the collapse of the Roman Empire on medicine | |

|The impact of Christianity and Islam on medicine | |

|The reasons for the acceptance of Galenic medicine | |

|The continuance of supernatural beliefs and treatments | |

|Developments in surgery | |

|Living conditions and health and hygiene | |

|Domestic medicine, childbirth, the role of women | |

|Hospitals and caring for the ill | |

(

Learning Objectives

(

Progression: moving forwards

(in the understanding of medicine)

Regression: moving backwards (in the understanding of medicine)

Key Terms

A fifteenth-century woodcut showing flagellants

Pilgrimage: a journey to somewhere sacred

Key Term

Cauterisation: burning a part of the body using a very hot piece of metal to stop bleeding

Key Term

A thirteenth-century hospital scene from a French manuscript

a) Understanding about disease did progress / didn’t progress (circle one) because…

b) Understanding about anatomy did progress / didn’t progress (circle one) because…

c) Understanding about surgery did progress / didn’t progress (circle one) because…

|By the end of this chapter you should be able to | |

|understand: | |

|The rebirth of Greek ideas of careful observation of | |

|nature | |

|Vesalius and advances in knowledge of anatomy | |

|Paré and developments in surgery | |

|Harvey and developments in physiology | |

|Impact of these developments on the medical treatment of | |

|the majority of the population | |

|Quacks, the growth of a medical profession and the reduced| |

|role of women in medical care | |

|Inoculation, Jenner and the development of vaccination | |

(

Learning Objectives

(

One of Leonardo da Vinci’s anatomical studies

(c. 1510)

One of Vesalius’ drawings of a human dissection from The Fabric of the Human Body (1543)

An illustration from Harvey’s Anatomical Treatise showing his discovery that valves let blood flow in one direction only

Two quack doctors selling sugar sticks and corn plasters, but the audience below are not convinced (1841)

Inoculation: the introduction of a disease agent into the body to create immunity

Vaccination: inoculation with a weakened strain of the virus to create immunity

Key Terms

(

Learning Objectives

(

|By the end of this chapter you should be able to understand:| |

|Pasteur and the development of the germ theory of disease | |

|Koch and developments in bacteriology | |

|Developments in drugs and vaccines | |

|The development of penicillin | |

|The battle against infectious and non-infectious disease | |

|The development of hospitals and caring for the ill, | |

|including the contributions of Florence Nightingale and Mary| |

|Seacole | |

A print of Pasteur directing an experiment on a chloroformed rabbit (1885)

A cartoon published in 1802 showing Jenner preparing to vaccinate a woman as those he has vaccinated start sprouting cows

Bacteriology: the study of bacteria in relation to disease

Key Terms

The German doctor

Paul Ehrlich (1854–1915)

1. He saw that the human body is able to make antibodies to kill germs.

2. He called antibodies ‘magic bullets’ as they targeted the bacteria.

3. He sought to recreate synthetic (man-made) magic bullets which would do the same thing as antibodies.

4. He knew that chemical dyes could stain specific bacteria so thought chemicals must be able to kill specific bacteria too.

5. In 1909 Ehrlich’s team found a magic bullet which targeted the syphilis microbe. He called it Salvarsan 606.

A modern antibiotics test plate

Antibiotic: medicine to stop infection by killing or stopping the growth of bacteria

Key Term

Florence Nightingale attending to the wounded soldiers at Scutari

|By the end of this chapter you | |

|should be able to understand: | |

|Developments in anaesthetics and antiseptics, | |

|including the work of Simpson and Lister | |

|Developments in blood transfusion | |

|Modern surgery, transplanting organs and plastic | |

|surgery | |

(

Learning Objectives

(

An early twentieth-century operating theatre

Anaesthetics: drugs used to protect patients from feeling pain

Key Term

Antiseptics: medicine used to protect against infection by stopping the growth of bacteria

Key Term

A 1944 American army blood recipient set for blood transfusions during the war

Soldiers serving in the Second World War often had heart injuries. Surgeons attempted dangerous heart surgery which they hadn’t before.

1939–1945

Canadian surgeon William Bigelow discovered that lowering the temperature of the patient’s body (inducing hypothermia) gave surgeons more time to cut the blood supply when opening the heart.

1950

1952

The first successful kidney transplant took place.

1967

South African surgeon Christiaan Barnard performed the first human heart transplant and the patient lived for 18 days. The problem now was that the drugs surgeons used to make the body accept the donor body part weakened the immune system and led to infections.

1970s

The drug cyclosporin was discovered which stopped the body rejecting organs and tissues. Patients could now survive transplants and live for years.

A print of one of the first x-rays showing fingers and a ring

|By the end of this chapter you should be able to | |

|understand: | |

|The impact of industrialisation on living conditions and | |

|on health and hygiene | |

|The development of public health systems | |

|The reforms of the Liberal governments, 1906–1914 | |

|The introduction and impact of the National Health Service| |

|The continuing debate about the provision of health care | |

Learning Objectives

(

(

People from the slums in Dublin (1901)

Cover of a leaflet published in 1911

- 01234567@BDHIùäÝÒËĽ¯¤™by the Liberal Publication Department

to promote the National Insurance Act

Poverty line: the minimum income to be able to afford basic needs, like food

Key Term

Welfare state: a system where the government provides for the health and well-being of all its citizens

Key Term

The Greek physician Hippocrates (c. 460 BC – c. 370 BC)

Statue of Asclepius, the Greek God of medicine

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