Ideas about CAUSE of disease Medieval (1250-1500) Supernatural ideas: The Church was hugely powerful: Belief in heaven / hell Case Study: The Black Death (1348) • No education, so people learned from church • God punishes sinners Killed 1/3 of British population 1348-50 • Disease is a punishment sent by God. Bubonic Plague: spread by fleas on rats Astrology Pneumonic Plague: spread by coughing Idea that the position of the stars affects our lives. Physician would consult star charts and when a Approaches to TREATMENT and PREVENTION Ideas about cause patient was born to make diagnosis People did not understand real cause, Key Individuals Treatments: they thought it was: Hippocrates Four Humours Religious/supernatural • Punishment from God Greek phyisician, devised idea of Four Humours This was an ancient idea, first put forward by Prayer; saying mass; fasting; going on pilgrimage – all advised as • Imbalance of four humours Galen Hippocrates (a Greek physician and philosopher). religious “treatments” Roman physician, author of 60+ books. Ideas The universe is made up of four elements; and the Some believed disease because punishment was sent by God, you How was it dealt with? were basis of medical understanding body is made up of four humours (liquids) should not try to treat. • Prayer / fasting / flagellation If these humours are in balance the body will be (whipping) Key Vocabulary healthy, when they are unbalanced you become ill. Humoural Treatments • Light fires / carry posies to ward off Galen (Roman physician) developed the idea with Physician suggested a treatment for each symptom, including miasma Physician: person who practices medicine theory of Opposites. For example, f you had a bleeding and purging; bathing (only available • Local governments tried to control by Barber surgeon: cut hair / carried out blood- phlegmy cold, this should be balanced by eating to rich); remedies (made from herbs and spices) - buildings new cemeteries letting something hot eg pepper. - close Parliament in 1349 Apothecary: mixed herbal remedies Prevention - enforcing street cleaning in cities, but Remedy: cure for an illness Miasma PRAY! this often didn’t happen Four Humours: liquids in body which must Bad smelling air thought to be harmful – so Practice basic hygiene (as recommended in the Regimen Sanitatis) remain in balance for good health corpses, rotting matter, swamps thought to cause Purifying bad air (eg carry a sweet-smelling “posy”; some measures Consequences of the Black Death disease. Ancient Greek theory, also believed by were taken to keep towns clean, like clearing animal corpses) Fewer workers, demand higher wages and Galen. had more freedoms. Who cared for the sick? • The Physician was university educated; expensive so only available if you were rich Examples of Continuity • Diagnosed illness by: observing sample of urine / faeces / blood; • People still believed in ideas of Hippocrates and Galen: Four Humours, consulting astrological charts. miasma • Apothecary mixed the herbal remedies. • Surgeon performed basic operations and bleeding • Church controlled education, very few books. Therefore very few new ideas, • Approx. 1,100 Hospitals by 1500, 30% run by Church. and little spread of information Provided clean place to rest and eat well. Many hospitals were places for travellers to stay MINOR CHANGE: Use of the Regimen Sanitatis resulted in more hygienic • Most people cared for at home (kept clear, fed, herbal remedies). conditions, although only slightly This was generally considered to be a woman’s role.

Medieval (1250 – 1500) Renaissance (1500-1700) C18th – C19th (1700-1900) Modern Day (1900 - ) Ideas about CAUSE of disease Renaissance (1500-1700) Time of discovery, scientific progress, experiments. - The Church had less control over life, so there Case Study: William Harvey Case Study: The Great Plague (1665) was a chance for the spread of new ideas. - The printing press helped ideas to spread. English doctor who investigated and Disease continued to strike after 1348 (Black Death) – 1665 - Royal Society allowed scientists to gather, share explained the circulation of the blood was a particularly bad year. research More than 65,000 died in London Studied in Cambridge and Italy, worked as a This led to lots of new ideas: eg royal doctor Prevention - Better understanding of anatomy, for example Approaches to TREATMENT and Measures recommended to help people avoid the Plague: blood circulated round the body PREVENTION His dissections and research led him to: - Prayer - Existence of “animalcules” - Quarantine (plague victim kept isolated from others to Treatment • Show the role of the heart, the stop spread of disease) Four Humours Transference – disease could be circulation of the blood. - “examiner” to check if anyone suffering in This theory had been proved wrong by scientists. transferred to an object by rubbing it • He contradicted Galen parish However, most people still believed it so most Lots more herbal remedies available from • Wrote book “An Anatomical Account of - “watchman” guard house of victims physicians continued to use old methods, eg newly discovered lands of the New World the Motion of Blood in Animals and - Cross marked on every affected house bleeding. The new science of chemistry resulted in Humans” - Pomander (ball full of sweet smelling herbs) carried to lots of chemical cures. E.g. antimony used keep away miasma Miasma to treat typhus A major breakthrough, but it did not have - Plague doctors wore special costume: This ides that disease spread by bad smelling air much practical use in medicine - Bird design to “transfer” disease away from was still believed Apothecaries and surgeons were better patient trained - Mask full of herbs - Public meeting, fairs, theatres cancelled to stop spread Key Individuals of disease Thomas Sydenham “English Hippocrates”. He Less hospitals available because many of - Carts travelled through cities to collect dead observed patients’ symptoms. This enabled him these had been run by the monasteries, identify the disease that needed to be treated. which were closed down by Henry VIII Vesalius Anatomist. Carried out dissections, Examples of Change found errors in Galen’s ideas (e.g. lower jaw = Prevention Ideas about cause of disease had one bone, not two. Published in “Fabric of the - Understanding that Four Humour theory was Examples of Continuity Human Body” advanced, but treatments were still not effective. So prevention still very wrong (though it was still widely used) - Belief in miasma as a cause of disease important. - Better understanding of human body - Herbal remedies still popular Key Vocabulary Cleanliness still important; though less use - More remedies available from New World - People still used humoural treatments Anatomy The human body of public baths since arrival of syphilis (e.g. bleeding), because patients believed Diagnose to look at symptoms to work out (newly discovered land in Americas) Moderation avoiding too much alcohol, in them. what disease a patient has cold, food - Use of chemical cures Miasma foul smells, thought to cause disease To reduce miasma, homeowners in some Quarantine isolating ill person to stop spread towns had to pay a fine if they did not Transference rubbing an object on a wound to clean outside their homes Changes in ideas, but not much development in actual treatments “transfer” illness from the patient

Medieval (1250 – 1500) Renaissance (1500-1700) C18th – C19th (1700-1900) Modern Day (1900 - ) Approaches to TREATMENT and PREVENTION C18th - 19th (1700-1900) Key Individuals Hospitals Louis Pasteur developed germ theory Florence Nightingale: nurse in Crimean War 1854; hospitals Case Study: Cholera (1854) Robert Koch identified specific microbes, appalling developed methods to study them better Made changes to way wounded soldiers treated Disease first arrived London 1831. Henry Bastian British doctor, did not believe in - Sanitation (clean hospital, bedding) Particularly affected the poor – those living in Germ Theory Ideas about CAUSE of disease - Nurses to provide care slums and workhouses. Florence Nightingale came up ideas of modern - Good meals provided Three “epidemics” (major outbreaks, killing nursing / hospital design C18th Age of “Enlightenment” – people Mortality rate (% of wounded dying) fell from 40% to 2% thousands). James Simpson discovered chloroform thinking for themselves, not just following Nightingale returned to GB Government tried to prevent by cleaning slums Joseph Lister develop use of carbolic acid to ideas of church - Set up nursing college; designed hospitals with wards to stop to reduce miasma – did not work. tackle infection in surgery disease spreading; wrote “Notes on Nursing” 1854 outbreak studied by John Snow. John Snow worked out that cholera caused by 1861, Louis Pasteur published Germ Snow plotted where all deaths had occurred on a dirty water Theory. Observed that “microbes” Surgery: 3 major problems: pain, infection, blood loss (this was not map. Edward Jenner came up with the concept of using present in the air, these made liquids rot “solved” until C20th) Identified that they were centred around Broad vaccination (he was investigating rotting beer). Anaesthetic developed to deal with pain. St water Pump. Proved microbes could be killed by heat Other drugs had been used (eg ether), but problems. Took handle off pump, no more victims (pasteurisation). James Simpson discovered chloroform. Discovered Broad St well was next to a cesspit Key Vocabulary 1878 published Germ Theory of infection, Some opposed as though pain was sent by God, but when Queen (toilet pit). Anaesthetic a drug which makes a patient unconscious proving microbes caused disease in Victoria used chloroform, it became popular Proved that cholera was spread by dirty water. during surgery humans. Antiseptic developed to deal with infection. After reading Germ a small organism which can cause disease Pasteur’s Germ Theory Joseph Lister used carbolic acid during Antiseptic germ-free Robert Koch identified that different operations to keep wound clean. Many doctors opposed at first, as Microbe germ that can cause disease microbes caused different diseases. carbolic was unpleasant Spontaneous generation idea about cause of decay First discovered cholera 1883. Epidemic rapid spread of a disease Came up with methods to study bacteria Prevention (grow in petri dish, stain with dye to make Edward Jenner develop vaccination to protect against smallpox. easier to see) – these methods made it Previously people had been inoculated (given small dose of disease possible for other scientists to make to develop immunity. 1776 Jenner worked out you could make someone immune to further discoveries. Examples of Change Examples of Continuity Koch’s work meant that scientists studied smallpox by injecting a small amount of cowpox. diseases, not symptoms. Lots of opposition from church, inoculators and scientists - Germ Theory – understanding that germs - Many people still believed in miasma Impact in Britain Public Health cause disease - Still major public health issues in GB doctors – led by Henry Bastian – did 1848 Public Health Act encouraged cities to provide clean water, - Surgery became safer cities. Widespread poverty but not compulsory. not believe in Germ Theory. They still - Hospitals more clean - No cure for blood loss in surgery believed in Spontaneous Generation 1852 government makes smallpox vaccinations compulsory (microbes spread from rotting matter by 1875 Public Health Act. Realisation government should intervene - Government became involved more involved - There was better understanding of miasma). to improve living conditions in cities. City authorities forced to: in health / medicine cause of disease, but still few cures GB government rejected germ theory provide clean water, dispose of sewage properly, public health - Vaccines developed to prevent disease until end of C19th. officer to monitor outbreak of disease, ensure good new housing.

Medieval (1250 – 1500) Renaissance (1500-1700) C18th – C19th (1700-1900) Modern Day (1900 - ) Ideas about CAUSE of disease Approaches to TREATMENT and PREVENTION Modern Day (1900 - ) Scientific understanding of the cause of disease Technology / Chemical cures replaced ideas of Four Humours, miasma. Doctors Magic bullet = attacks disease, not body Case Study: Lung Cancer use evidence based knowledge to diagnose Salvason 606 – first developed to attack syphilis patients. Penicillin (see below) Second most common cancer in the UK. 85% of cases Technology has helped to identify and combat diseases are smokers / ex-smokers Technology developed to diagnose: In C19th only 1% of cancers were lung cancer; 1918 blood tests; x-rays; ultrasound NHS 10%; 1927 14% (smoking became more popular – Key Individuals scans; endoscopes (camera 1911 National Insurance Act only covered working men. mainly due to tobacco company advertising). which can see inside the body). 1948 – to provide free healthcare for all from cradle to grave. Lung cancer hard to diagnose accurately with X-ray. Hospital, GP, dentist, ambulance, health visitor Crick and Watson discovered structure of DNA Nowadays it can be diagnosed using CT scan – which Alexander Fleming first to use penicillin, left Genetics Ongoing debate about cost / quality of service is more accurate. Scientists realised that microbes could not cause all notes about what he discovered When diagnosed treatment can be: Florey and Chain developed use of penicillin disease – some were passed from parent to child - remove infected part of lung (hereditary illness). - Transplant lung from healthy patient 1900 a German scientist first came up with the - Radiotherapy: attacking the cancer with radiation Key Vocabulary theory of genetics, but microscopes were not - Chemotherapy: attacking the caner with powerful enough to prove the idea. chemicals. Hereditary disease illness passed from parent 1953 Watson and Crick discovered the shape of Government realised smoking was a problem in to child DNA (an acid in every human cell carrying info 1950s, but made lots of money Magic bullet chemical which kills disease, but about characteristics). Pevention from tobacco tax. does not affect rest of body This meant they could find the part of the DNA Government has assumed responsibility for public health Government action: Antibiotic treatment which destroys or stops which caused hereditary disease. Compulsory vaccinations - Advertising ban growth of bacteria in the body Using this information, doctors can know if Laws to provide healthy environment (eg Clean Air Act 1956) - Ban on smoking in public Penicillin first antibiotic someone is likely to suffer from a hereditary illness, Communication about health risks of lifestyle choice (eg anti- - Anti-smoking campaigns Genetics information about a person stored on and take steps to prevent the impact smoking campaigns) - Raising taxes DNA in every cell.

Lifestyle During C20th we have better understood the Case Study: Penicillin Examples of Change Examples of Continuity impact of lifestyle choices on health. Smoking 1871 Joseph Lister used penicillin to treat a patient, but left It is the biggest cause of preventable disease in the no record of his discovery. - Use of science to diagnose / understand disease - Still unable to treat some world now 1928 Alexander Fleming noticed that in his lab, some mould - NHS healthcare free for all illnesses such as cancer and A poor diet with too much sugar or fat can cause was killing bacteria in a dirty petri dish (it has drifted in - Government taking responsibility for public viruses. heart disease and type 2 diabetes. through the window). He didn’t study further but published health Other lifestyle choices which can cause disease his findings. - Huge increase in the amount of treatments / include: excessive alcohol, drug use, unprotected Florey and Chain were studying antibiotics. They read sex and tanning. Fleming’s work, 1940 tested successfully on mice. surgery which can be given But couldn’t produce large quantities. - Lifestyle factors have become an important When US joined WWII 1941, Florey and Chain got backing cause of disease / death from big American drug companies to mass produce.

Medieval (1250 – 1500) Renaissance (1500-1700) C18th – C19th (1700-1900) Modern Day (1900 - )