SOCH111. Session 11.1 Western Health History 19 th Century

Transcription

1 SOCH111 Session 11.1 Western Health History 19 th Century

2 Germ Theory The germ theory states that microorganisms, which are too small to be seen without the aid of a microscope, can invade the body and cause certain diseases. Until the acceptance of the germ theory, many people believed that disease was punishment for a person's evil behaviour. When entire populations fell ill, the disease was often blamed on swamp vapours or foul odours from sewage.

3 Germ Theory Even many educated individuals, such as the prominent seventeenth century English physician William Harvey, believed that epidemics were caused by miasmas, poisonous vapours created by planetary movements affecting the Earth, or by disturbances within the Earth itself.

4 Germ Theory The germ theory of disease is the single most important contribution by the science of microbiology to the general welfare of the world's people, perhaps the single most important contribution of any modern scientific discipline. It also is the single most important contribution to the practice of modern medicine, essentially defining the term with the invention of antimicrobial chemotherapeutics.

5 Germ Theory The development of the germ theory was made possible by the certain laboratory tools and techniques that permitted the study of bacteria during the seventeenth and eighteenth centuries. The invention of primitive microscopes by the English scientist Robert Hooke and the Dutch merchant and amateur scientist Anton van Leeuwenhoek in the seventeenth century, gave scientists the means to observe microorganisms. During this period a debate raged among biologists regarding the concept of spontaneous generation.

6 Germ Theory Until the second part of the nineteenth century, many educated people believed that some lower life forms could arise spontaneously from nonliving matter, for example, flies from manure and maggots from decaying corpses. In 1668, however, the Italian physician Francisco Redi demonstrated that decaying meat in a container covered with a fine net did not produce maggots.

7 Germ Theory Redi asserted this was proof that merely keeping egg-laying flies from the meat by covering it with a net while permitting the passage of air into the containers was enough to prevent the appearance of maggots. However, the belief in spontaneous generation remained widespread even in the scientific community.

8 Germ Theory In the 1700s, more evidence that microorganisms can cause certain diseases was passed over by physicians, who did not make the connection between vaccination and micro-organisms. During the early part of the eighteenth century, Lady Montague, wife of the British ambassador to that country, noticed that the women of Constantinople routinely practiced a form of smallpox prevention that included "treating" healthy people with pus from individuals suffering from smallpox.

9 Germ Theory Lady Montague noticed that the Turkish women removed pus from the lesions of smallpox victims and inserted a tiny bit of it into the veins of recipients. While the practice generally caused a mild form of the illness, many of these same people remained healthy while others succumbed to smallpox epidemics.

10 Germ Theory The reasons for the success of this preventive treatment, called variolation, were not understood at the time, and depended on the coincidental use of a less virulent smallpox virus and the fact that the virus was introduced through the skin, rather than through its usually route of entry the respiratory tract Lady Montague introduced the practice of variolation to England, where physician Edward Jenner later modified and improved the technique of variolation.

11 Edward Jenner Jenner noticed that milkmaids who contracted cowpox on their hands from touching the lesions on the udders of cows with the disease rarely got smallpox. He showed that inoculating people with cowpox can prevent smallpox. The success of this technique, which demonstrated that the identical substance need not be used to stimulate the body's protective mechanisms, still did not convince many educated people of the existence of diseasecausing micro-organisms.

12 Germ Theory In 1848, Ignaz Semmelweis, a Hungarian physician working in German hospitals, discovered that a sometimes fatal infection commonly found in maternity hospitals in Europe could be prevented by simple hygiene. Semmelweis demonstrated that medical students doing autopsies on the bodies of women who died from puerperal fever often spread that disease to maternity patients they subsequently examined.

13 Germ Theory He ordered these students to wash their hands in chlorinated lime water before examining pregnant women. Although the rate of puerperal fever in his hospital plummeted dramatically, many other physicians continued to criticise this practice as being useless.

14 Germ Theory In 1854, modern epidemiology was born when the English physician John Snow determined that the source of cholera epidemic in London was the contaminated water of the Broad Street pump. After he ordered the pump closed, the epidemic ebbed. Nevertheless, many physicians refused to believe that invisible organisms could spread disease.

15 Louis Pasteur The argument took an important turn in 1857 however when the French chemist Louis Pasteur discovered "diseases" of wine and beer.

16 Louis Pasteur French brewers asked Pasteur to determine why wine and beer sometimes spoiled. Pasteur showed that, while yeasts produce alcohol from the sugar in the brew, bacteria can change the alcohol to vinegar. His suggestion that brewers heat their product enough to kill bacteria but not yeast, was a boon to the brewing industry a process called pasteurisation. In addition, the connection Pasteur made between food spoilage and micro-organisms was a key step in demonstrating the link between micro-organisms and disease.

17 Robert Koch Pasteur's work followed earlier demonstrations by both himself and Agostino Bassi, an amateur microscopist, that silkworm diseases can be caused by micro-organisms. While these observations in the 1830s linked the activity of micro-organisms to disease, it was not until 1876 the German physician Robert Koch proved that bacteria can cause diseases. Koch showed that the bacterium Bacillus anthracis was the cause of anthrax in cattle and sheep, and he discovered the organism that causes tuberculosis.

18 Robert Koch Koch's systematic methodology in proving the cause of anthrax was generalised into a specific set of guidelines for determining the cause of infectious diseases, now known as Koch's postulates.

19 Robert Koch By showing how specific organisms can be identified as the cause of specific diseases, Koch helped to destroy the notion of spontaneous generation, and laid the foundation for modern medical microbiology. Koch's postulates introduced what has been called the "Golden Era" of medical bacteriology. Between 1879 and 1889, German microbiologists isolated the organisms that cause cholera, typhoid fever, diphtheria, pneumonia, tetanus, meningitis, gonorrhoea, as well the staphylococcus and streptococcus organisms.

20 Joseph Lister English physician Joseph Lister built on the work of both Semmelweis and Pasteur. Lister began soaking surgical dressings in carbolic acid (phenol) to prevent postoperative infection. Other surgeons adopted this practice, which was one of the earliest attempts to control infectious microorganisms.

21 Paul Ehrlich While working on Koch s research team, Ehrlich became interested in antibodies that the body produces. He discovered that antibodies killed specific germs but didn t damage other parts of the body or tissue. Ehrlich called these antibodies magic bullets. He began to try and produce a synthetic magic bullet that would kill specific bacteria.

22 Paul Ehrlich Ehrlich set up his own research institute and began looking for a magic bullet to beat syphilis. He used chemical compounds of arsenic but met with little success. He produced 605 variations without any luck and dismissed variation 606 as well. A research assistant re-tested 606 and found it worked! One of the most important discoveries that we have yet studied was nearly thrown away.

23 Alexander Fleming Fleming worked as a doctor during World War I and was used to dealing with serious wounds. He was frustrated by an inability to prevent infection in deep wounds. He made it his mission to find a substance that would kill microbes. In 1928 when experimenting with germs in a lab one day he noticed that no germs grew near a lump of mould that developed on one of the dishes. He had stumbled across Penicillin.

24 Alexander Fleming Fleming discovered that Penicillin could stop the most deadly of germs. He needed to find a way of turning it into a drug so it could be used to treat humans. Unbelievably he could not secure the money from the British government or anywhere else for further research. In 1931 he stopped his work on Penicillin.

25 Howard Florey and Ernst Chain In 1938 Howard Florey read Fleming s research articles on Penicillin. Florey and his partner Ernst Chain decided to investigate. They succeeded in making small quantities of Penicillin in powder form. On 25 th May 1940, 8 mice were injected with the streptococci bacteria. Four were also given regular doses of penicillin. The mice that had no antibiotics died within 16 hours - History had been made.

26 Development of Anaesthetics By the 1800s there were no decent anaesthetics, people relied on alcohol, opium and hypnosis. In 1799 Humphrey Davey discovered that nitrous oxide (laughing gas) relieved pain. His discovery was ignored by the medical profession who believed it unimportant. In 1845 Horace Wells saw people inhaling the gas at a fair. He observed that they failed to feel the effects of pain.

27 Development of Anaesthetics In 1846 William Morton removed a tumour from a patients neck using ether as an anaesthetic. In December of the same year Robert Liston removed a patients leg in 26 seconds! The medical profession began to sit up and take notice. In 1847 James Simpson experimented with chloroform. He administered it to over 50 women and the results were impressive.

28 Development of Anaesthetics There were various reasons why people were opposed to the this development: It was difficult to judge the correct amount - accidents happened. People opposed on religious grounds e.g. childbirth. Some people didn t trust surgeons. Others felt that men that relied on anaesthetics were soft. Opposition melted away when Queen Victoria used chloroform to give birth to her 8 th child. By the end of the 19 th century the anaesthetist had become a specialist in his own right.

29 Development of Pharmaceutical Industry Most of today's major pharmaceutical companies were founded in the late 19th and early 20th centuries. Key discoveries of the 1920s and 1930s, such as insulin and penicillin, became mass-manufactured and distributed. Legislation was enacted to test and approve drugs and to require appropriate labelling. Prescription and non-prescription drugs became legally distinguished from one another as the pharmaceutical industry matured. The industry got underway in earnest from the 1950s, due to the development of systematic scientific approaches, understanding of human biology (including DNA) and sophisticated manufacturing techniques.

30 Development of Pharmaceutical Industry The middle third of the 20th century witnessed a blossoming of pharmaceutical invention, with breakthroughs in the development of synthetic vitamins, sulfonamides, antibiotics, hormones, psychotropics, antihistamines, and new vaccines. Several of these constituted entirely new classes of medicines. Deaths in infancy were cut in half, while maternal deaths from infections arising during childbirth declined by more than 90%. Illnesses such as tuberculosis, diphtheria, and pneumonia could be treated and cured for the first time in human history

31 Development of Pharmaceutical Industry As in other domains, wartime support for research accelerated the development of certain therapies. Programs sponsored by the U.S. government focused on anti-malarials, cortisone (which was thought to permit aviators to fly higher without blacking out), and, most especially, penicillin. The development of penicillin by pharmaceutical companies under the oversight of the War Production Board gave firms a leading position after WWII. In the late 1940s, they produced over half of the world's pharmaceuticals and accounted for onethird of international trade in medicines.

32 Development of Pharmaceutical Industry The primary methods used for drug invention shifted radically between 1930 and During the advent of the antibiotic era, drug firms screened thousands of soil samples in a global search for antimicrobial agents. Antibiotics including streptomycin, chlortetracycline, chloramphenicol, erythromycin and tetracycline gave companies the opportunity to extol the miracles of medical research to health professionals and consumers alike.

33 Physiotherapy Physiotherapy is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. Physiotherapists are experts in the diagnosis, management and prevention of movement disorders. Using a wide range of drug-free techniques to relieve pain, restore function and movement and prevent further problems, physios employ a combination of manual therapy, movement training and physical and electrophysical agents.

34 History of Physiotherapy Physical therapy (Physiotherapy) has its origins in ancient history with the advent of physical treatments and massage in China circa 2500 BC. The modern practice of physical therapy was developed in London in 1896, believing hospital patients needed to be massaged on a regular basis in order to maintain adequate muscle function and mobility.

35 History of Physiotherapy This special interest group grew rapidly and in 1920 the Chartered Society of Physiotherapy was formed in the United Kingdom. Similar organisations were developed in other countries. The care and rehabilitation of the large numbers of amputees resulting from the World Wars of the early 20th century, as well as care of patients suffering from diseases such as polio galvanised the development of physical therapy worldwide.

36 Occupational Therapy Occupational therapists (OTs) work in a broad range of environments to help patients participate in their chosen life activities. Their clients include people born with disabilities, and those whose health suffers because of injury or illness. Working closely with physiotherapists, they teach patients to use particular movements (or compensate for a lack of movement) in day-to-day activities. They also help people adapt their environment (modify their home to prevent falls, for example) and train them to use speciallydeveloped equipment (to access a computer, for instance).

37 History of Occupational Therapy With returning veterans from World war 1, the rising incidence of industrial and automotive accidents, and medical advances that saved more and more lives, a growing population faced long-term residual disability with few available resources for reconstructing lives. In 1917, a group of well-educated men and women founded the National Society for the Promotion of Occupational Therapy.

38 History of Occupational Therapy These pioneers seized upon meaningful activity or "occupations" as an important therapeutic tool in the recovery and revitalisation of the ill and disabled. During its early years, Occupational Therapy centred on hospital care, often providing the only programs for people who were spending their entire lives in institutions. Today, Occupational Therapy has expanded greatly to meet new social needs as well. These include the growth of the aging population, a large increase in the number of premature infants, the rising incidence of chronic health problems, and the growing awareness of the connection between lifestyle, occupation, and longterm wellness.

39 Nursing Nursing emerged as a profession in the late 19th century. Before this time, nursing did not require any training, was badly paid and did not have a respectable reputation. Florence Nightingale was instrumental in bringing about this change. In 1860, Nightingale set up the first nurses' training school at St. Thomas's Hospital; this became the foundation of most nursing programmes within the Western world.

40 Midwifery "Midwife" is a word which in English was translated to mean "with woman. Midwifery is one of the oldest professions in history. Midwives feature in the bible and even Socrates wrote of his mother who was a respected midwife. Until the beginning of the twentieth century, most midwives were self-employed with experience, but no formal training. Midwifery was a profession passed on from mother to daughter, nurse to doctor and doctor to nurse.

41 Midwifery The profession of midwifery continued without major changes throughout the centuries, even through the Dark and Middle Ages. In their practices, midwives routinely used herbs and potions, as forerunners of today's modern pharmaceuticals. The midwives of these centuries generally continued to learn by the apprentice model.

42 Midwifery As an apprentice, skills and knowledge were shared from generation to generation but without the development of a formalised system of university education. There have been many advances in the status and responsibilities of midwives, most affluent countries eventually developed formalised programs and many hospitals now see midwives working under the guidance of Obstetricians.

43 History of Dentistry Oral disease has been a problem for humans from the beginning of history. Skulls of Cro-Magnons, who inhabited the earth 25,000 years ago, showed evidence of tooth decay. The earliest recorded reference to oral disease is from an ancient (5000 BC) Sumerian text that describes "tooth worms" as a cause of dental decay. There is historical evidence that the Chinese used acupuncture around 2700 BC to treat pain associated with tooth decay.

44 History of Dentistry The papyri of ancient Egypt make references to diseases of the teeth, as well as prescriptions for substances such as olive oil, dates, onions, beans, and green lead, to be mixed and applied "against the throbbing of the bennut blisters in the teeth. An Egyptian lower jaw, dated by experts from 2900 to 2750 BC, demonstrates two holes drilled through the bone, presumably to drain an abscessed tooth. By the 5th century BC, Herodotus, a Greek historian, wrote "in Egypt, medicine is practiced on a plan of separation--each physician treats a single disorder, and no more...some undertaking to cure diseases of the eye, others the head, others again of the teeth."

45 History of Dentistry Aesculapius, a Greek physician, who lived between 1300 and 1200 BC, is credited by many with the concept of extracting diseased teeth. Later ( BC), Hippocrates and Aristotle wrote of ointments and cautery with a red hot wire to treat diseases of the teeth and oral tissues. They also spoke of tooth extraction and the use of wires to stabilise jaw fractures or bind loose teeth.

46 History of Dentistry A renowned Roman medical writer, Celsus (100 BC), wrote extensively of oral diseases, including bleeding gums and ulcers of the oral cavity, as well as dental treatment such as narcotic-containing emollients and astringents. Arabian physicians attached great importance to clean teeth. They described various procedures to "scrape" the teeth and designed sets of specialized instruments to accomplish that task. Mouthwashes and dentifrice powders were applied by the Arabians using a "toothbrush," a small polishing stick that was beaten and softened at one end.

47 History of Dentistry Throughout the Middle Ages in Europe, dentistry was made available to wealthier individuals by physicians or surgeons who would go to the patient's home. Decay would sometimes be removed from teeth with a "dental drill ; a metal rod that was rotated between the palms. Dentistry for poorer people took place in the marketplace, where self-taught vagabonds would extract teeth for a small fee. From the Middle Ages to the early 1700s much dental therapy was provided by so called "barber surgeons."

48 History of Dentistry These jacks-of-all-trades would not only extract teeth and perform minor surgery, but they also cut hair, applied leeches to let blood, and performed embalming. Italian sources from the 1400s mention the use of gold leaf as dental filling material. Later, the French described the use of soft lead fillings to repair teeth after decay was removed. Pierre Fauchard ( ), a French surgeon, is credited with being the "father of modem dentistry."

49 History of Dentistry His book, The Surgeon Dentist, A Treatise on Teeth describes the basic oral anatomy and function, signs and symptoms of oral pathology, operative methods for removing decay and restoring teeth, periodontal disease, orthodontics, replacement of missing teeth, and tooth transplantation. Fauchard`s text was followed by others that continued to expand the knowledge of the profession throughout Europe. Until the mid-1800s, dentures continued to be individually constructed by skilled artisans.

50 History of Dentistry Gold, silver, and ivory were common components, causing them to be very expensive and available only to the very wealthy. In 1851 a process to harden the juices of certain tropical plants into vulcanised rubber was discovered. The ability to mould this new material against a model of the patient's mouth and attach artificial porcelain teeth allowed the manufacture of less expensive dentures. Later, acrylic plastics replaced the use of rubber and porcelain in denture construction.

51 History of Dentistry A major contribution from the dental profession to the future of health care occurred in 1844 when Dr. Horace Wells, observed an exhibition of people reacting to inhalation of nitrous oxide (laughing gas). He initiated the use of nitrous oxide inhalation during dental therapy and founded the concept of inhalation analgesia and anaesthesia. The medical community later modified and adopted inhalation anaesthesia as a standard surgical management procedure.

52 History of Dentistry Greene Vardiman Black ( ) was the leading reformer of dentistry. Black devised a foot engine that allowed the dentist to keep both hands free while powering the dental drill. He developed modem techniques for filling teeth based upon biological principles and microscopic evaluation. Black also noted a densely matted bacterial coating on the teeth, and he proposed that dental caries and periodontal diseases were infections initiated by Bacteria. It was not until the early 1960s, however, that scientific evidence confirmed this theory.

53 Other Allied Health Disciplines Dietetics Podiatry Radiography Audiology Speech pathology Social Work Osteopathy Chiropractic

54 References Allied Health, viewed 22/10/07 Germ Theory, viewed 21/10/07 Germ Theory, viewed 21/10/07 History of medicine, viewed 22/10/07 History of Medicine, viewed 22/10/07 History of Medicine, viewed 22/10/07 Midwifery, viewed 22/10/07 Osteopathy, viewed 23/10/07 Pharmacy, viewed 22/10/07 Physiotherapy, viewed 22/10/07 The Pharmaceutical Golden Era: , viewed 23/10/07 The history of Midwifery, viewed 22/10/07 Images; commonc.wikipedia.org unless otherwise specified

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