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Medicine through time

This unit is a study of change over time focusing on developments in medicine from 1350 up to the present day.

It is vital that you are aware of changes over time and what factors lead to this change. There are examples of case studies throughout this revision guide which are intended to give examples of this, e.g. the Black Death

A simple mnemonic you might wish to use to help you remember most of the key factors for change is;

CABSTWIG

(Communication, Attitudes & Beliefs, Science & Technology, War, Individuals and Government)

Two key areas you must know about are;

Ideas about the causes of disease

How disease is treated or prevented over time including the role of doctors, nurses and hospitals.

Medicine Through Time- a Summary

Ideas about the Causes of Disease

|1350-1750 |1750-1900 |1900 onwards |

|The Supernatural- witches, the devil or God |Some people still believed in the Supernatural- |More rational ideas based on Science, e.g. Germ |

|punishing us. The Church encouraged this belief. |witches, the devil or God punishing us. Power of the|Theory; however, this did not explain the |

|Common sense- They had a basic understanding that |Church dwindling. |hereditary, lifestyle or environmental causes of |

|bad smells could make people ill. |They still had a belief that bad smells could make |disease. |

|Astrological- The movement of the stars and planets |people ill; Miasma Theory | |

|could cause illness or certain emotions. Comets |Astrological- The movement of the stars and planets | |

|could be an omen that an outbreak of disease was |could cause illness or certain emotions. Comets | |

|imminent. |could be an omen that an outbreak of disease was | |

|The Four Humours- The four liquids (blood, phlegm, |imminent. | |

|black bile and yellow bile) could become unbalanced |Spontaneous Generation – the belief that | |

|and make a person ill. This theory dominated |micro-organisms from decaying objects caused disease| |

|medicine for the next 1500 years, even when people | | |

|believed less in supernatural causes. This theory | | |

|meant that people didn’t need medical expertise or | | |

|training to treat the sick. | | |

The Origins of Medicine.

The Medical Renaissance- increased understanding in medicine.

Changing understanding of the cause of disease

1350-1750

Case Study 1- The Black Death 1348

Killed both rich and poor, the plague came several times after 1361. The Black Death 1348 included both the Bubonic and Pneumonic Plague. People believed it was caused by corrupt air, the Church blamed supernatural causes or God was punishing that people. Some blamed the Jews and said they were poisoning Christians.

Case Study 2- The Great Plague 1665

People believed it was caused by a comet that had appeared before the Plague. Religious people believed God had sent it, others blamed the air and invisible creatures that could enter the body.

The factors aiding understanding of cause of disease during the Medical Renaissance

• Beliefs- The Reformation weakened the Catholic Church so scholars and doctors could question theories.

• Science and technology- Johann Gutenburg introduced the printing press to Europe 1454 so books could be made quickly and cost less. Ideas and developments were shared much more quickly.

• Wars- many wars during the 16th and 17th Centuries meant opportunities to practice for men like Pare but it also prevented the spread of ideas and knowledge.

• Communications- Old books, which the Church had hidden, became available and travel to The New World brought new plants and cures eg quinine for Malaria.

• Money- European countries had grown wealthier as wars decreased and trade increased, more money was spent on education and luxuries.

• Education- Literacy increased and the number of schools, Church control of universities lessened, professional medical societies were set up eg The Royal College of Surgeons.

• Individuals- Vesalius and Harvey proved Galen wrong.

• Da Vinci and Michelangelo used art to improve anatomical understanding.

The Scientific Revolution- rapid growth in sciences such as astronomy, maths, physics and chemistry, which helped doctors understand the body better. Why?

• Science & technology- interest in astronomy using telescopes, which led to microscopes.

• Beliefs- shifted from religious to scientific explanations for the universe. People wanted proof and reasoning.

• Communications- more societies were set up such as the Royal Society in London and the Academie de Science in France. These gave scientists the chance to meet and discuss new discoveries; they also helped publish people’s work.

• Government- Charles II was interested in science and new medicines, he granted a Royal Charter to the Royal Society which boosted public interest.

• Education- Medical schools in universities became more scientific as doctors had to learn anatomy, chemistry and botany instead of reading Galen.

• Individuals- Descartes a philosopher argued everything must be reasoned so scientist and doctors need to conduct tests and link ideas to reach judgements. Galileo proved the earth went around the sun and Newton discovered gravity, these showed how much more there was to understand and that things people took for granted could be wrong.

1750-1900

Louis Pasteur- French scientist hired by brewing company to stop beer going bad. He knew something was getting into the beer from the air and went on to develop his Germ Theory. He also worked with the dairy, silk and chicken industries. Pasteur entered a competition to disprove Spontaneous Generation and prove his own theory, he won and his Germ Theory was published in 1861. With government funding he proved that micro-organisms cause disease and so he had explained the cause of contagious diseases and infections. Robert Koch- German doctor, meticulous researcher. Worked for the German government with a team of bacteriologists. Researched Anthrax as well as other diseases, grew and observed bacteria, developed a method of staining bacteria so they could be studied more easily.

What caused the breakthrough in understanding the causes of disease by 1880?

• Individuals- Dutch clockmaker Anthony Van Leeuwenhoek developed an early microscope and saw ‘animalcules’ which were on and in almost everything. Pasteur proved his Germ Theory. Joseph Lister developed a microscope that could magnified by 9000. Robert Koch experimented on animals to understand illness and developed a new solid medium to study bacteria in- this led to identifying the bacteria for anthrax, TB and Cholera and then cures could be discovered.

• Technology- By the 1800s purer glass led to more powerful microscopes. Sterilised glass flasks, thinner tubes and other equipment could be used more reliably in experiments. New discoveries in dyes enabled Koch to stain the bacteria he wanted to identify.

• Government/Money- The French government ran the competition to disprove Generation Theory. Pasteur was provided a team of specialists to work with him. The German government gave Koch a full time job and research team as well as money.

• Industry- Pasteur hired and paid by a brewing company to find why beer went bad and then the French silk industry to find out what disease was affecting silk worms.

• Communications- Anthony Van Leeuwenhoek published his findings in 200 papers. Pasteur’s Germ Theory was published in 1861. People were able to travel far more to be treated as transport improved and fewer wars were fought.

• War- Germany and France had fought a bitter war 1870-71 so Pasteur and Koch were natural rivals and spurred on to each make discoveries and find vaccines before the other.

1900-Present

The use of x-ray

X-rays were first identified by Wilhelm Rontgen in 1895 when he was experimenting with cathode rays and found they could travel through mediums such as paper and flesh. His discovery caused great excitement and within 6 months hospitals were installing x-ray machines.

X-ray enabled doctors to see inside the body so that diagnosis could be made for diseases and internal wounds or problems without patients needing to be cut open. It was particularly useful during the World wars for injuries soldiers had gained.

Marie Curie’s discovery of Radium whilst experimenting with x-rays led to the use of radiography to diagnose cancer.

The discovery of DNA

DNA exists as a list of instructions in every cell of our bodies. We each have more than 3000million letters of code. Instructions are grouped together in sets called codes, every gene has a different function.

By the early 20th century scientists knew DNA existed and that it carried genetic information but they didn’t understand how it did this.

1951- Maurice Wilkins and Rosalind Franklin worked together at King’s College London. Franklin developed a technique to take a photo of a single strand of DNA using X-RAYS but wasn’t able to describe it.

1953- Using Franklin’s x-ray photos, two scientists called Crick and Watson who were working in a Cambridge laboratory discovered DNA was a double helix and a blueprint for life.

1990- The Human Genome Project was set up to identify the role of each of the 100,000 genes in a human DNA molecule and compile a complete map of human DNA.

Why was DNA discovered in 1953?

Individuals- Wilkins was an expert in x-ray photography, Franklin used his experience to develop a method of photographing a single strand. Crick was a specialist in molecular biology and genetics, he knew a lot on biophysics too and was partnered with Watson, also a genetics specialist.

Technology- Microscopes allowed scientists to look in cells, Mendel had showed that characteristics are passed from one generation to the next. X-ray allowed the study of DNA.

Money- This type of research involved many complex processes and expensive equipment, it needed highly skilled people and was time consuming. Money came from both governments and industry.

Teamwork- Crick and Watson inspired each other and were described as fun-loving, ambitious, impatient and honest. They would tell each other if one was heading in the wrong direction and kept each other focussed.

Why was there so much progress with the Human Genome Project?

Research teams- 18 countries took part in completing the map of DNA. Each team took different strands of DNA to discover it’s purpose.

Money- from governments and large drug companies who hoped to profit from drugs developed through DNA.

Technology- computerisation was vital in collecting, recording and analysing data.

Communications- Use of CDs, DVDs and the internet made sharing developments around the world possible in minutes.

Impact of DNA

Treatments

Approaches to Treatment and Prevention of Illness

1350-1750

A range of treatments were used in medieval times:

Humoural- Trying to balance the 4 humours in the body through actions such as bleeding, purging (vomiting), hot/cold foods and changes in climate.

Herbal Remedies- The main treatment used by doctors and villagers. Knowledge of herbs was passed down by word of mouth or books. Many remedies had been developed through trial and error e.g. anti-bacterial properties of garlic. Foreign herbs were increasingly available but there had been little change in treatments by 1750.

Who treated the sick?

• Physicians- qualified doctors who studied the works of Galen at university; it was very expensive to see a qualified physician.

• Apothecary- sold and mixed medicines, were not supposed to treat or prescribe for patients but many did for a small fee.

• Surgeon- trained by observing and copying experienced surgeons, given licenses by local Bishops and were though of as 2nd class doctors.

• Midwife- supervised the last weeks of pregnancy and delivered the baby, if there were problems they had to refer the patient to a physician.

• Family- most common, wife or mother who looked after and treated family members.

• Wise Woman- good knowledge of herbs and treatments which had been passed down through generations but they could be accused of witchcraft if things went badly.

• Travelling Quack- travelled to fairs and markets and sold herbal remedies, most wee fraudsters.

• Hospitals- before 1700 there were few; after 1700 new hospitals opened by charities and local councils; most looked after the poor but would not admit anyone with infectious diseases; rich people paid for someone to care for them at home.

1750-1900

During this period the methods used to fight disease changed:

Case Study 1: SMALLPOX

| |

|Fighting Smallpox before the 1720s: |

|People avoided those who were infected. Their belongings were disinfected with vinegar after their death. Ineffective and most people who survived were badly |

|scarred. |

| |

|Fighting Smallpox 1720-1790, Inoculation: |

|Matter (pus) taken from a Smallpox scab and applied to an open cut so that the person would develop a mild form of the disease. When antibodies developed they|

|would prevent the patient from catching the disease again. |

|Why did inoculation develop? Lady Wortley Montague used it with her children after seeing it used in Turkey, Travel to Asia meant this Chinese treatment had |

|spread, doctors could make a good profit inoculating against a terrifying disease. |

|Was it effective? For some, yes. Many developed more serious infections than planned and even died. The people who had been inoculated were sometimes |

|contagious. Many fear it or couldn’t afford it. |

| |

|Fighting Smallpox after the 1790s, Vaccination: |

|Matter was taken from someone infected with Cowpox, a milder disease. It was put into a cut and the person was uncomfortable whilst suffering from Cowpox but |

|then immune from getting Smallpox. |

|Why did Vaccination develop? Dr Jenner in Gloucestershire learnt from observing milkmaids and then did 24 trials to prove that vaccination worked. He recorded|

|results carefully. Jenner wrote to the Royal Society who published his work in 1798, it was translated into even Turkish and Arabic by 1812. The government |

|funded Jenner £30,000 for a vaccination clinic. Napoleon vaccinated his soldiers in 1805 and in the USA President Jefferson publically promoted vaccination. |

|Scientific methods were used by Jenner and other doctors to repeat tests and record all results carefully. |

|Impact? Vaccination was very effective and safer than inoculation but: |

|Vaccination was not free so the poor couldn’t get it done. |

|Jenner couldn’t explain why vaccination worked as there was no knowledge of germs yet so people believed the idea was crazy. Some doctors were not convinced. |

|Vaccination could only prevent one serious illness- Smallpox. |

|People feared new ideas, especially one that meant getting a cow disease. |

Fighting disease after 1879:

A range of vaccinations were developed by allowing viruses to weaken in matter before putting it into someone. This meant antibodies had a better chance of fighting off the disease and a person then became immune.

What helped doctors develop these vaccinations?

• Individuals- Pasteur was thorough and driven. He discovered a vaccine for chicken cholera, chicken pox, cholera and anthrax. Koch in competition with Pasteur discovered vaccines for TB and Typhoid.

• Chance- Pasteur’s assistant tested old matter on chickens with cholera by mistake.

• Government and money- research teams and labs were funded by the French government. The German govt funded Koch due to the intense completion with the French.

• Communication- Pasteur had read about Jenner’s work and was able to develop the idea.

• Science and technology- microscopes meant they could see micro-organisms. Industrial revolution led to new dyes which enabled Koch to see different types of bacteria- would eventually lead to the discovery of the first magic bullets.

How did treatment change?

Domestic medicine- The development of thermometers helped home diagnosis but little changed- people gave warmth, food and comfort. Common sense and herbal remedies still prevailed.

Patent medicines- by 1800, ‘cure all’ patent medicines could be bought cheaply from quacks. Most were ineffective and they were regulated by the government by the 1880s.

Pharmaceuticals- chemical drugs were developed form the 1880s including aspirin and sold by companies like Boots, Welcome and Beecham.

Healers/practitioners- at the start of the 18th Century, ¾ of all people who practised medicine were unqualified. The 1858 Medical Act made people get qualifications and a General Medical Council was set up to keep a list of approved doctors and explained what student should know.

Physicians still only available to the rich and many methods such as bleeding were used though they did little for infectious diseases

What does Jenner’s work tell us about the training of doctors?

1) Students were encouraged to carry out experiments with careful observation and recording. Jenner learned his methods form the surgeon John Hunter and experimented on 23 cases before writing up his findings in detail

2) Doctors had access to learning from both Latin texts and modern discoveries. Jenner’s own works were published and translated into many languages.

3) Professional societies helped doctors share ideas and findings. Jenner was a fellow of the Royal Society from 1788 and his work was being used in America by 1803.

1900- Present

Developments in Fighting Bacteria- contagious diseases

• The First Magic Bullet= Salversan 606 in 1905. It was a chemical which attacked the Diptheria virus. Paul Erlich and his team discovered the correct dose on the 606th attempt. His assistant Sahashiro Hata happened to retest a batch and found it worked. It was dangerous for the patient but killed the disease.

• Prontosil was a chemical compound containing sulphonamides which attacked the bacteria which caused blood poisoning. It was also discovered by chance when Domagk’s daughter was playing and fell on an infected needle in 1932. They also tested it on mice and recorded everything carefully.

• Other Magic Bullets 1932-34- cured a range of disease from Scarlet Fever to Meningitis, Pneumonia and Gonorrhoea- all based on the sulphonamides which come from coal tar.

These were all aided by the fact they worked in research teams with modern electron microscopes from 1931, they were also funded by drug companies keen to make a profit.

The Discovery of Penicillin

Mould first discovered by John Sanderson, 1880s Joseph Lister use it to treat an infected wound on a nurse but he left no notes and didn’t continue to use it.

Penicillin was rediscovered by Alexander Fleming at St Mary’s Hospital 1928 and proved that it killed infection but lacked facilities and support test it properly.

In the 1930s, two Oxford students, Florey and Chain were interested in Flemings work and during the Second World War the British government agreed to fund research. Mass production was eventually funded by the American government and millions of lives were saved. Four major drug companies worked together to keep up the demand for penicillin during the war.

The Training of Doctors

1860- Some scientific education but very hands-on training, limited understanding of causes or equipment. They were highly respected, relied on payments from patients. There were no specialists or females, some held surgeries for the poor in local dispensaries.

1930- Better education, some knowledge of causes, and basic equipment like stethoscopes, x-ray and thermometers. They were highly respected, still paid by patients and could refer them on to specialists some did charity work and visited the poor at home. Few were female, in 1859 Elizabeth Garrett Anderson, became the first woman in Britain to qualify as a doctor.

2000+ Highly educated then trained with hands-on experience. Understanding of many causes of disease, hi-tech equipment like body scans and laser treatment. Less respected as greater number of patients, many are female. Salaries paid by government unless private doctor, can refer to a range of specialists.

Improvements in other Treatments:

• Marie Curie researched and developed radiotherapy- using radium to remove cancerous growths in patients by the early 20th Century.

• Major improvements in surgical techniques.

• Huge ranges of new drugs are produced each year, we have thousands of varieties of magic bullets.

• There are a variety of vaccinations such as for polio, and German measles.

• Genetic engineering is possible so we are now able to treat hereditary diseases and we can manipulate genes inside the body. We can produce insulin for people with diabetes.

• Increased use in alternative therapies such as acupuncture.

Why so much progress in the last Century?

1) Industry and money- enormous profits mean companies will spend millions of pounds on research.

2) The government- funds research and treatment through the National Health Service.

3) Science and tech- microscopes now enable us to see inside cells and even add/remove parts of cells. X-ray machines and MRI scans allow doctors to diagnose cancer and illnesses within the body.

4) Individuals- Fleming, Rontagen and Curie’s have individually led to improvements in treatments of various illnesses.

Concerns for the future

Some bacteria has become resistant to antibiotics.

Mistakes still happen eg Thalidomide.

New illnesses are constantly appearing. Although we know about defective gene’s there is no way yet to prevent them or treat them.

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Hippocrates- Greek doctor. His Hippocratic Collection of medical books were used for hundreds of years. He made careful observations and recorded symptoms and treatments so that he could learn for future patients. He developed the theory of the humours and how to rebalance them by bleeding, purging and using natural treatments like a good diet and exercise.

Galen- Roman doctor. A surgeon to Rome’s gladiators, he also travelled with the Roman army for 12 years. He also observed patients carefully but dissected mainly animals. He developed the theory of the four humours by using opposites to treat illness eg blood is a ‘summer’ humour and its opposite is phlegm which is ‘winter.’ He wrote over 60 books on Hippocrates and his own experiences.

Vesalius- Born 1514, studied medicine in Paris and Italy where he specialised in anatomy and became a professor of surgery and wrote his book, ‘The Fabric of the Human Body’ published in 1543. He found through dissections on people that Galen was wrong on some anatomical details. People were angry at his criticisms of Galen but he proved that the lower jaw is in one piece, not two. He also proved that blood couldn’t travel through the Septum in the heart from one side to the other.

Harvey- Born 1578, doctor in London then lecturer in anatomy. Published ‘An Anatomical Account of the Motion of the Heart and Blood in Animals’ in 1628. He proved that blood is not made in the liver and then used up as Galen suggested, instead it is pumped by the heart and moves around the body through arteries and veins. He couldn’t prove the existence of capillaries because microscopes were not yet strong enough. He encouraged people to test Galen and experiment more.

Gene Therapy- using healthy genes to cure the sick when disease is caused by one abnormal gene. This is possible but not yet fully developed.

Customised drugs- creating drugs to suit individuals and their genetic condition.

Genetic Engineering- creating new plants and animals eg new varieties of drought resistant wheat.

Genetic screening/testing- doctors can screen patients to find faulty genes and then produce medicine to prevent illness. Unborn babies can also be tested for conditions such as Downs Syndrome.

Case Study 1:

The Black Death 1348

Bishops led processions and pleaded with God, the Flagellants whipped themselves and painted crosses on their bodies. People used perfumes and herbs to ward off deadly vapours. Church bells were rung, people wore charms and talismans, and they cast spells. Doctors tried to balance the four humours.

Case Study 2:

The Great Plague 1665

Charms were worn, people used treatments like feathers from a chicken’s tail but mostly they did the same as in 1348. The sick were now locked up and guarded to prevent them spreading infection.

Florence Nightingale

She was a nurse during the Crimean War who was shocked by what she saw in military hospitals that she set about improving conditions and the standard of nursing care patients received. She published “Notes for Nursing” in 1859 and set up a training school at St Thomas’ Hospital.

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