Prehistory Prehistory is before written language.

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1 Prehistory Prehistory is before written language. How do we know this? 1. Aboriginal people in Australia whose beliefs and ways of life have not changed for centuries. 2. Skeletons discovered from prehistoric times. Scientists are able to test their bones for many types of disease, examine injuries and get an idea of their diet. 3. Written sources from more advanced civilisation who had visited areas of the word where people were still considered to be prehistory. For example when the Romans visited Britain. What did prehistoric people die of? 1. Disease 2. Infections 3. Warfare with other tribes 4. Occasionally food shortages and famines However, here are some interesting facts: 1. Prehistoric people were very fit with good teeth. 2. They were shorter than people today. 3. They died before the age of 40. What problems exist with Archaeological evidence? 1. Skeletons help answer some questions but not all. 2. There are few prehistoric sites that contain human skeletons. 3. Skeletons on a certain site may not represent all age groups or sexes. 4. Bones may have been damaged in excavations or over time. 1

2 Ancient Egypt Egypt was a very wealth country that was based on the River Nile. How did wealth in Egypt lead to improvements in medicine? The wealthy would hire specialist doctors who spent most of their lives trying to improve their understanding of medicine and health. The wealthy would hire metal workers to make them jewellery and to make bronze instruments for the specialist doctors. What other features help in the improvement of Egyptian medicine? TRADE IMPROVED WRITING RELIGION THE NILE AND FARMING Egypt traded with countries in parts of Africa and Asia for example China. Through trade new herbs and plants were being imported along with new knowledge about health. The Egyptians developed the papyrus (paper made from reeds). This allowed them to write down their ideas and store them easier than stone resulting in libraries and books for education. Egyptians were very religious believing that the dead would need their bodies in the afterlife. Therefore, bodies were embalmed (mummified) leading Egyptians to be able to identify some organs like the heart, lungs and brain. When thinking about illness the Egyptians looked to the natural world for inspiration. Thus, Egyptians got some of their ideas from the importance of the River Nile. If the river flowed freely crops would grow but if it became blocked crops would die leading some Egyptian thinkers to believe that human illness must be because channels in their body became blocked. 2

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4 Causes of illness and treatments Question Answer Cause of illness Rotten food in the bowels caused gases resulting in the channels to become blocked. The supernatural Treatments Herbal remedies made from plants and minerals, set broken bones, removing cysts, (no internal surgery, no dissection), amulets (charms, prayers and offerings to the Gods. How did religion help the development of Egyptian medicine? Embalming allowed the Egyptians learn a bit about the human anatomy by allowing them to identify some organs such as the brain, heart and lungs. In order to the respect the Gods the Egyptians must bath twice a day, drink out of clean cups, shave their bodies and wear clean clothes. However, did religion hinder the development of Egyptian medicine? Yes it did. Although they were able to identify some organs their religion forbade them to dissect the body stopping any chance of the Egyptians to learn about more of the human anatomy and how the body works. Dissection was not allowed because the body was to be kept whole to enter into the afterlife and in Egypt the extreme heat could damage the body causing it to decompose and smell. 4

5 Ancient Greece Similar to the Egyptians the Gods played a major role in how the Greeks viewed health. The Greeks also borrowed many medical ideas from the Egyptians but they, as well, had lots of new ideas. The MOST IMPORTANT new idea was the THEORY OF THE FOUR HUMOURS. The theory affected the study and practise of medicine for over 2000 years! Religion The God of healing in Ancient Greece was Asclepius who was helped by his two daughters Panacea and Hygeia. The ancient Greeks believed that if they visited and slept in an Asclepion (hospital complex) then Asclepius and his daughters would visit them in their dreams and cure them. Take a look at the Asclepion notice how the other buildings and functions of the hospital can benefit a patient and help improve their health. Hospital wards (Abaton) where patients slept at night and were visited by Asclepius and his daughters Bath houses where patients can stay clean, swim and exercise Temple where patients can pray and ask for help A stadium for entertainment to have fun and relax A gym where patients can exercise and stay fit A benefit that you cannot see is that the Asclepion was quiet, peaceful and outside the cities in the fresh air 5

6 Natural Approaches The father of medicine Hippocrates Hi Although he believed in the Gods and their role in health, his theory of the four humours demonstrated the idea that some illnesses were natural. Therefore, if the illness was not caused by God it could be cured by man. What was the Theory of the Four Humours? What caused illness? The four humours out of balance What are humours? Liquids in the body Why four? Hippocrates observed the body having four liquids which he then linked to the four seasons and four elements the rule of 4! What were the four liquids? 1. Blood: people sometimes cough up blood or have nosebleeds. 2. Yellow bile: people often vomit up their half-digested food after a meal. 3. Black bile: people sometimes vomit even when they have not eaten. This vomit is a dark, evil-smelling liquid. 4. Phlegm: People often sneeze or cough up slimy, revolting phlegm. How did the humours link to the seasons and elements? Element AIR Element FIRE Element EARTH Element WATER Season SPRING Season SUMMER Season AUTUMN Season WINTER Liquid BLOOD Liquid YELLOW BILE Liquid BLACK BILE Liquid PHLEGM 6

7 How did the Greeks try to rebalance the humours? Herbal remedies Ointments to clean wounds (and they dressed wounds with linen) But their most famous treatments to rebalance the humours were: Bleeding: a scratch or cut was made on the skin and the blood was let out into a cup (a procedure used right through to the 19 th century!). Vomiting and Purging: This involved the doctor using different herbal concoctions to purge the patient s bowels (use the toilet) or making the patient vomit. Bloodletting through time Greek/Roman Middle Ages 7

8 What could Greek surgeons do? Medical Renaissance Set broken bone Industrial Revolution Amputation Draining of the lungs Cataracts Trephinning However, very few operations were done inside the body. The Greeks were unable to stop the bleeding, pain and infection that occurred during and after surgery. Why Hippocrates was important and what impact did he have on the development of medicine? Observation Hippocrates showed how important it was to observe patients carefully to record and monitor symptoms. Impact of observation Doctors were able to choose the right cure and the observation notes could be used to help diagnosis and treat future patients. Hi, it s me again. Check out what I have done! Recording Hippocrates showed how important it was to record observations. Impact of recording These recordings lead to medical books that were used doctors to identify the illness and cure. Hippocratic Oath The oath is still used today. It makes clear that doctors are not magicians. Also, doctors must keep high standards of treatments and behaviour for the benefit of the patient rather to make themselves rich. Impact of the Hippocratic Oath The oath created trust between the doctor and patient. Hippocratic Collection The Hippocratic Collection contains books which doctors used for centuries. These books included clinical observations and treatments. Impact of the Hippocratic Collection The work recorded in the books by Hippocrates influenced the great Roman doctor Galen and doctors until the 19 th century. Cause of Disease the four humours Hippocrates developed the theory of the four humours to explain the causes of diseases. He encouraged people to look for natural treatments for illnesses rather than rely on the Gods Impact of the four humours The general concept that illness was caused by the unbalance of humours lasted until the 19 th century (over 2000 years!). 8

9 Why was Alexandria so important during the time of the Greeks? Alexandria was a centre of medical knowledge. Doctors from China, India, Egypt and the Middle East would visit and study in the city. Alexandria had a university, a library and it allowed for dissection. Dissection was considered wrong by the Ancient Greeks and Romans. Thus, great doctors such as the Roman doctor Galen travelled to Alexandria to learn more about the body and to study. China Egypt Middle East India Summary Comparison Prehistory, Ancient Egypt and Ancient Greece Who treated the sick? What did they know about the body? How did they treat and prevent illness? What did they think caused disease? Prehistory Ancient Egypt Ancient Greece Priests Priests Specialist doctors Doctors Women Women Medicine Men (Shaman) Women Limited Herbal remedies Charms and spells Trephining Gods Evil spirits They could identify some parts of the body but they did not understand what they did Herbal remedies Charms and spells Simple surgery Personal hygiene Gods Food rotting in the channels in the body They could identify some parts of the body and began to understand some of its working Herbal remedies Charms and spells Simple surgery Personal Hygiene Observation Rest Diet and exercise Bleeding Gods The humours in the body out of balance 9

10 Ancient Rome How were the Romans and Greeks similar? How were they different? Greek Empire Mostly small cities less than 20,000 people which did not pose health problems Not very centralised. Each city was independent. Ideas spread slowly. Greek philosophers were famous for having ideas and theories about everything. Had only a small army for each city, which got together only when there was a war. There were wealthy people who could afford to pay for doctors to care for them. Roman Empire Large cities Rome itself had a million people. Many people living cramped together posed health problems. Very centralised with strong government. Quick communications around the empire. New ideas and treatments spread quickly. Romans were less interested in theories. They were efficient, well-organised people who liked practical solutions to illness as well as everything else. The Roman army had hundreds of thousands of soldiers, permanently stationed all over the empire. Frequently at war. The government provided the army with the best medical care as they depended on the army to control the empire. There were even more wealthy people than in the Greek Empire. 10

11 A healthy army means a healthy empire! The Roman Empire was much bigger than the Egyptians or Greek empires. The Romans controlled most of Europe, England, North Africa and the Middle East. To protect and extend their vast empire it was important to have a large, well-trained and healthy army. In doing so there was an emphasis placed on the location of military buildings, supplying fresh water and keeping their army fit. Military camps, such as the ones found at Ribchester and Housesteades in England had access to fresh water, bath houses and hospitals. Aerial view of a Roman hospital at Housesteads Hadrian s Wall Operating theatre Corridors Wards, offices and kitchens The practical methods and ideas used to help the Roman army were eventually used in Roman homes and cities. This allowed for Romans cities to grow with some sources indicating that Rome itself was inhabitants by over 1 million people! This feat was not achieved again until the Industrial Revolution when London topped over a million people after the census was completed in Model of what Rome may have looked like 2000 years ago 11

12 How did the Romans keep their towns healthy? All towns are kept away from marshlands. Quiet down the Emperor speaks! Build cisterns and fountains for people to collect water from or relax by. Also, those who can afford may have built piping systems to bring water to and from their house. Build sewers underground to take away sewage from private houses and public toilets Build public toilets in towns so people can clean up, clear out and catch up on the latest gossip! Build aqueducts and bricklined channels called conduits to supply fresh water to towns. Also keep extra water in reservoirs. Always test the water supply! Build public baths in every town and make them cheap so that everyone can afford to use them. This is what the Emperor was rambling on about! What about the doctors? 12

13 Doctors: Were employed by the army Were employed by many cities to give free treatment to the poor Some were women specialising in treating women s illnesses How were they trained? Some medical students learned by reading the Hippocratic Collection but only the wealthiest owned copies of the books Others read them in the great libraries of Rome or Alexandria Many became apprentices to experienced doctors, watching, then copying their methods What treatments did they use? Like the Greeks, the Romans believed that illness was caused by the humours being unbalanced. The main treatments used were very similar to that of the Greeks: Exercise: Many trained at public baths or at gymnasiums. A Roman writer of the time Celsus wrote: He who has been engaged in the day, whether in domestic or on public affairs, ought to keep some portion of the day for the care of the body. The primary care is exercise Changes in diet: Many doctors believed that the changes in diet can help with certain illnesses. Galen s Theory of the Opposites used certain diseases to offset certain conditions that unbalanced the humours. Herbal remedies: Roman families used herbs and vegetables in medical treatments. Roman doctors would use opium as a weak anaesthetic. Surgery: Bleeding Amputations Trephining Removal of cataracts from the eye 13

14 Who was Galen? Galen was born in AD 129 in Greece which was controlled by the Roman Empire. He studied medicine at Alexandria and started his career as a surgeon at a Gladiator s school. This provided Galen with the opportunity to treat different wounds and experiment with new treatments. He became very popular and respected throughout the Roman Empire. Galen even became the personal doctor for the Emperor! Galen s ideas and methods were extremely important. He had taken the best ideas of Hippocrates and combined them with his own work. What did he do? Observation Galen emphasised the importance of Hippocrates methods. He told doctors to observe, record and use their experience of past cases to decide how to treat an illness. Observation In his early days Galen was able to dissect bodies in Alexandria. In Rome, however, he usually had to make do with animals for his experiments. Thus, when comparing the animal to humans, some of his ideas were wrong. However, a lot was correct The four humours Like Hippocrates he believed in the theory of the four humours and that treatments should restore the balance of the humours. Galen introduced a new version of the four humours called the Theory of the Opposites. Theory of the Opposites Galen believed in using opposites to balance humours. For example, if the problem was too much phlegm caused during winter then the treatment should include something hot. Galen wrote books Galen wrote 60 books on medicine. They were the main books used by medical students for over 1500 years! Brain controls the body One of Galen s most famous experiments was proving that the brain controlled the body. In front of an audience he cut a pig it squealed. He then cut a nerve that ran from the brain to the body the pig fell silent. So did his audience who were shocked and amazed. Design Galen believed that every organ has a special role to play. He believed that the gods must have designed them to fit perfectly. 14

15 Summary Comparison of the Ancient World Prehistory, Ancient Egypt, Ancient Greece and Ancient Rome Who treated the sick? Prehistory Ancient Egypt Ancient Greece Ancient Rome Medicine Men Priests Priests Priests (Shaman) Specialist doctors Trained doctors Trained doctors Women Women Women Women What did they know about the body? How did they treat and prevent illness? What did they think caused disease? Limited Herbal remedies Charms and spells Trephining Gods Evil spirits They could identify some parts of the body but they did not understand what they did Herbal remedies Charms and spells Simple surgery Personal hygiene Gods Food rotting in the channels in the body They could identify some parts of the body and began to understand some of its working Herbal remedies Charms and spells Simple surgery Personal Hygiene Observed observation Rest Diet and exercise Bleeding Gods The humours in the body out of balance They could identify some part of the body and understood some of its working i.e. that the brain controls the body (Galen) Herbal remedies Charms and spells Simple surgery Personal Hygiene Observations Rest Diet and exercise Bleeding Public health schemes Gods The humours in the body out of balance ` 15

16 The Middle Ages (AD ) The Roman Empire collapsed and with it all the advancements it had made. To replace the empire were small kingdoms that fought each other. It appears that war became the prerogative not education and the arts. The result? What was the big idea for medicine during the Middle Ages? So, you want to know what the big idea was? Well, our big idea is that we don t have new ideas! That s right! In the Middle Ages people believed that they must respect tradition and the old ideas are the right ideas. Because most of the effort went into funding wars little money was spent on education. The majority of people were unable to read the work of Hippocrates or Galen, therefore, few people were able to train to be doctors. If you were rich you may be able to afford a doctor but if you were poor, like the majority of people, then you turned to women. Women did what they always did help the sick using traditional methods passed down from the Egyptians, Greeks and Romans. Did herbal remedies actually work? Scientists have analysed many herbal remedies. They have discovered that many herbs would have helped to cure illness. 16

17 The Middle Ages was not one continuous era but can be divided into roughly 3 phrases Phase 1 Chaos in Western Europe (AD ) Phase 2 The growing power of the Christian Church (AD ) Phase 3 Things start to change in the late Middle Ages (AD ) Small kingdoms and tribes were often at war with each other Wars destroyed the Roman public health systems. It also destroyed medical libraries. The rulers of small kingdoms and tribes built up defences and armies rather than improving medical skills or invest in public health. War disrupted trade so countries became poorer. Travel became more dangerous thus reducing communication between doctors. Education and the development of technology were disrupted. In Europe the training of doctors was abandoned. Copies of Galen s book were lost, destroyed or hidden away for safety. Christianity survived the collapse of the Roman Empire and became very powerful during the Middle Ages. They sent missionaries throughout Europe to convert pagan tribes and kingdoms. Each village had its church and priest who told people what to believe and how to behave. Conservatism: The pope and his bishops were afraid that new ideas would challenge the power of the Church. Every new idea was checked to make sure it did not challenge the Bible. Education: Monasteries controlled education. Priests and monks were often the only people who learned to read in this period. The monasteries also controlled what people read. The only libraries were in monasteries. The Church sometimes banned book which they did not want people to read. Superstition: The ancient Greeks had looked for rational explanations. The Church taught the opposite that there were supernatural explanations for everything. People believed that God, the Devil, or the planets controlled their lives. After about AD 1000 Europe had begun to recover from the period of Chaos. Reasons why? Harvest improved Trade increased Scholars travelled more freely There was more money around The Church also became richer By the 1300s The Church had set up universities where doctors could be trained Armies took trained doctors to war with them where they gained experience as surgeons on the battlefields Rulers were again taking measures to clean up towns Merchants and scholars were once again travelling around Europe, spreading ideas 17

18 What about those who did become doctors? How did they train? In AD 900 the first university medical school in Europe was set up Old manuscript/books of Galen were rediscovered and translated In the late Middle Ages anyone who wanted to be a doctor had to attend medical school What were they taught? Attended lectures to learn about the work of Hippocrates and Galen and other medical thinkers In the later stages of the Middle Ages students were allowed to dissect one corpse a year (in the early stages of the Middle Ages the Church disallowed any dissection). They were taught anatomy by book and dissection Take the Hippocratic Oath Took lessons on Astrology stars and planets Could women become doctors (as they had during the Roman period)? Women were not allowed to attend university, thus they were unable to become doctors. Instead they continue to carry out much of the everyday medical care in town and villages like they also had before. Women could be midwives and surgeons. Surgeons are not the surgeons of today they were untrained and had no link to doctors. Did surgery improve during the Middle Ages? Surgeons were not taught at universities. People became surgeons by being apprenticed to another surgeon, watching his or her work and copying it. However, master surgeons had to have a licence and sometimes take lengthy examinations. Yes 18

19 No For pain they used a basic anaesthetic using a mixture of hemlock, henbane and wine (called Dwale) Against infection (outside of body) they would use wine and/or ointments to clean and dress the wound To pinpoint pain some surgeons used the planets and stars Unable to stop the bleeding Unable to stop infection inside the body How did hospitals treat their patients? Unlike the hospitals of Ancient Greece and Ancient Rome hospitals during the Middle Ages did not treat everyone or those who were admitted never met with a doctor. Hospitals during the Middle Ages were staffed by women, usually nuns, and priests. A doctor may be called in if the patient had the money to afford one! Who were not allowed in? People with infectious diseases (i.e. flu) Pregnant women No intolerable people People with wounds People who are cripple People who were considered insane How did they treat those patients who were allowed in? Herbal remedies Prayer Attending church service in the hospital chapel 19

20 A Case Study: The Black Death After the collapse of Rome Europe slipped into a dark age with war running the treasury dry, travel became dangerous and trade between other civilizations became nonexistent. However, in the later Middle Ages many things began to improve including trade but with trade increasing so did the risk of infectious diseases. Europe was devastated by a series of plaques known as the Black Death from Some historians have estimated that 40% of the European population died. What types of plague were there? 1. Bubonic plague made people suddenly feel very cold and tired. Painful swelling (Buboes) appeared in their armpits and groin and small blisters all over their bodies. This was followed by high fever and severe headaches. People would die within days. This form of Black Death was spread by fleas. 2. Pneumonic plague attacked the victim s lungs, causing breathing problems. Victims began to cough up blood and died more rapidly than those who had bubonic plague. This form of Black Death was spread by people breathing or coughing germs onto one another. How were they buried? A London chronicler in the Middle Ages wrote: they dug broad, deep pits and buried the bodies together and, reducing everyone to the same level, threw them into the ground treating everyone alike except the more eminent (i.e. King) 20

21 How did people respond to the plaque? Many waited and hoped that their families would survive The Church sent out orders for churchmen to lead processions, pleading with God to end the plague. The Flagellants wore white hoods with red crosses on them and they would walk through towns and villages whipping themselves drawing blood as a way to ask God for man s forgiveness Some people made candles their own height and lit them in church as an offering to God In Barcelona the townspeople encircled the town with candles A pope lit a large fire around him and sat in the middle Some believed that you should avoid eating too much Avoid taking baths Light fires in your room at night during the winter Inhale perfumes every morning Many of their responses are linked to the four humours, theory of the opposites and supernatural superstition. During the summer eat cold things What did they think caused the Black Death? 1. The body s humours were out of balance 2. The movement of the sun and planets 3. God and the Devil 4. Invisible fumes or poisons in the air (Miasma theory) 5. Some common sense ideas i.e. dirty towns and villages 6. Blocked digestive systems 7. Some people blamed Jewish people 21

22 8. Disrespecting God drinking and gambling, etc. The plague returned to England in the 17 th century. The same causes and responses were thought of as were used during the middle ages! Who helped the sick and dying? Plague doctors: Plague doctors would wear heavy garments, a hood with a beak filled with sweet smelling herbs. 22

23 The Crusades and Medicine In 1096 Pope Urban II called for a Christian Crusade to wage war against the Muslims in the Holy Land to take control of Jerusalem. The Europeans defeated the Muslim armies and took control of Jerusalem and the Holy Lands in Wars between the Europeans and Muslims throughout the rest of the Middle Ages. In doing so it became apparent that the Roman Middle East did not follow the same path as Roman Europe. Instead of making limited progress the Muslims were in the midst of a golden age in medicine. What did Muslims do? They translated the books of Hippocrates, Galen and other ancient medical writers The used ointments and herbs Believed in the four humours and the Greek and Roman ways to balance them i.e. blood letting Basic use of ligatures How did the Islamic religion help in the development of medicine? Help The Quran teaches that caring for the sick is important Hindered Religious law said that human bodies could not be dissected Muslim doctors believed that all important information about how the body works had already been discovered anyway (I.e. in the Quran, books of Hippocrates and Galen) 23

24 Summary Comparison of the Ancient World and the Middle Ages Who treated the sick? What did they know about the body? How did they treat and prevent illness? What did they think caused disease? Prehistory Ancient Egypt Ancient Greece Ancient Rome Middle Ages Priests Priests Priests Priests Specialist Trained doctors Trained doctors Trained doctors doctors Women Women Surgeons Women Women Medicine Men (Shaman) Women Limited Herbal remedies Charms and spells Trephining Gods Evil spirits They could identify some parts of the body but they did not understand what they did Herbal remedies Charms and spells Simple surgery Personal hygiene Gods Food rotting in the channels in the body They could identify some parts of the body and began to understand some of its working Herbal remedies Charms and spells Simple surgery Personal Hygiene Observation Rest Diet and exercise Bleeding Gods The humours in the body out of balance They could identify some parts of the body and understood some of its working i.e. that the brain controls the body (Galen) Herbal remedies Charms and spells Simple surgery Personal Hygiene Observation Rest Diet and exercise Bleeding Public health schemes Gods The humours in the body out of balance Same as the Greeks and Romans Herbal remedies Charms and spells Simple surgery Personal Hygiene Observation Rest Diet and exercise Bleeding Public health schemes God The humours in the body out of balance 24

25 The Medical Renaissance (AD ) The Medical Renaissance was period of major medical breakthroughs in anatomy, physiology (understanding how the body works) and surgery. Yet, even though medical knowledge improved it had no noticeable effect (but it did lay the foundations for future discoveries) on people s health because they still did not know what caused illness or disease. There were three individual geniuses who stood out from the rest during the medical renaissance Who were they? 1. Andreas Vesalius 2. Ambroise Pare 3. William Harvey Andreas Vesalius Ambroise Pare William Harvey Country of Belgium France England origin Born death Specialism Anatomy Surgery (A war surgeon) What was being done or thought of before? Impact? Challenge to Galen? Influenced by? Doctors believed that the book of Galen and other ancient doctors were completely accurate and contained all the knowledge they needed. Therefore there was no need to learn more about anatomy by dissecting human bodies. Vesalius showed that Galen was wrong in some important details of anatomy. The Human jaw is not two pieces but one That the septum in the heart does not have holes Also, he provided the medical world with detailed examinations and studies of the human anatomy He proved Galen wrong. There are no holes in the septum in the heart The human lower jaw is one bone not two Art Renaissance, Technology (printing press) Wounds were treated by pouring boiling oil onto them. Doctors believed this would help them to heal. They stopped a wound bleeding by sealing it with a redhot iron. This was called cauterising. Pare discovered that: Wounds healed more quickly if boiling oil was not used Instead simple bandages with ointments works better He stopped cauterising wounds Instead he used ligatures to close arteries His work is reflected in the treatments of the Ancient Greeks and Ancient Romans. War, chance, Technology (printing press) 1. Blood circulation 2. Using scientific methods Many doctors still believed in Galen s idea that new blood was constantly being manufactured in the liver to replace blood that was burnt up in the body in the same way as wood is burnt by fire. Harvey showed that: Ideas must be supported by evidence. Blood flow around the body The blood is carried away from the heart by the arteries and returns to the heart in veins He proved that the heart acts as a pump Blood does not burn up And the liver does not produce blood He proved Galen wrong. Blood was not created in the liver Blood did not burn up in the body Technology (the water pump, printing press) 25

26 Other changes that helped in these new discoveries Better education: Literacy was increasing and there were many more schools in the 16 th and 17 th centuries Increase in wealth People were willing to challenge old ideas by experimenting they could prove whether their theories were correct Other ideas were being challenged Copernicus said that the earth travels around the sun, not the sun around the earth Improved technologies for example, better microscopes, water pumps, machines Did the work of Vesalius, Pare and Harvey or others have an immediate effect on the work of healers and on their patients? Other prominent healers during the medical renaissance Born death Who were they? Grace Midway Richard Wiseman Treating the plague James Woodforde Wealthy lady of the house Surgeon to King Charles II Parson and diarist Old ideas The four humours Bleeding Herbs and ointments The four humours Oil to cauterise Astrology God and the Devil Superstition Herbs and ointments The four humours New ideas from: Vesalius Pare Harvey Others? Grace Midway was influenced by a German physician and chemist. Paracelsus ( ) believed that Galen was wrong and believed that disease attacked from the outside of the body. Thus, he devised mineral remedies with which he thought the body could defend itself. He was influenced by the work of Pare but believed that in times of battle on sea or ground that the easiest and quickest way to deal with a womb is to use oil. Ligatures was a slow process and many still died from infection Nothing really made a difference He was influenced by the work of Lady Mary Wortley Montague who brought back to England the concept of inoculation which saved people from small pox 26

27 The medical renaissance was the start of new thinking and experimentation in medicine. Yet, although medical knowledge drastically increased, generally public health remained similar to that of the Middle Ages and the ancient world. Many consider this era to the laying of the foundation for future discoveries to happen. Many discoveries were before their time and made little difference to the lives of the people of the time but made a massive impact on future generations. For example: Discovery Immediate impact? Impact on future generations? Pare Use of ligatures Limited impact. Yes, it was better than cauterising but the process was slow and many people died from internal infection. Yes, once doctors were able to eliminate infection inside the body (300 years later) Pare s work became very relevant. Pare s use of ligatures is still used today! Stopped using oil instead treated with bandages and ointments Yes, it made an immediate impact. There was a higher survival rate against infection than those treated with hot oil. Yes, the use of bandages and ointments are still used today. Harvey Blood circulation No impact. Yes his work laid the foundation for future discoveries in the 20 th century. Blood types Blood transfusions Vesalius Anatomy Limited, his work challenged Galen and he encouraged all doctors to dissect. Yes his work laid the foundation for 19 th and 20 th century surgery and the study of anatomy. Surgeons were able to perform complex surgeries 27

28 Where would you go for treatment? Licensed healers Unlicensed healers Who? Description Who? Description Fully qualified doctors who had The first person to treat nearly Physician studied fourteen years at university they were all men They knew the work of Galen and other writers such as Vesalius, Pare and Harvey They charged large fees Family all sicknesses was the wife of mother of the patient Surgeon Apothecary Midwife Men and women Trained as apprentices Given licenses by the local bishop Charged fees Looked down on by physicians Sold and mixed medicines that had been prescribed by physicians Charged a small fee Licensed by the local bishop Supervised the last week of pregnancy Delivered babies If there were complications at birth a physician would intervene Lady of the Manor Wise women Travelling quack Girls from wealthy families were expected to learn how to treat illnesses and common injuries Ladies treated people in their village and local arms as well as their own families and servants Example: Lady Grace In every village and town there were wise women who local people trusted Deep knowledge of herbs and treatments But if a treatment went wrong women could be accused of being a witch Every fair and market had someone trying to sell cure-alls Travelled the country Most took people s money and ran! How did the status of women healers change? The role of women in medicine began to change during the medical renaissance. Women were still the first to treat illnesses in families, become a surgeon and midwives but with new technology and wealth their roles began to diminish. 1. Treating illness: families with money may turn to the Lady but usually would have a personal physician 2. Surgeon: Women were being excluded from education and this type of discrimination began to take hold when applying for apprenticeships to become a surgeon 3. Midwife: In 1620 Peter Chamberlain invented obstetric forceps, used to deliver babies. However, anatomical knowledge was needed to use it and since only men were able to study anatomy at university they began to replace midwives. 28

29 The Industrial Revolution (AD ) During the Industrial Revolution the development of medicine accelerated beyond that of the Ancient world and the Middle Ages. What is even more impressive is that health began to actually improve in line with the new medical advances! Why had they stopped reading Galen in the nineteenth century? The work of Galen had dominated the development of medicine for 1500 years up to the Industrial Revolution. However, the advances in medical knowledge during the Medical Renaissance began to chip away at his authority. The final nail in the coffin was in 1861 when Louis Pasteur of France discovered the germ which forever changed our approach to illness and treatment Knowledge of the world New understanding of the body In the 1500s Vesalius had begun a revolution in the understanding of the human body. He showed that Galen s descriptions were incomplete and, sometimes, even wrong. He encouraged all doctors to do their own dissections on human corpses rather than relying on Galen s work. The microscope The invention of the microscope helped further to undermine Galen s work. For example, it proved that Harvey s ideas were right. From 1600s doctors and scientists increasingly used microscopes to investigate medical details which Galen could not possibly have discovered. Galen was simply irrelevant to such work. Why did they begin to fall out of love with Galen? Training of doctors These new ideas and techniques were being spread through better training for doctors. It became part of their training to carry out dissections, to use microscopes and to think scientifically. Galen s books were no longer important. The Church was no longer in control of medical training and education. Scientists gradually discovered that many ancient ideas about the natural world particularly the Greek theory of the four elements which had formed the basis of the four humours were wrong. For example, they discovered that air itself is made up of different gases. New explanations for disease It was difficult to disprove the theory of the four humours by experiment, but by the nineteenth century scientists did not accept it as an explanation of disease it simply did not fit in with their new understanding of the natural world. They developed their own explanations of disease based on careful observation and research. The most popular theory in the early 1800s was bad air (miasma theory), but in 1861 they discovered the answer germs! 29

30 How did changes in the nineteenth century affect medicine and health? Urbanisation The growth of towns created many health problems. Poor housing and infected water supplies made killer diseases spread more rapidly than ever before. Technology New technology helped medicine. For example, development in steel-making helped to produce a thin syringe needle that did not break; improvements in glass-making led to better microscopes lenses and the first thermometer. War Major wars during the period affected development in health. For example, the Crimean War in the nineteenth century, led to improvements in the standards of nursing and hospitals. Political change In 1800 Parliament believed it should not interfere in people s lives. If people were unhealthy that was their business! (Laissez-Faire) By 1900 Parliament was making laws to improve people s health in a way that would have been unthinkable in the early 1800s. For example forcing towns to install sewers or implement vaccination programmes. Entrepreneurs Medicine became big business. Some entrepreneurs made millions of pounds from almost useless remedies. However, others put money into scientific research to find drugs which would help to cure disease. Scientific medicine Science helped medicine. Scientists discovered the links between germs and disease. Chemists researching the properties of different substances found, for example, a gas which could be used as an anaesthetic and a dye which killed bacteria. Improved communications Communications were revolutionised in this period. Faster trains allowed scientists and doctors to gather at conferences and learn from each others ideas. By 1900 you could get a train from London to Paris in less than a day. There were more newspapers and improved education meant more people could read. News could be reported more quickly because of the invention of the telegraph. For example, details of important scientific experiments carried out in France were reported in British newspapers the next day. 30

31 What did people die of in the nineteenth century? Here are about a few Disease Method of Infection Symptoms Who? TB (Tuberculosis) The bacteria spread in the tiny droplets of moisture produced when coughing Coughing with blood stained spit, weight loss and chest pains Everyone Smallpox Cholera Whooping cough Measles The virus is spread like flu from person to person by coughing or sneezing and by touching an infected person Acquired from contaminated water The bacteria spread through droplets of moisture produced when coughing and sneezing; very infectious The virus spreads through droplets of moisture produced when coughing and sneezing; highly infectious Starts with a rash that develops into pus-filled blisters. The blisters become crusty and fall off leaving deep scars or killing the victim Watery diarrhoea and sickness followed by rapid dehydration and death, sometimes within 24 hours. Fits of coughing Catarrh, rashes across the body Everyone Everyone Children suffered more with it than adults Mainly children What were the major killers? 1. Smallpox 2. Cholera 3. TB Smallpox victim Also, infant mortality was extremely high. Our record starts in 1801 (the first census for the United Kingdom). During the 1800s, out of 1000 live births, over a 100 new born babies would die compared to just 4.6 today! 31

32 There are 8 major players during the Industrial Revolution who lead the charge in the discovery the cause of illness, treatments and research. Who are they? 1. Edward Jenner: (1798) Vaccine for smallpox 2. James Simpson: (1847) Discovered anaesthetic 3. Florence Nightingale: (1850) Developed new attitudes towards health and cleanliness 4. Edwin Chadwick 5. John (1854) Snow Realised that there was a link between dirt and disease 6. Louis Pasteur: (1861) Discovered the germ 7. Robert Koch: (1875) Proved Pasteur s theory 8. Joseph Lister: (1867) Discovered antiseptics What did they do and what impact did they have on the development of medicine? Player 1: Edward Jenner What did he do? 1798 Discovered a vaccine for smallpox Story behind the discovery Impact Any opposition to his discove There were already inoculations for smallpox introduced by Lady Mary Wortley Montagu in BUT inoculations were dangerous because it involved using the disease itself! Despite the dangers it could work and doctors made a lot of money. He observed the fact that milkmaids who caught cowpox seldom contracted smallpox during outbreaks He set up an experiment to test whether cow pox could prevent small pox. He used 23 different people giving each cowpox and then exposing them to smallpox It Showed the value of careful observation and experimentation In 1803 doctors were using the technique in America In 1805 Napoleon vaccinated his army against smallpox By 1812 his work was being translated in the Middle East and sold in Central Asia In 1852 vaccines were made compulsory by the government against small pox Once the germ was discovered vaccines were created for hundreds of diseases Vaccinations are still used today Som people simply did not like anything new the ideas sounded odd Sce thought it was unbelievabl that a disease that comes f cows can protect people fr human diseases Jen could still not offer any explanations to why it wor he only had the evidence t worked Doc who were making money o inoculations did not want t lose that income Vac could be dangerous if not properly mixed 32

33 worked and he had evidence to support it Jenner developed the first vaccine (but he still did not know why it worked) What is the difference between an inoculation and a vaccine? An inoculation is when you are given a weakened form for the disease which allows the human immune system to attack it and create antibodies to attack future infection, whereas, a vaccine is when a person is given a similar, but, safer disease which will do the same thing as an inoculation. Player 2: James Simpson What did he do? 1847 Discovered anaesthetic Story behind the discovery Impact Any opposition to his discovery? James was a professor of midwifery at Edinburgh University He hated the pain that women went through during childbirth he was determined to find a way to help them He set up an experiment with some friends. He poured chloroform into three glasses and then they inhaled the fluid. They collapsed onto the floor and were unconscious for over a minute When they awoke they had cuts and bruises but had felt no pain! It stopped pain during surgery and childbirth It allowed doctors more time to operate inside of the body It allowed doctors to take more care when operating inside the body It allowed doctors to carry out more complex surgeries Used by Queen Victoria to give birth in Anaesthetic is still used today for surgery and childbirth Many believed that pain was a gift from God Many believed that pain at childbirth was women s punishment for the first sin Pain is what makes us human It was dangerous if too much was used Some doctors got carried away and caused more damage than good Player 3: Florence Nightingale What did she do? 1850s New attitudes to health Story behind the discovery Impact Rival She grew up wealthy and decided to train as a nurse She helped soldiers on the front line during the Crimea War in Cleanliness can improve health Reorganised hospitals Reformed hospital procedures more light, Mary Seacole was a black nurse who also helped soldiers on the front line of the Crimea War in 1854 She 33

34 and cleanliness 1854 After rearranging the front line hospitals focusing on cleanliness the death rate of wounded soldiers sharply declined making her very popular to the soldiers and people in England who heard about her work in the newspapers On her return to the United Kingdom she worked to improve hospitals and nurse training open windows for fresh air, beds needed to be changed on a daily basis Nurse training Her ideas were supported by the discovery of the germ in 1861 Her attitudes to health and cleanliness is believed today paid her own way to Crimea to help She believed in cleanliness but she was popular with the soldiers because she allowed them to drink and enjoy themselves She fought racial prejudices throughout her career Her and Florence Nightingale never really saw eye to eye Player 4 and 5: Edwin Chadwick and John Snow What did he do? Story behind the discovery Impact Any opposition to his discovery? 1854 Edwin Chadwick Both Edwin Chadwick Link between dirt and disease Edwin Chadwick worked for the government and in 1831 after another deadly cholera outbreak he was asked to investigate whether disease was linked to unhealthy living conditions His report, which was completed in 1842, painted a filthy picture of England. He made many recommendations: cities and towns needed sewers, waste collection and a doctor in every town John Snow In 1854 another deadly cholera led John Snow to prove that it was due to contaminated water He proved that the a cesspool 1848 Public Health Act: legislation to encourage local authorities to clean up but would not provide money or force local authorities to do so but it was a start Public Health Act: No more laissez-faire philosophy to governing. This act forced local authorities to clean up their towns. Many of, if not all, of the required measures were taken from the research and recommendations proposed by Chadwick and Snow. The government - They did not take the report serious - His recommendations would cost too much - They believed that government should not interfere in people s lives - They took a hands off approach to governing (laissez-faire) 34

35 (waste dump) was leaking into the water supply on Broad Street Thus, anyone who had used the Broad Street water pump were the ones affected with cholera He removed the handle to the pump and no more cholera in that area he made the link! He now had his own and Chadwick s evidence and research to prove it What did the 1875 Public Health Act say that local authorities had to do? 1. Provide clean water 2. Build sewer systems and provide proper drainage 3. Appoint a Medical Officer of Health The act was passed for many reasons: scientific developments proved that Chadwick and Snow were correct, horrifying statistics, new voters (the working class was able to vote), weakening of laissez-faire philosophy to governing and the improvement in education Player 6: Louis Pasteur What did he do? 1861 Discovered the germ Story behind the discovery French scientist Louis helped a brewing company to find out why their alcohol was going bad. With the use of a powerful microscope he discovered tiny bacteria germinating (growing) in the liquid. He called them germs He boiled the liquid and the germ died Louis then set up a science laboratory with a research team to continue to expand of his discovery Proposed the germ theory that decay, illness is caused by microorganisms (germ theory: germs cause disease, they are airborne, killed by heating) Most of Louis early work was with animals A member of his Impact The germ theory opened the door to modern medicine The germ theory led to many discoveries to vaccinate against deadly diseases which had an immediate effect on people s lives Pasteurisation of dairy products (boiling milk to kill off bacteria that causes products to decay or go sour) Maximised the potential research groups can provide Proved that Hippocrates and Galen were wrong about the four humours Proved that God did not cause illness Germ theory still very important today Competition between him and his rival Robert Koch accelerated research resulting in the discover 35

36 research team accidentally injected a chicken with old germs but the chicken did not die. He realised that the body had become immune by attacking the weaker germs this proved Jenner s work! His rival was Robert Koch of Germany of new vaccines Dispels the theory of spontaneous generation Player 7: Robert Koch What did he do? 1875 Proved Pasteur s theory Story behind the discovery German scientist who was very interested in Pasteur s germ theory He discovered that the germ theory could be used to cure or vaccinate against human diseases something Pasteur had not done by studying anthrax which affects animals and humans He was meticulous in his research Discovered that you can stain certain bacteria to observe them under a microscope His discovery spurred Louis Pasteur into action. Impact Vaccines for numerous diseases: TB and Cholera Maximised the potential research groups can provide His work led to many discoveries to vaccinate against deadly diseases which had an immediate effect on people s lives Staining bacteria lead to faster identification and influence teams of researchers to find cures to disease Did germ theory help scientists cure diseases? Louis Pasteur and his team 1880 Typhus 1894 Plague 1884 Tetanus 1898 Dysentery 1886 Pneumonia 1887 Meningitis Robert Koch and his team 1882 Tuberculosis 1883 Cholera Player 8: Joseph Lister What did he do? 1867 Discovered antiseptics Story behind the discovery Impact Any opposition to his discovery? His father developed better microscopes Lister had the best medical training He was a surgeon in Glasgow and later in London Even after successful operations, patients often died because their wounds became infected Lister wanted to find a way His discovery had an immediate impact because survival during and after surgeries drastically improved due to a decrease in death because of infection Doctors across the United Kingdom and beyond began to use his ideas Operating theatres became cleaner more sterile Longer Some doctors believed that Lister s recommendations were impractical - The antiseptic hurt their hands chapped them - it was costly (the spray and gloves) - slowed operations down 36

37 to stop it Lister read Pasteur s work on bacteria. He thought that bacteria might be causing the infections He used carbolic spray to kill these bacteria it worked he had found a way to kill infection (on the outside of the body) and more complicated surgeries became possible as the danger of infection was reduced How did surgery improve during the nineteenth century? Problem with surgery Description How did it change in the 19 th century? Pain Surgery was incredibly painful. Discovery of anaesthetics (chloroform) by James Simpson in 1847 Infection Many patients died after surgery due to infection inside and outside of the body Discovery of Germ Theory by Louis Pasteur in 1861 The work of Robert Koch in proving the germ theory Discovery of antiseptics by Joseph Lister in 1867 (outside of body) *Inside of body was solved with the discovery of penicillin by Alexander Fleming and its mass production in 1944 Bleeding Doctors were unable to stop the bleeding or give the patient more blood Discovery of anaesthetics (chloroform) by James Simpson in 1847 allowed doctors to use ligatures to tie off arteries and veins *Blood transfusions and the discovery of blood types came in the 20 th century What about women can they finally become doctors? What were the problems? The main problems were prejudice and discrimination. Women were viewed as inferior to men (not as smart or able to perform as a doctor) 37

38 Women were unable to attend university. Since you had to attend university to be a doctor there were not women doctors (This rule is from the Middle Ages and Medical Renaissance) Lectures would be unable to teach at a high level if a woman was present in lesson A belief that they should be housewives and stay at home to raise the children 1852 the government introduced the Medical Registration Act which required all doctors to belong to one of the Colleges of Physicians, Surgeons or Apothecaries all were closed to women. What changed? Elizabeth Garrett that shook the world of medicine In the 1860s Elizabeth Garrett worked as a nurse during the day but attended lectures at Middlesex Hospital Elizabeth passed all medical examinations but she was unable at first because she could not join the Colleges of Physicians, Surgeons or Apothecaries However, she did become the first female doctor She became a role model for other women and the tide slowly turned in their favour. 20 th Century medicine The 20 th century continued on with the discoveries made in the late 18 th and 19 th centuries. War has always played a role on the development of medicine but World War I and II were wars never seen 38

39 before. New technologies caused unimaginable injuries and deaths but medicine adapted and new discoveries brought major benefits and improvement to our health. How did World War I improve medicine and health? Surgery Millions were wounded, giving surgeons the opportunity to experiment with new techniques. Surgeons developed new techniques to repair broken bones and to perform skin grafts (the basis for plastic surgery)! Head wounds were particularly common. Surgery to the eye, ear, nose and throat all improved rapidly. Even brain surgery advanced. X-rays X-rays were discovered before the war in During the war they were used very successfully to find bullets and shrapnel lodged in the body. Governments paid for more x-ray machines to be made. Bleeding The deep wounds made by bombs and machine-gun fire meant that many soldiers were bleeding to death before they could be operated on. Blood transfusion was used effectively for the first time. Methods of storing blood and transporting it were improved. Housing The poor health of recruits to the army made the government very worried about their living conditions at home. This made the government more eager to improve health care at home (in the UK). The soldiers who fought in the war were promised good housing when they returned homes for heroes. This speeded up the process of getting rid of unhealthy slum housing in Britain. Over 700,000 new homes were built in the 1930s. List of major improvements because of World War I: 1. X-rays 2. Bleeding blood transfusions, storing blood 3. Fighting infection 4. New techniques to repair broken bones 5. Improved methods of grafting skin 39

40 6. Improved surgery of the eye, ear, nose and throat 7. Successfully attempted brain surgery What was the impact of World War II on medicine and health in Britain? 1. Blood transfusion: This further improved during WWII. Blood could be stored for longer. Civilians donated blood. 2. Diet: Rationing improved some people s diet. The government used posters to encourage healthy eating. 3. Drugs: Penicillin was developed the first antibiotic (kills infection inside the body). 4. Poverty: Over 1.5 million children were evacuated from the cities to the countryside. The experience highlighted for everyone the living standards of rich and poor. It increased the commitment of the government to fight poverty more seriously after the war. 5. Surgery: Further advances were made during WWII in the use of skin grafts and the treatment of burns. 6. Hygiene: Government posters educated people about basic health and hygiene. 7. Disease: The government launched its national diphtheria immunisation campaign. 8. The National Health Service (NHS): In 1942 William Beveridge, a leading civil servant, proposed that there should be a free health service for all. Why does war improve surgery? 40

41 Thinking of factors The government appears to play a massive role in the development of medicine and health during the 20 th century! Here are more examples! A Case Study: The Development of Penicillin 41

42 The story of the discovery of penicillin begins with Paul Ehrlich. Ehrlich was part of Robert Koch s research team. Koch had shown that certain dyes sought out certain bacteria (staining). Ehrlich was fascinated by the way the body created anti-bodies which killed the bacteria but did not harm anything else. He compared the anti-bodies to magic bullets. Ehrlich was convinced that a chemical could be found which might to do the same. In search of magic bullets Magic bullet 1: Salvarsan 606 In 1905 he began looking for a chemical magic bullet to treat syphilis. He tested 605 chemicals with no success but 606 worked! Although, it was dangerous to use and could kill the patient he had proved that a chemical compound could be used to destroy bacteria. Hence the name Salvarsan 606. Magic bullet 2: Prontosil In 1932 Gerhardt Domagk tried out Prontosil, a red dye. He tested it on mice and it worked. Domagk got an opportunity to test on humans much sooner that he had expected. His daughter accidentally pricked her finger on a contaminated needle contracting severe blood poisoning. With his daughter near to death, Domagk decided to risk using Prontosil even though he had not tried it on any human before. He gave her a large dose. She recovered. The second magic bullet had been found. It was years later that scientists realised that the active ingredient in Prontosil was Sulphonamides the race was on to find more diseases it could cure! When was penicillin discovered? 42

43 Penicillin itself is made for a mould called penicillium. Several scientists and doctors trialled penicillin in the late 1800s but nothing came from it. It was only in 1928 that Alexander Fleming rediscovered it. Alexander Fleming What did he do? 1928 Discovered Penicillin Story behind the discovery Discovered by chance Fleming was in his laboratory surrounded by innumerable dishes. He was checking each dish to whether they had been contaminated (when a dish is open anything from the air can fall in) As usual many had certain moulds growing inside Except for one there was no mould and the colony of staphylococci had been dissolved But how? He found that he had left a window open that penicillin bacteria had come through and landed in the dish. He tested the theory and every time the penicillin killed off the bacteria. He was motivated by the suffering he saw as a doctor in WWI Impact Short term He demonstrated through research and supported by evidence that penicillin can kill infection BUT he was unable to mass produce it or had the facilities needed to mass produce it Influenced other research teams to research penicillin Long term Still used today to kill infections inside the body Revolutionised treatments and cures Influenced Chain and Florey who took the development of penicillin to the next level human testing and mass production How was penicillin developed? Fleming did not have enough money or government support to continue experimenting with penicillin. It would be in 11 years after his discovery that penicillin would be back on the agenda. In 1939 two scientists from Oxford, Howard Florey and Ernst Chain gathered together a research time to develop penicillin. After the outbreak of WWII they asked the British government for funding which they got. There were three stages to the development of penicillin: Stage 1: Growing penicillin Stage 2: testing the penicillin on animals Stage 3: the first human trial of penicillin (the first patient died but the trial confirmed it worked) The problem now was how to mass produce it! How was penicillin mass produced? 43

44 To mass produce penicillin more research and investment would be necessary to produce a large quantity of doses. In Britain there was threat of German bombing so Florey and Chain turned to America. Once America entered the war the situation changed. The American government contribution to the mass production of penicillin: 1942: gave $80 million to four drug companies to find a way to mass produce penicillin By 1943: the first batch was ready it was first used by the British army in North Africa By 1944: enough penicillin had been produced to treat all causalities on D-day By 1945: the American army were using 2 million doses a month Penicillin: Why then? Government British government funded Florey and Chain s research in 1939 US government gave drug companies $80 million dollars in 1942 to start production of penicillin Technology Advances in all areas Industry New drug companies Individuals Fleming, Florey and Chain Scientific experiment Chance War Communications Timeline 1928: Fleming discovered mould (penicillin) can kill germs (factor: chance, individual genius) 1929: Fleming writes articles about penicillin (factor: communication) 1939: Florey and Chain are funded by the British government to research penicillin (factor: government) 1940: Penicillin used on mice 1941: Penicillin used on a human 1942: US and British governments co-operate to fund the production of penicillin (factor: government) 1944: Enough penicillin to treat all the allied forces wounded in the D-day invasion of Europe (factor: war) 44

45 From cradle to grave the National Health Services 1911 National Health Insurance Since the beginning of the 1900s the government had become increasingly aware of the health problems facing ordinary people. In 1911 the government introduced a National Insurance scheme. Workers and their employer made weekly contributions to a central fund. What did it do? Used for workers sickness benefit Free medical care from a panel doctor Problems with national insurance Only covered those who work Only the individual not families, many women and children did not have coverage The elderly, mentally ill and chronically ill were not covered The introduction of the National Insurance was a precursor to the creation of the National Health Service (NHS) 1948 National Health Service (NHS) By 1942 people were beginning to think about how the health system should be organised when the war ended. In that year William Beveridge put forward his ideas about a free health service. By 1944 the system was being planned and in 1946 a bill was introduced and passed by Parliament that officially created the NHS. The NHS officially started in What services did it provide? Hospitals Medical research Maternity and child welfare Health centres Vaccinations Ambulances Family doctors Medicines Dentists Home nursing Why did people oppose the NHS? 1. Local authorities and voluntary organisations: these bodies are who originally ran the hospitals before the government took them over. 2. The cost: argument raged over the enormous costs involved to the tax payer. 3. The British Medical Association (BMA): They represented the medical profession. Doctors did not want to be employed by the government and be told where to work, because they would no longer be able to sell their services. They feared that this would result in a loss of income. 45

46 Why was infant mortality so high? Why did infant mortality fall so rapidly after 1900? Housing: Many people lived in overcrowded, poor quality housing. These homes were damp, dirty and had no toilets. Diet: Parents and babies had poor diets. Disease: Infectious diseases spread rapidly, because vaccines had not been developed for some of the most common killer diseases. Medical care: Many parents could not afford medical care. Education: There were not enough trained midwives to help and give advice to new mothers. Some parents did not know how to keep their babies healthy. What changed why has infant mortality fallen? New vaccines Scientists created new vaccines to protect babies from deadly diseases. The government ran national campaigns to vaccinate all new born children. Midwives In 1902 the government said that all midwives must be trained. School meals In 1906 the government started to provide school meals, so that children of poor families could get some good food. Banned back to back housing In 1909 the government banned back to back housing and began to enforce building regulations. In the 1930s councils began to clear the slums. Education for mothers In 1919 local councils started clinics for mothers to be educating and advising them on health and hygiene. Penicillin (Antibiotics) The development of penicillin led to new vaccines and medicines that drastically improved people s health. National Health Service (NHS) In 1948 the NHS was set up. It provided free medical treatment and medicines for everyone. New technology Since the 1970s technology has advanced greatly: babies can now be scanned before they are born to check that they are healthy and premature babies can be kept alive when they would have died in

47 A Case Study: DNA the greatest discovery of all? DNA is inside every cell of your body. It is the code inside your genes. Genes decide everything about you. Even in the 1800s scientists knew that DNA existed and that it somehow controlled what we are like but that was all they knew. That was the case until: 1953: two scientists called Francis Crick and James Watson discovered the structure of DNA and how it passed on information from parent to children In the 1990s: the Human Genome Project began working out the exact contents of the DNA in the human body finding out exactly what DNA does. The information contained in one person would fill about 160,000 history textbooks. What is DNA? It is like a long list of instructions like a computer programme that operates in every cell of the body. There are more than 300 million letters of code in your body s programme. In the shape of a double helix These instructions are grouped together into sets of instructions called genes. Each gene has a different function. For example some genes decide your eye colour and some determine whether you will get a disease or disability. Everyone s DNA carries slightly different instructions which is why human beings are all different. Why was the structure of DNA discovered in 1953? Francis Crick and James Watson were great scientists. They were both experts and were very good at working together (factor: individual genius) Networking with other scientists (factor: communication) Crick and Watson were able to use the best equipment improved microscopes, x-ray photography, etc. (factor: technology) Huge sums of money from the government and other industries (factor: government) 47

48 In this section you will find how the seven factors helped or hindered the development of medicine through time Factors Religion War Government Individuals Science and technology Communications Chance i

49 Factor: Religion They believed that evil spirits were also in waste so they would use the toilet on the outside of camp Prehistory Ancient Egypt Help Hindered Help Hindered Believed that the Gods caused illness Promoted cleanliness to respect the gods. I.e bath daily in cold water, drink from clean bronze cups, shave their bodies Embalming allowed them to identify some organs They were not allowed to dissect bodies They had to bury the dead quickly so they were unable to examine bodies longer during the embalming process heart o comple Later MA Allowed the study of Galen Allowed one dissection per year Funded universities Funded hospitals Middle Ages Medical Renaissance Help Hindered Help Hindered Early MA Allowed No Galen dissections Restricted the training of doctors No dissections Taught the God and the Devil caused disease Later MA Taught that God and the Devil caused disease and illness All new ideas were made illegal only Galen could be studied Factor: War Only allowed for the study of Galen new ideas were looked down on Taught the God and the Devil caused disease Nightin her cal Prehistory Ancient Egypt Ancient Greece Help Hindered Help Hindered Help Hindered ii

50 Middle Ages Medical Renaissance Industrial Revolution Help Hindered Help Hindered Help Hindered During After Pare Florence the crusades MA doctors leant from the Muslim/Arab doctors the collapse of Rome money was diverted to build armies, produce weapons and attack other tribes or other kingdoms was a battlefield surgeon when he ran out of oil he used ointments and bandages which worked better than the oil Nightingale was a nurse on the frontlines of the Crimean War her work on cleanliness saved thousands of lives Factor: Government Prehistory Ancient Egypt Ancient Gre Help Hindered Help Hindered Help Built hospitals (Asclepions) Middle Ages Medical Renaissance Industrial Revo Help Hindered Help Hindered Help iii

51 Ordered the cleaning of cities during times of epidemics i.e. plague Diverted money away from education to fund wars with other tribes or kingdoms Governments were adopted Church views to illness superstition, later Galen s work Idea of Laissez-faire begins in the 1700s In 1830s Commissioned Chadwick to report on health across Britain Compulsory vaccinations in Public Health Act all councils must provide clean water, sewers and a health official 1876 laws against pollution of rivers Other laws were passed at the end of the 19 th century Factor: Individuals Prehistory Ancient Egypt Ancient Greece Help Hindered Help Hindered Help Hindered Hippocrates Erasistratus Herophilus Middle Ages Medical Renaissance Industrial Revolution Help Hindered Help Hindered Help Hindered Pare Vesalius Harvey Arab doctors Paracelsus John of Jenner Simpson Chadwick and Snow iv and Chain