GCSE Medicine in Britain – c1250- Present – Ideas about the of

1250-C1500

1 Supernatural and punishment from God for sins, or to test your faith. Leprosy especially seen as punishment. Demons, witches, evil spirits. religious explanations:

2 Astrology movement of the planets caused disease.

3 Rational explanations: Theory of the Four Humours. Hippocrates. Humours unbalanced. assumed disease had a 4 natural cause Miasma theory. Bad air – swamps, corpses etc. Bad smell suggested sin

5 Hippocrates Greek. Body was made up of Four Humours, Black Bile, Yellow Bile, Blood and Phlegm. They linked to the four elements and seasons. If they became unbalanced you would get ill, so you would need to rebalance them. ‘Father of Medicine’ –clinical observation (watch and record details, use this to help with future cases), importance of exercise, Hippocratic Oath for doctors (a promise to obey rules of behaviour in their professional lives.)

6 Greek doctor working in Rome. Built on Hippocrates’ ideas – theory of opposites. To heal illness use the opposites humours, e.g. using hot to cure cold. Also dissected animals to find out about anatomy (structure of body) but made mistakes. Linked to the church so could not be criticised

7 Power of the Church Roman Catholic. Lead by the Pope in Rome. Prevented progress: Controlled education and taught Galen was the absolute truth. People didn’t look for cures as they believed they would go to Heaven. Also they believed God caused and cured disease. Couldn’t dissect. Helped progress: Christian duty to care for the sick, set up hospitals in Monasteries, wrote books on herbal cures, translated Hippocrates and Galen’s books. Learnt Muslim ideas when fighting in the Crusades.

1500-1750

8 Ideas about the causes Miasmas/ Chemical changes within the body/ Theory of 4 Humours – used less. / Still God and Supernatural ideas - used less but people still used charms and of disease in the body prayed during

9 animalcules a new idea (tiny animals – ie – seen under microscope)

10 Sydenham Founder of clinical medicine. Emphasised carefully observation and accurate record keeping (The English Hippocrates).Classified like plants. Studied epidemics. Observed the difference between measles and Scarlet Fever. Used iron for anomia, quinine for , laudanum for pain relief. Wrote books. Said doctors should visit the sick. Said disease caused by atmospheres.

1750-1900

11 Spontaneous was a popular theory – rotting matter created microbes, which caused the miasmata. generation

12 Germ Theory 1861 – Germs in air caused disease –

13 Pasteur and Koch Pasteur – Britain slow to listen, followed Bastian’s spontaneous generation ideas. Lister did follow Pasteur. John Tyndall, a physicist, similarly linked dirt and disease, but people found ideas hard to accept. Koch made it easier for other doctors to study microbes and inspired them to

14 1875 – found the germ that caused – which proved germ theory was true and meant vaccines could be developed. Also stained microbes

15 1854 – proved that was spread through water

1900- present day

16 Crick+ Discovered the double helix structure of DNA in 1953. Watson 17 By 2000 Human Genome Project had identified each gene in the body. Used x-ray photography work of Franklin.

18 Used x-ray photography work of Franklin. GCSE Medicine in Britain – c1250- Present – Ideas about Treatment of Disease 1250-C1500

1 Religious actions: prayer, repent sins, fasting, touching relics, going on pilgrimages, flagellate (whip yourself). Exorcisms to remove evil spirits.

2 Supernatural: checking horoscope before treatment. Lucky charms.

3 Rational: Rebalance the Humours - bloodletting (could use leeches or cupping) or purging. Herbal remedies from apothecaries and wise women. Purifying the air – herbs, flowers, oranges

4 Caring for the sick Number of hospitals increased – 1,100 by 1500. Mostly cared for poor and old. 30% of them owned by Church, rest by an endowment (money left in will). Most sick people cared for at home, mostly by women. Leper hospitals built outside cities. 5 Dick Whittington Lord Mayor of around 1400, set up an 8 bed hospital for unmarried mothers

6 Healers Physicians – diagnosed and recommended treatment, trained at university. Watched dissection and listened to Galen’s description. Little practical experience. Very expensive. Diagnosed through urine sample and astrology. Apothecaries – mixed herbal remedies. Trained through apprenticeships. (a medieval chemist) Barbour Surgeons – least qualified, little training also cut hair. External - pulling teeth, treating cataracts and amputations. Pain, , bloodloss.

1500-1750

7 Treatment – continued from Restore the humours- purging, blood letting/ Herbal remedies – including ones from the New World/ Chemical remedies- made by alchemists/ Prayer / The King –people still believed 1250-1500- little change that the King could cure diseases such as scrofula (a skin disease) by touch./ Hippocrates’ idea - Everything in moderation/ Keeping clean/ Remove miasmas- clean the streets.

8 Hospitals Henry VIII closed monasteries so many church run hospitals closed down. They were gradually replaced by free hospitals which were paid for by charities. They were run by trained physicians and focussed on treating their patients to help them get better. St Mary’s of Bethlehem hospital was set up as Britain’s first lunatic asylum. (Bedlam) St Bartholomew’s Hospital in London became a centre of innovation and research. Many hospitals wouldn’t accept anyone with an infectious disease! Pest houses – Hospitals which specialised in one disease. E.g. plague or pox. They had started to realise disease were contagious but had no idea why.

9 Healers 1. Apothecaries - sold medicines and drugs from their shops. Trained as apprentices. 2. Barber-surgeons – were used for small operations (and haircuts!) 3. Quack doctors – sold medicines and treatments in the streets. 4. Wise women- skilled in herbal remedies. They provided care in the local community. 5. Physicians-trained healers. Expensive. They gradually started to be trained in ways other than Galen’s. Some were trained in wards, they studied the works of Vesalius and Harvey, training emphasised the need for observation and taking a scientific approach. They could do human dissections and use new equipment such as microscopes and thermometers. More text books due to the printing press.

10 The power of the Protestant Christianity spread across Europe and reduced the power of the church. The church had less control over medical learning. Most people recognised that God did not cause disease. Church However in times of epidemics religious causes were turned to. The church had less power after the Reformation

1750-1900

11 Treatment Not much change – still miasma belief so (eg) cholera still dealt with by burning tar, burning dead people’s clothes. Inoculation used for smallpox but dangerous. 2nd half of 19th century – patent medicines (‘cure-alls’ )sold millions but had dangerous ingredients.

12 Simpson and Lister Key developers of chloroform (1847), the first successful anaesthetic and carbolic acid (1865), the first antiseptic

13 Anaesthetics and Anaesthetics stopped pain (previously just opium or alcohol). Laughing gas from 1795 didn’t knock patient out. Ether from 1846 was flammable+caused vomiting. Opposition from Christians antiseptics and because of Hannah Greener. Black Period – more deaths. Then antiseptic and aseptic surgery, though doctors didn’t like carbolic acid or Lister

14 Hospitals 1859 – first cottage hospital (small hospital provided nursing care, with medical treatment from local GP) – 300 by 1900. Also voluntary hospitals in London. Most rich treated at home. Those who couldn’t support themselves treated in workhouses 1867 new infirmaries instead of this, paid for by rate-payers. Antiseptics used

1900- present day

15 New Lots of technology for treatment now (chemotherapy for cancer, kidney dialysis machines to do the work of kidneys if they fail) and also for diagnosis – MRI scans, CT scans, Technology endoscopes (camera put inside body for keyhole surgery) etc

16 Hospitals Pre-NHS – many hospitals run by charities – most offering basic care for the sick, some for specific conditions like TB. 1948 – NHS hospitals – free care for all 17 Doctors 1902 Midwives Act – proper training for them.. and Nurses 1919 Nursing Act set up General Nursing Council. All nurses must now (since 2013) have a degree Doctors study for 7 years and then specialise. GPs now provide much wider range of care. GCSE Medicine in Britain – c1250- Present – Ideas about Prevention of Disease 1250-C1500

1 Religious actions: prayer, repent sins, fasting, touching relics, going on pilgrimages, flagellate (whip yourself). Exorcisms to remove evil spirits.

2 Supernatural: checking horoscope before treatment. Lucky charms.

3 Rational: Rebalance the Humours - bloodletting (could use leeches or cupping) or purging. Herbal remedies from apothecaries and wise women. Purifying the air – herbs, flowers, oranges 4 Government more interested in defending the county and keeping it peaceful than improving health

1500-1750

5 Prevention Not much changed from 1250-1500 - though in towns you could be fined for not cleaning the street in front of your house. Barometers and thermometers used to check link between weather and disease

1750-1900

6 Edward Jenner 1796 – used cowpox germs to protect against smallpox – the first vaccination. Tested it on 23 people. Lots of opposition, including from Christians and from people who had done inoculation.

7 Prevention New approaches to prevention: the development and use of vaccinations and the Act 1875

8 Nursed in the Crimean War in the 1850s, cut death rates from 42% to 2%. Then wrote 200 books about hospitals, including Notes on Nursing and Notes on Hospitals, and set up a training school for nurses in the 1860s at St Thomas’. [still believed in miasma] Made nursing respectable

9 1848 Public Health Act Previous laissez-faire attitude, then 1848 Public Health Act made action on clean water and sewage voluntary.

10 1875 Public Health Act 1875 Public Health Act made it compulsory for towns to take action. Change mostly because of (1) Snow (2) working men getting the vote in 1867 (3) 1858.

1900- present day

11 Public Approaches to public health and prevention of disease and illness: increased use of vaccinations; improved access to treatments available through state funding health+ of medical and hospital care; Liberal welfare reforms in the early twentieth century; the establishment of the NHS and the role of Aneurin Bevan; widening scope prevention of government provision in the later twentieth century – education and regulation for health, for example in relation to smoking and diet. 12 Research showed how poor the poor were – eg Booth and Rowntree’s report (Booth showed 35% of east London in poverty)

13 1902-11 Liberal Reforms – including free school meals, health checks at school, National Insurance Act

14 Second World War - people taking in evacuees were shocked by how poor they were.

15 Beveridge Report and NHS – care ‘from the cradle to the grave’ – see below for changes since then

16 Bevan Labour Health Minister – set up NHS 1948.

17 Prepared to compromise where necessary – eg allowed docts to continue to treat parents privately.

18 Beveridge Civil servant – his report 1942 recommended the setting up of an NHS

19 Government Vaccinations provided free (though scare over MMR vaccine in 1990s). intervention 20 Cost of NHS – more than £100 billion a year.

21 No smoking in public place 2007.

22 Prevention/education – 5 a day, don’t go to A&E for minor problems GCSE Medicine in Britain – c1250- Present – Case studies

1. The

Bubonic- fleas Causes– Treatments – Prevention Pneumonic -airborne. – punishment from God, miasma, Jews, sin, positions of planets, – confuses sins and pray, bleeding and purging – pray and fast, leave the area, carry sweet herbs, imbalance of humours. (but seemed to make worse), sweet herbs or quarantine (new people stay away for 40 days), clean fire to clean air. streets (or don’t, maybe bad smell will drive out miasma)

2. Case study: the Great Plague 1665

Recurrence of the Black Death. Causes– Treatments – Prevention 100,000 people died in London. • Astrology • Magic, religion, • Stray pigs/dogs/cats/etc. killed. Spread by the bites of fleas from rats. BUT no one at • Cats, dogs, pigs and rabbits • Lucy charms, , praying, • Bodies buried at night (mass graves) the time knew that! • Bad smells – miasmas fasting • Houses boarded up & painted with a red cross. • Punishment from God • Bloodletting, purging • Council provided food. Watchmen to ensure no-one left. • Caught from other people • Transference – dried toads, live • ‘Pest houses’ for sick people. • Filth in the streets chickens on the buboes. • Bills of mortality published to show causes/extent of death. • Imbalance of humours • Herbal remedies • Barrels of tar burnt in the street to clean the air • Other people • Smelling posies of flowers and herbs, chew tobacco

3 Pare He was trained as a barber surgeon but became an army surgeon. He developed new treatments for gunshot wounds including an ointment that was used to stop wounds getting infected. He developed a new technique for stopping serious bleeding using silk threads and ligatures. More people survived because of his work. 4 Vesalius Medical professor in Padua, Italy. Specialism was anatomy. Performed dissections. Wrote books – The fabric of the Human body. Books contained accurate diagrams and drawing by artists such as Leonardo da Vinci. He pointed out Galen’s mistakes e.g. jaw bone, no holes in the septum of the heart. His work didn’t have an impact on diagnosis and treatment but he improved knowledge of anatomy and inspired other anatomists. 5 Harvey He was English and worked at the Royal College of Physicians. He was the royal physician to King James I and Charles II. His specialism was the heart. He observed the hearts of cold blooded living animals. Harvey proved Galen wrong about blood flow and the heart. He realised blood flowed around the body in a one way system and that the heart worked like a pump. Book 1628 – on the motion of the heart. His ideas changed the way people viewed anatomy. He showed how the heart work and this in time led on to blood transfusions and complex surgery, but they didn’t know about blood groups until 1901. But it had a limited impact on diagnosis and treatment. At first not everyone believed him (50 years). Bloodletting continued even though Harvey showed it was wrong. 6 Jenner and Vaccination Smallpox very serious – 11 epidemics in London in 18th century. Inoculation = deliberately giving someone the disease, to protect them later. Jenner published in 1798 and 1796 government then funded vaccine. Hostility because strange idea, and Jenner couldn’t explain how it worked. 1852 smallpox vaccination compulsory, enforced from 1872.

7 Fighting Cholera in First came to Britain 1831 – epidemics every decade to 1860s. Killed people in a week. Tar barrels burnt, but it didn’t help. In 1848-9 Snow suggested cholera was being London 1854 transmitted by dirty water (not miasma). Snow proved this in 1854 epidemic – mapped deaths in and linked them to contaminated Broad Street pump

8 Magic Ehrlich 1st Magic Bullet Discovered the first cure of a specific disease 1909 Salvarsan 606 for syphilis Bullets 9 Domagk 2nd Magic Bullet Prontosil– blood poisoning

10 Fleming Floery and 1928 – Fleming noticed unexpected mould growing in his experiment – penicillin, the first antibiotic. He published but didn’t get funding. Chain – Penicillin 11 1939 – Florey and Chain researched, produced penicillin but couldn’t get enough

12 1941 US govt agreed funding due to WW2

13 Fighting Lung Cancer

Rare 150 years ago – has Causes treatment Prevention increased in recent years – Cigarette smoking – 90% of cases due to this/ or passive Surgery –since 1930s but new micro instruments and Government anti smocking campaigns – showing the 40,000 diagnosed a year smoking cameras have far less impact on the body and speed dancers of smoking Difficult to treat as difficult to recovery Banning of advertising of cigarettes and making them diagnose early Radiotherapy – kills cancer cells with radiation almost invisible in shops 1 in 3 live longer than a year Chemotherapy – since 1970s – using powerful chemicals Smoking being banned in public spaces after diagnosis 10% for more to attack cancer cells Smoking recently banned in cars with small children than 5 years Immunotherapy – trials have been taking place to boost the and stop the cancer cells resisting it