Ideas about Causes of Disease and Treatments page 1 of 3

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1 1 Ideas about Causes of Disease and Treatments page 1 of 3 Summary the real cause of disease was unknown until Pasteur s germ theory in Previous to that main theory that was believed about cause and treatment was the 4- humours theory. Hippocrates, a Greek doctor, came up with this by observing that there were 4 elements, 4 seasons and thus he deduced that there were 4 humours in the body that needed to be kept in balance. Balance meant health, imbalance meant you were unhealthy. The Roman doctor Galen really believed this theory and belief in Galen is what kept the 4-humours theory as virtually the unquestioned approach to diagnosing and treating illness. In 1861 Pasteur came up with Germ Theory. It took a few years for it to be universally accepted. Once it was accepted then medicines, vaccinations could all be developed to treat illness more in the way that we think of things today. Key time periods/key Dates Greek Hippocrates was Greek Roman Galen was from the Roman period. Medieval 1. Influence of Islam -Islam encouraged medical learning as Muhammad said For every disease Allah (God) has given a cure -preserved books from of Galen and Hippocrates, hospitals treated patients not just cared for them, scientists encouraged to discover new cures -Knowledge from Islamic doctors spread via books that came to Europe via Italy. 2. Influence of Christianity -hindered medicine as it was believed that illness was a punishment from God. Prayers more important than drugs. Hospitals run by monks focus on caring not curing, believed in miraculous curing eg going on pilgrimage. Believed in helping sick as Jesus had helped healed the sick - From Medieval Supernatural and Natural Thinking 4-humours theory the main theory of the cause of disease the idea that the body is made of of 4-humours blood, phlegm, yellow bile and black bile. If the humours got out of balance then you were ill. The aim of any treatment was to restore the balance of the humours. Believed up until Germ theory of 1861 Purgatives things that induce vomiting or diarrhoea to restore balance Bleeding/Blood-letting treatment based on 4-humours theory restore balance by removing blood from the body. Done up until germ theory Ideas about what caused disease imbalance of humours, miasma, Superstitious causes eg God punishment from God for sins, astrology planets and stars aligned in a way to cause ill-health Ideas about Treatments natural eg herbal remedies (onions/garlic), praying to God, Urine Chart (medieval) used to diagnose illness physician would look at urine colour, taste it, smell it and use this to decide on a treatment Zodiac Chart would tell a physician treatment based on the astrology eg when to treat a person, what part of the body to take blood from Flagellants associated with Black Death of 1348 people who went from town to town whipping themselves in order to prevent getting the Black Death thought the cause was punishment from God Herbal Treatments wise women had a knowledge of herbs that would help 1 Hippocrates came up with the 4- humours theory. He was a Greek physician (doctor) Galen kept the 4-humours theory going for 100s of years (he was a Roman physician) Wise women associated with villages a women who had a knowledge of herbal remedies Apothecaries like a chemist of today associated with towns, you could buy remedies from them Ibn Sina (Avicenna) - Islamic doctor, wrote an encyclopaedia containing information on many drugs, it became the standard European medical textbook Rhazes Islamic Doctor- wrote many books, first doctor to distinguish measles from small pox Ibn-al-Nafis challenged Galen about the heart said it circulated via the lungs

2 2 Ideas about Causes of Disease and Treatments page 2 of 3 Key Dates 1500s 1600s The Renaissance 1798 First small pox vaccination 1853 Vaccination for small pox made compulsory Anti vaccine league set up opposing compulsory small pox vaccine 1861 Pasteur s Germ Theory 1870s 1890s many microbes for many diseases identified such as cholera, TB, anthrax, dysentery, typhoid and more 1880 Koch discovers the TB microbe. It was so small it was missed by other doctors First human vaccine rabies by Pasteur 1890s onwards many more human vaccines developed Renaissance (ideas about cause of disease the same as medieval, and most treatments the same) Renaissance a period of time of new inventions (eg the microscope, the printing press), travel to new lands (America, India, Australia), developments in art (more accurate drawings of the human body), development of scientific method New Herbal Remedies travel to the new world meant some new herbs for treatments eg opium, tobacco, cinchona bark (which is aspirin), Quacks travelling salesmen/conmen who sold cure-all medicines (up until the Victorian times) Culpepper s Complete Herbal book of herbal remedies printing press helped to spread this useful knowledge Blood-letting still a common treatment Early Modern (ideas about cause of disease the same as medieval and renaissance, and most treatments the same, although idea of God and 4-humours was fading, but still believed) Spontaneous Generation - as a cause of disease the idea that decaying, rotting matter turns into germs. New Theories - Contagionists believed that disease was person to person/anti-contagionists believed that disease came from environment thus cleaning/hygiene was important Small Pox biggest killer of the 18 th century Vaccination Jenner uses cow pox to make a vaccination for small pox 19 th Century/Victorian England Vaccinations against a range of diseases. Pasteur discovers how vaccinations work by doing work on chicken cholera. Anthrax Koch discovers the microbe but Pasteur develops the vaccine for it (for animals) Staining microbes/using photographic lenses enabled Koch to work out which microbe caused which disease. Magic Bullets chemical cures for disease discovered - First one was for syphilis in Renaissance Wise Women/Apothecaries the same as medieval Galen believed as in medieval Sydenham English doctor at this time Early Modern Inoculation for small pox - main way of preventing small pox Inoculators made a lot of money from it Jenner came up with vaccination for small pox 19 th Century Anti-Vaccine League opposed compulsory vaccination Pasteur - French scientist who came up with germ theory in Rival of Koch Koch German doctor who found out which microbes caused which disease. Rival of Pasteur

3 3 Ideas about causes of Disease and Treatments page 3 of 3 Key Dates 20 th century Modern Medicine 1928 Fleming discovers penicillin 1938 Florey and Chain 1953 Crick and Watson 1968 First British Heart Transplant 1980 Small pox eradicated 20 th century The real cause of disease and technological developments meant that huge advances in medicine have been made -from s - free vaccines for TB, diphtheria, whooping cough, tetanus, polio, measles, mumps, rubella all still offered today -hearing aids, organ transplants, open heart surgery, contraceptive pill, heart transplants, key hole surgery, IVF fertility treatment, small pox eradication, cancer treatment chemotherapy, prosthetics -growth of pharmaceutical industry growth of amount of drugs to treat illness, -growth of alternative medicine acupuncture, aromatherapy, homeopathy, -antibiotic resistance overuse of antibiotics has meant some diseases are resistant to them Fleming Motivated by his experiences in WWII and treating soldiers. Accidentally discovered penicillin by leaving dirty petri dishes Fleming discovered that the mould was killing the bacteria. Fleming thought it was an anti-septic not an antibiotic. He didn t test it, and therefore few people took Fleming s discovery seriously Florey and Chain able to prove penicillin worked to kill infection but got no funding to mass produce it. The American government funded this after Pearl Harbour attack of By the end of WWII penicillin was being mass produced Crick and Watson discovered DNA. Developments in hereditary illness could be made, as well as genetic screening and gene therapy 3

4 4 Public Health Medieval to Present Day page 1 of 3 Summary Public Health is when the authorities/government take an active role in helping people stay healthy by taking measures (doing things) to prevent illness. The authorities/government are able to do this by using taxes (rates) collected from the people. Today, public health is a priority for the government/society and we have full public health/full government intervention in that we have a free (at the point of access/using it) NHS, guaranteed clean streets due to rubbish collection, guaranteed clean water. It also extends to alleviating poverty as poverty and higher levels of illness were proven to be linked. This means taking measures/doing things to help keep people out of poverty, such as unemployment benefit or providing free school meals. Up until germ theory (1861), public health was not a priority. The authorities/government didn t intervene/get involved public health measures were reactionary and this means that the authorities/government might do some things in reaction to an epidemic. Examples of this are the Black Death 1348, The Plague epidemic 1665, and the Cholera outbreaks in the 19 th century. After germ theory began to be more accepted, there was more of a case to get the government to take an active role and to stop their laissez faire (don t get involved/don t intervene). This was coupled with the actions of individuals, politicians and some factors such as the Boer War. This led to the full government intervention that we have today Key Time Periods/Key Dates Roman Britain had good public health (aqueducts, latrines (privies) mainly because they needed to keep the army healthy. After they left Britain in 410 AD, all of these facilities and knowledge was lost Medieval Britain - Towns virtually non-existent public health overflowing cesspits, cesspits near wells/contamination of water supplies, animal waste on streets (waste from slaughter and faeces/poo), Attempts to clean the towns were made laws to encourage clean steets, most towns had privies, some towns got water from springs so water was clean Monasteries public health better there privies (toilets) put where waste would flow away, pipes delivered clean water, monks washed regularly clothes and hands/feet, hospitals to treat sick Renaissance after 1665 plague stricter quarantine laws prevent epidemic diseases coming to the country on ships From Renaissance to 19 th century public health still not a priority- no commitment to spend money on public health Public Health up to the 19 th Century The Black Death 1348 new disease that spread very quickly due to poor public health streets dirty animal waste on streets, poor cleaning of streets, throwing rubbish on streets made rats breed quickly, no idea about the real cause of disease Belief of the causes of the Black Death miasma, position of the stars/planets, God, wells poisoned by Jews Treatments of the Black Death prayer, moving away from those with plague, some quarantine, unusual remedies like strapping a shaved chicken to the buboes, treatments based on 4-humours theory The Great Plague of 1665 authorities react to the plague epidemic and order certain public health measures- people recognised there was a connection between dirt and disease - sweeping streets, quarantine - women searchers to tell if person died of plague and then a cross painted on that door, bodies moved at night and buried in mass plague pits, gathering in crowds banned eg theatre was banned Causes of the Great Plague same as medieval times-treatments of Plague Renaissance smoking to keep poisoned air away/burning tar, using animals eg frogs/pigeons to draw 4 out plague. Moving away/quarantine. Plague ends due to rats developing greater resistance to disease Flagellents Black Death thought the Black Death was a punishment from God - they thought that by whipping themselves they could atone for people s sins thus prevent the Black Death Raker- cleaned streets (poorly paid, not enforced) Gong Farmer emptied cesspits Charles II King during the Plague of 1665

5 5 Public Health 19 th and 20 th century page 2 of 3 Summary There were many changes in public health on the 19 th century. At the beginning of the century the government and the wealthy upper and middle classes strongly held to the belief of laissez faire and did not want to invest their taxes in providing public health facilities. This was due to the attitude that the poor should help themselves out of poverty, and that it was their fault that they were poor. This was also pre-germ theory and so the true cause of disease wasn t known. As the century progressed there was not only a change in knowledge of the cause of disease, but a change in attitude about why the poor were poor. This led to increased government intervention, to the point that in the 20 th century, in 1948, the government took full responsibility for the health of the nation, and security of the nation by providing the cradle to grave welfare state. Key Dates 1831/32 first cholera outbreak/epidemic in England; first time cholera had ever been in England; quick death 1842 Chadwick s Report on the Labouring Poor suggested the government intervene and improve conditions in the poorer areas of towns. Basically suggested diverting/moving funds from workhouses to better public health. Suggestions were ignored by government 1848/49 second cholera epidemic First Public Health Act, which was based on Chadwick s suggestions. Government reacted to the cholera outbreak of 1848, not compulsory 1853/54 third cholera outbreak 1854 First Public Health act abolished (as it didn t prevent another outbreak of cholera), John Snow proves that cholera is in the water. His findings are largely ignored 1858 The Great Stink. Rich now affected by poor public health 1866/67 Fourth Cholera outbreak 1867 more working class men get the vote; encourages government to improve/implement (start) public health, so that they will get the votes of the working classes 1875 Second Public Health Act compulsory clean water supply, proper toilets, drains, sewers, better standard of housing, shorter working hours for women and children, compulsory education Industrialisation rapid development of machines/factories Rapid/very fast Growth of Towns mass migration of people from the Laissez Faire means the government should not get involved/should not use taxes/rates and invest in public health, prevailing idea about government intervention Cholera new disease in England, very quick unpleasant death Report on the Labouring Poor written by Chadwick 1842, linked ill health and poverty, suggested that the government provide sewers, clean water, remove rubbish from streets. He suggested that taxes be used to fund this (and not the workhouses basically said if the government spent the money on public health there would be no need to spend money on workhouses) The Great Stink very hot summer in 1858, Thames evaporated revealing the filth, the smell was so 5 vile that Parliament couldn t meet, the rich are affected by poor public health and so are more motivated to take measures/do something Miasma the idea that bad smells/corrupted air causes disease Spontaneous Generation the idea that microbes/germs appear as if by magic from rotting matter and that germs are the result of disease Edwin Chadwick was minister for workhouses but did an investigation/wrote a report Louis Pasteur discovered Germ theory John Snow used scientific method to prove that cholera was in the water by mapping an area of London and linking the outbreak to a specific water pump Joseph Bazalgette the sewer king oversaw the construction of London s sewers (after Great Stink)

6 6 Public Health in the 19 th and 20 th centuries - page 3 of 3 Key Dates 1890s Charles Booth and Seebohm Rowntree and other rich men (but not politicians) investigate and highlight the link between poverty and ill health and pressurise the government for 1901 Rowntree produces his Poverty Line Boer War 1906 Liberal government wins a landslide victory, largely due to their campaign promised to introduce reforms/laws to improve lives of poor The Liberal Reforms 1906 Free School Meals Act, 1907 Free Medical inspections, 1908 Children s and Young persons act Children are protected people- parents can be charged with neglect, 1908 Old Age pension act, 1909 first job centres set up, 1911 National Insurance Act 1942 Beveridge Report 1948 Introduction of the cradle to grave welfare state Full government intervention in terms of public health. Prevention and treatment/cure Poverty Line a line that shows the minimum amount of money needed to live living on it or falling below it means you are living in poverty Rowntree s Poverty Line produced/done by Rowntree; proved that poverty was out of the control of the people, revealed that poverty occurred at certain points in a person s life (eg childhood, old age) and that the government should provide help at these stages Boer War reveals/highlights that more government intervention needed and that poverty and ill-health are still a problem due to recruits for the war being both underweight and under height Liberal Reforms laws promised by and done by the Liberal Government to improve life for the poor WWII people were making sacrifices and felt they deserved better lives which included good housing and free health care 5-Giants that could ruin lives disease, want (being in financial need), ignorance (lack of education), idleness (being unemployed), squalor (very bad housing/living conditions. Cradle to Grave Welfare State the idea that the government should take charge of social security/health care 6 NHS National Healthcare Service 1948 Charles Booth investigate poverty in London, found that 30% lived in extreme poverty he used this to pressurise the government to intervene/get involved Seebohm Rowntree produced Poverty Line he used this to pressurise the government to intervene/get involved Liberal Government government that introduced reforms at the beginning of the 20 th century David Lloyd George Liberal Government Politician who introduced the reforms (he was the Chancellor of the Exchequer) Beveridge wrote a report in 1842 identifying need for the welfare state based on the right of all people to be free of the 5 giants Bevin introduced the cradle to grave welfare stated which included the NHS in 1948

7 7 Surgery and Anatomy page 1 of 3 Summary Surgery from the Medieval period up to the 19 th century was a risky business. Surgeons had not idea that dirt carried disease. Some believed it was good to cause pus in wounds and operations were done without effective anaesthetics. Surgery was limited since surgeons could not help patients with deep wounds to the body; these patients would die from bleeding, shock and infection. Pain, infection and blood loss were the major problems in surgery and remained up until the 19 th century. A lot of surgery occurred on a battlefield. In everyday life surgery was performed as a last resort. Barber surgeons did minor surgery on the outside of the body. Speed was the priority and speed (along with a very dirty apron) was the mark of a good surgeon, and surgeons were considered a lower class within the medical profession. Much remained the same until the 19 th century when there was a revolution in surgery. Chloroform was discovered to be an effective anaesthetic and carbolic acid was found to be and effective antiseptic. There was however opposition to these. Eventually there was acceptance and surgery developed. WWI and WWII were both important in the development of surgery. The scientific developments of the 20 th century meant continued major developments in surgery Key Time periods/key Dates Medieval Surgery Any advancements were made by surgical pioneers who tried new methods. Books were read in Latin by religious men and were translated in to English. Surgery however remained very basic and very dangerous. 3 problems of surgery PAIN, INFECTION BLOOD LOSS (PIB) These limited the surgery that could be done Speed the main priority in surgery. A surgeon was judged on how fast they and had a good reputation if they were very fast Barber Surgeons barber who carried out surgery and dentistry. Considered a lower class than physicians (medical doctors) Bloodletting medical treatment of removing blood from a patient by opening a vein or using leeching to suck it out. Done to balance the humours Amputation cutting off a limb a main type of surgery Cauterisation using a heated iron to stop bleeding and seal a wound thus stopping the flow of blood Trepanning drilling holes in the skull Apprenticeship surgeons learned their skill by being apprenticed to another surgeon watching an copying them. Some learned on battlefields Anaesthetics opium/hemlock use as anaesthetics- overdoses possible, a lot of surgery 7 had involved no anaesthetic Medieval John of Ardene example of in English medieval surgeon. War surgeon. Set up the Guild of Surgeons. Use Arab knowledge and Knowledge from experience of 100-years war Abulcasis Muslim surgeon wrote books and invented 26 new surgical instruments; made cauterisation popular

8 8 Surgery and Anatomy Page 2 of 3 Key time periods /Key Dates Renaissance time period of the Renaissance 1500s Pare and Vesalius 1600s - Harvey Early Modern 1700s John Hunter a pioneer of scientific surgery. Some hospitals begin to teach surgery Renaissance period of change and development. Surgery mostly stayed the same but there were some individuals who made discoveries in terms of surgery and anatomy. These did not have impact (did not change things) at the time but laid the foundations for the future developments and advancements Gunshot wounds new wounds gunpowder it was thought to be poisonous (it wasn t). Pare made developments in the area of treating gunshot wounds. Boiling Oil- treatment used to treat gunshot wounds thought to kill the poison Ligatures silk threads that were used to tie off arteries to stop bleeding in surgery. Used by Pare The Fabric of the Human Body the book produced by Vesalius showing his findings on anatomy Renaissance Pare (surgery) used ligatures to tie arteries instead of using cauterisation. Used a cream instead of boiling oil. Not widely believed or useful at the time Harvey (surgery) Blood worked out that blood circulated around the body in 1 direction. Disproved Galen who said that blood was produced in the liver. Heart - Proved that the heart pumps blood around the body. Not widely believed or useful at the time Vesalius (anatomy) did dissections on his own and realised that Galen was wrong about anatomy. Examples the jaw bone is one bone and not 2. (Galen had dissected animals). Proved Galen wrong. His books were translated into English and read by English surgeons. Not widely believed or useful at the time John Hunter pioneer of scientific surgery (see hospitals section for more information on John Hunter) 8

9 9 Key time periods /Key Dates 1847 chloroform as an anaesthetic discovered by James Simpson 1848 Hannah Greener dies of a chloroform overdoes during minor toe surgery 1850 Queen Victoria uses chloroform and likes it 1861 Germ theory discovered bacteria cause disease Carbolic Acid discovered as an effective anti-septic Black period of surgery death rate in surgery increased due to discovery of chloroform as deeper surgery could be carried out, yet the problem of infection had yet to be conquered. Led to opposition of chloroform 1895 X-rays discovered WWI field hospitals - new weapons mean new wounds and development in surgery eg head wounds 1915/1916 blood sodium citrate and citrate glucose means blood doesn t clot and can be stored for longer 1938 Blood transfusion service set up enabling blood banks to store blood. This is still in existence today 1967 First heart transplant surgery Surgery and Anatomy Page 3 of 3 Revolution in Surgery 19 th and 20 th centuries Pain/Infection/Blood loss (PIB) in the 19 th century still the main problems with surgery Speed still the priority in surgery a surgeon was judged on his speed and his reputation depended on it Anaesthetic something that dulls pain, numbs the body, makes you unconscious Nitrous Oxide/Ether anaesthetics used before chloroform. (Ether was flammable and caused vomiting) Chloroform used as an anaesthetic Opposition to Chloroform slowed surgeons down reputation was based on speed, pain meant you were fighting to stay alive, childbirth God intended women to have pain, death due to overdoses, Anti-Septic a chemical applied to wounds/surgical instruments to clean it and to prevent bacteria from being/growing on it Carbolic Acid was used to clean sewers Lister made the link that it could be used to Aseptic keeping an environment/the air (eg in an operating theatre) free of any bacteria Opposition to Carbolic Acid unpleasant to use cracked the skin, a lot needed and was quite messy, took time for germ theory to be accepted therefore for an antiseptic to be accepted, Lister kept changing the precise way it should be used which made surgeons lose faith in him/carbolic acid, X-rays used extensively for the first time in WWI could locate broken bones/shrapnel or bullets and so know exactly where to operate Blood transfusion having blood put in you. The blood comes from another person Sodium Citrate keeps blood from clotting, enabling blood banks meaning more surgery could be done Citrate glucose stores blood for longer, meaning more blood transfusions so more surgery (WWI) Plastic Surgery developed during WWI facial (face) wounds due to shrapnel, first done in WWI. This continued to develop during WWII. It continues today. Plastic surgery units are often attached to burns units. 9 Heart Surgery progressed in WWII shrapnel taken out of hearts which helped to develop other heart surgery after the war, also transplant surgery/key hole surgery/laser surgery part of modern surgery James Simpson discovered chloroform as an anaesthetic Joseph Lister discovered that carbolic acid worked well as an antiseptic Hannah Greener died of an overdose of chloroform during minor surgery on her toe (an example of why there was opposition to chloroform) Landsteiner discovered blood groups therefore enabling blood transfusions in surgery Queen Victoria liked chloroform helped with acceptance of chloroform Elizabeth Garrett Anderson first female surgeon Marie Currie = developed x- rays Gilles did plastic surgery in WWI McIndoe did plastic surgery in WWII

10 10 Hospitals over time Summary In the Middle Ages hospitals were primarily in monasteries and care was given by monks and nuns. They were more like today s care homes than hospitals. Care was more important than cure. This remained the case until the 18 th century. The scientific revolution that was beginning meant that surgeons such as John Hunter were making advancements in hospitals. Hospitals then developed further with the introduction of the NHS in Key time periods /Key Date new general hospitals set up in London By 1800 London Hospitals had over 20,000 patients Middle Ages Hospitals were funded (given money by) the Church or wealthy people -Hospitals focused on caring for the sick and not curing; most patients had a priest rather than a doctor -nuns cared for the sick Over 700 hospitals set up between most in monasteries -treatments based on the beliefs of the time (see section on beliefs of causes/treatments in this booklet) 18 th Century- 1700s Scientific medicine in more modern hospitals began -funded (paid for) either by the rich or by local people getting together to set up a hospital -many new hospitals built 5 new general hospitals built in 1700s, hospitals had specialist wards, some hospitals trained doctors, treatment mostly based on 4-humours theory; less emphasis on illness being sent from God and the scientific method/approach becoming more common, some hospitals had pharmacies, specialist hospitals began to grow eg maternity hospitals 10 Monks/Nuns gave most treatment in hospitals John Hunter pioneer of scientific surgery wrote many books based on his observations, skill at dissecting and his experience as an army surgeon -taught many surgeons (eg Jenner) some of his pupils went on to establish teaching hospitals -Demanded careful observation in surgery; would take risks and do radical surgery rather than just opt for amputation -had a large collection of anatomical animals plants, fossils, diseased organs, - which could be used in teaching and helping to understand disease

11 11 Hospitals page 1 of 2 Key time periods /Key Dates 1850s Crimean War WWI field hospitals and hospitals in England for treatment and recovery WWII field hospitals and hospitals in England for treatment and recovery 1948 NHS set up 19th Century hospitals Crimean War = Florence Nightingale, who believed in the miasma theory, developed hospitals in terms of cleanliness, promoting having separate wards and training nurses. Previous to this nurses did not have proper training. She set up nursing schools, set standards for nurses eg no drinking of alcohol, and made nursing professional WWI and WWII medical knowledge develops and hospitals develop with more treatments offered in hospitals wounded soldiers treated in field hospitals but also in hospitals in England. Creation of the NHS this puts all hospitals under government control. Surgery, treatment of disease, blood tests, x-rays, labour wards all offered in hospitals Florence Nightingale pioneer of modern nursing. 11

12 Factors 12 Factors are things that are not directly connected with medicine, that have had an influence on the development of medicine. The factor might help or hinder medicine Looking the factors, explain how they have helped medicine, or have hindered medicine. Use all time periods to do this War Science and Technology Individual Brilliance/Genius/ the role of the individual Chance (luck) Government Communication Superstition and religion 12

13 13 Britain : Health and the People 1000 Present Day 13

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