History of Medicine Revision Notes.

2. Contagion= people would not come into contact with an infected person

3. Poisoning wells= People believed that the Jews had poisoned the wells ∴ Many Jews were burnt alive

4. Punishment from God= Groups of people called Flagellants whipped themselves in the hope of God forgiving them of their sins so they would not catch the Black Death

5. Four Humours= people believed that if the four humours were balanced then, you would not catch the Black Death

 Medical Renaissance (1500-1650)

• There was LARGE Medical Progress

• Three main figure heads:

• Ambroise Pare (a French Surgeon)
• Andreas Vesalius (Professor at Padua)
• William Harvey (an English Doctor)

Why was there such a huge improvement in medicine in the Renaissance period?

• Interest in the Ancient world= people provided ancient medical theories and were interested in Galen’s original books

• Desire to portray the Human Body more Accurately= Artists carried out dissections in order to find about more about the human body/anatomy

• Interest in the Natural word= interested in finding out about animals and plants

• Willingness to question accepted authority= people began to question Galen’s work and found mistakes (i.e. He dissected on animals)

 Ambroise Pare:

1. Treatment of Gunshot wounds: They used to be treated by pouring oil on them BUT this was inhumane and pare found a better way of healing gunshot wounds (see below)

• When? = 1536 (during the Italian wars)
• Where? = On the battle field in the Italian Wars
• What? = He ran out of boiling oil in the battlefield during the Italian Wars ∴ He created an ointment made of oil of rose, turpentine and egg yolk. He applied it to the wound and it turned out to be a better cure for gunshot wounds

Factors, which enabled him to make this advancement:

• Chance: He ran out of boiling oil
• Role of War: The Italian Wars
• Medical Renaissance
• Need: Many people were still dying from gunshot wounds and it (boiling oil) was an inhumane way of treating them
• Pare’s Personality: He knew the importance of experimenting (much like Edward Jenner, see later ;>)

2. Stopping Bleeding by sealing wounds: Wounds used to be sealed by a hot cautery iron BUT Pare found a more humane way of sealing the wounds using a Knife, a crow’s beak and double thread. 

• When? = 1575
• What? = Pare fed the patient with eggs and bread. He then used a KNIFE to amputate the limb. He then sewed the veins and arteries to STOP BLEEDING. He then used a CROWS BEAK to retrieve the ends of the vessels and then bound them together with DOUBLE THREAD ∴ MORE HUMANE

3. Proved that Bezoar was NOT a universal cure for poison: Bezoar used to be used as a cure for poison BUT Pare discovered that it could not cure poison

What? = He gave a man who was about to be hanged some poison and then gave him some Bezoar. He died shortly afterwards ∴ Pare showed that Bezoar was not a cure for poison

 Andreas Vesalius:

• He was a professor at Padua at a young age ∴ extremely determined and intelligent

• He was very interested in Galen and disproving his theories 

• In 1538, he published 6 anatomical drawings ∴ this was a new concept, his anatomy description was backed up by anatomical drawings

• In 1540, he staged a famous public dissection at Bologna where he firstly dissected a dog, and then he dissected a human body. He proved that Galen’s idea about the human body having two jawbones was WRONG. ∴ he showed Galen’s books were based on his dissections on animals

• In 1543, he published the ‘Fabric of the Human Body’ which was a complete anatomy backed up with anatomical drawings based on human dissection.

Importance of the ‘Fabric of the Human Body’:

• It provided a complete anatomy based on Human dissections ∴ progress made

• The fabric of human body was backed up with anatomical drawings which was a new concept ∴ Progress made

• It corrected Galen’s mistakes ∴ Progress made

• He double-checked the writing before it was printed to make sure everything was printed correctly ∴ Progress in medicine could be made

His views on the movement of Blood in the body:

He doubted the existence of holes in the septum ∴ doubted Galen’s ideas of holes in the septum but did not know how blood circulated the body

William Harvey:

• He studied under Fabricius at Padua

• He announced the circulation of blood

• He wrote his book, ‘On the movement of the Heart and blood in animals” in 1628

His work: 

• He proved no blood flows through holes in the septum ∴ disproved Galen

• He carried out dissections on frogs to prove that blood flows in one direction only

• He stated that there is a fixed amount of blood in the body

• He stated that blood goes to the heart via the veins and goes away from the heart via the arteries

Reasons for his Breakthrough:

• The work of others:

• Studying under Fabricius
• Learning from Padua
• Vesalius’ work

• Harvey’s personality:

• He was curious and knew the importance of experimenting (i.e. the dissection of frogs to show blood flows in one direction only)

• Medical Renaissance:

• I.e. willingness to challenge old ideas (i.e. Harvey disproved Galen and stated that blood did not pass through holes in the septum and Artists carried out dissections to find out more about the anatomy)

• New Inventions: Such as the firepump, which Harvey used to show worked in similar way to Heart

The Great Plague in 1665

• Advancements in medicine made in the Renaissance seemed to be OF NOTHING ∴ Medicine digressed again

• The theories of disease were similar to the Black Death in 1348

• Apart from Contagion, all theories of disease were supernatural, such as Punishment from god, bad air, the position of planets and insects in the air

 Medicine in the 18th Century

Medicine advanced again!

Impact of Science

• Invention of the microscope ∴ doctors could look closer at the anatomy
• Better education ∴ Medical students were taught better as Medicine became a respected profession ∴ Doctors were more knowledgeable
• Advancements in chemistry ∴ gave Doctors new ideas about how the body worked

Impact of the Industrial Revolution:

• Better communications built (i.e. railways, cars etc) ∴ Medical ideas were spread more easily
• Development of technology and engineering

 Edward Jenner and Vaccination (1798):

• He discovered vaccination in 1798

How did he discover it?

1. Sarah Nelmes (a cow maid) caught cowpox

2. Edward Jenner then took a sample of pus from Sarah Nelmes and infected James Phipps with it

3. James Phipps got ill as he had cowpox

4. Edward Jenner then took a sample of pus from a smallpox patient and infected James Phipps with it

5. James Phipps did not catch smallpox ∴ VACCINATION DISCOVERED

 What Enabled Vaccination to be discovered?

NEED: the Government realised many people were dying from smallpox (even Monarchs) ∴ a vaccination was needed. 9/10 people caught smallpox and of those 10% died

INOCULATION: this led to a vaccination being discovered, as it was similar to vaccination. A mild form of smallpox was scratched into the persons bloodstream, they were then kept in a warm room until the symptoms disappeared BUT, many people still died from inoculation but it led to vaccination.

Edward JENNER (individuals): He understood the importance of scientific observation and experimenting from studying under John Hunter (a famous surgeon). He was also aware of a local belief that cow maids did NOT catch smallpox.

DEVELOPMENT OF SCIENCE: Physics had improved ∴ microscopes were more advanced. Chemistry had also improved ∴ doctors knew more about the anatomy

BETTER MEDICAL EDUCATION: Medical students were taught better as medicine became a respected profession ∴ Doctors were more knowledgeable 

 Opposition of Vaccination:

Who opposed it?

• Inoculators (would lose a lot of money) 
• The anti-vaccine society (Fears about Jenner using cowpox to prevent smallpox)
• The general public (questioned it as it was a new idea)

Why did they oppose it?

• Inoculators would lose a lot of money because of vaccination

• Jenner COULD NOT EXPLAIN HIS THEORY because the germ theory had not been discovered

• Like all new ideas, it was questioned by the general public

• The Anti-vaccine society had fears of Jenner using cowpox to prevent smallpox

• Edward Jenner was a country doctor

Why was it Accepted Eventually + Who Supported it?

• The Royal Family
• The Government
• Napoleon

REMEMBER- It was accepted because the statistics proved that it worked and the number of deaths from smallpox was reduced significantly

In 1872, vaccination was made compulsory and strictly enforced !

Discovery of the Germ Theory:

Spontaneous Generation Theory: People used to believe germs were the RESULT of disease and NOT the cause (before Louis Pasteur’s germ theory in 1864)

Louis Pasteur’s Germ Theory: He carried out a public experiment in 1864 using a swan neck flask to show that germs were the CAUSE of disease

He was extremely determined, he began working on the Anthrax germ in 1877 after a brain haemorrhage BUT he was told to stop by the French Government and work on the Chicken cholera microbe/germ as it was killing chickens and losing farmers a lot of money in France.

He had a fierce rivalry with Robert Koch, a German doctor who linked each germ/microbe to a particular disease. This was because of the Franco-Prussian war between Germany and France in which France had lost. ∴ they were both urged on by it, and wanted to win prestige for their country (i.e. the French government funded Pasteur’s research team).

Pasteur found vaccines for:

• Chicken cholera in 1880
• Anthrax in 1881
• Rabies in 1885

 Robert Koch:

• He was a German doctor

• He was more intellectual than Pasteur because he linked each germ to a certain disease ∴ more knowledgeable BUT, he failed to produce a vaccine for Anthrax ∴ could argue Louis Pasteur was more experimental

• He indentified the microbes for Anthrax, TB and Cholera

Koch’s Importance:

• He indentified the microbe for Anthrax in 1875 by studying the blood of anthrax-infected mice. He extracted their blood and re-infected the mice ∴ He got a pure sample of the anthrax microbe

• He also indentified the microbes for Tuberculosis (TB) and Cholera

• He developed a solid culture called AGAR JELLY, which he could breed colonies of the microbes. It was also more reliable than Pasteur’s liquid culture.

• He used industrial dyes to stain the microbes so they could be seen under the microscope

• He attached a camera lens to his microscope to PHOTOGRAPH the microbe

 Pasteur’s Discoveries/Experiments:

Chicken Cholera, 1880

Background info: It was definitely needed, the government told Pasteur to stop working on the vaccination for Anthrax after he began work on it in 1877; French poultry farmers were losing a lot of money because chickens were dying. Also Pasteur had read of Koch’s achievements and wanted to win prestige for France.

• Pasteur’s research team developed a liquid culture for the cholera microbe to grow in

Batch A:

• Pasteur gave a member of his research team, Charles Chamberlain, the liquid culture but he went on holiday and forgot to inject the chickens with it. ∴ The culture was exposed to air and he injected the First batch of chickens with the culture when he returned from holiday = They did NOT DIE

• Pasteur then told him to inject the chickens with a stronger, fresh culture BUT, they still did NOT DIE

Batch B:

• Pasteur then left a liquid culture exposed to air and injected a new batch of chickens with it. He then injected the same chickens with a fresher and stronger culture. The chickens did NOT DIE

Batch C:

• Pasteur then injected a new batch with the stronger, fresher culture only. They DIED ∴ Vaccine was created. Chickens, which were exposed to the weaker culture, first did not die. This is the process of Attenuation.

 Anthrax, 1881:

Background Info: It took place in 1881 in a farm in France. He was given 60 sheep to work with.

• His research team produced a weakened strain of Anthrax

• Out of the 60 sheep:

• 25 were vaccinated then given the deadly anthrax germs = did NOT DIE
• 25 were just given the deadly anthrax germs= DIED
• 10 were used as a control in the experiment= stayed the same because they were a control

∴ Vaccine Created

 Rabies, 1885:

• Pasteur carried out a series of injections on rabbits spines that had been drying for 14 days and used the process of attenuation to get a gradual increase of the strength of germs which would lead to immunity BUT, Pasteur was unsure

• Chance happening? Pasteur’s team got lucky when a young boy called Joseph Meister who had been bitten by a dog needed treating. ∴ Pasteur gave him a series of injections and he did NOT DIE from rabies ∴ Vaccine created

 Discovery of Penicillin (the World’s First anti-biotic)

• 3 individuals helped develop penicillin:

• Ernst Chain (a Jewish refugee and a key part of Florey’s research team)
• Howard Florey (head of the research team)
• Alexander Fleming (worked in a military hospital in Boulogne)

Stage 1: Flemings ‘Discovery’:

• He did NOT discover/invent penicillin as it is a natural substance (i.e. mould).

• 1914: Fleming spent time working in a military hospital in Boulogne where he was frustrated that antiseptics such as carbolic acid could not stop infection in deep wounds

• 1928: he made a chance discovery of penicillin in his lab BUT he could NOT ISOLATE the germ-killing substance in the mould

• 1929: he published an article about how mould can be used to get rid of unwanted laboratory germs BUT failed to recognise its wider use in saving lives!

Flemings Chance Discovery in 1928:

1. The culture dish became contaminated with a rare mould while he was away

2. He strangely did NOT incubate this culture dish unlike others

3. The culture dish was left UNDISTURBED for two weeks in his lab

4. The weather happened to cold ∴ the perfect conditions for mould to grow and bacteria to be killed

Stage 2: Howard Florey and Ernst Chain: Development

Background info: Howard Florey= he was a professor of pathology and the head of the research team

Ernst chain= he was a Jewish refugee and a key part of Florey’s research team

1938: Florey’s research team wanted to study natural substances that kill bacteria. Ernst Chain then read Fleming’s articles on penicillin ∴ the research team produced a pure sample of penicillin to test on mice

May 1940: They conducted a successful test on mice that had been given penicillin ∴ the mice did NOT DIE

HOWEVER, Florey’s research team could not produce penicillin in large amounts because they did not have the resources ∴ They had to produce penicillin in milk bottles and milk churns by a process called Freeze-Drying which was developed by Ernst chain

October 1940:  Florey’s research team carried out the first test of penicillin on a human dying policeman. It turned out to be successful BUT the supplies of penicillin ran out ∴ the Policeman died, but it shows that it was successful in saving lives

 Stage 3: Mass Production

• Mass production was the main problem Howard Florey’s research team faced. It was unlikely British chemical firms would invest in mass producing penicillin because Britain was fully engaged in World War II at the time ∴ the British chemical firms were too busy producing explosives

∴ Florey visited America to try to convince the US chemical firms to invest in mass-producing penicillin. 

1941: Florey’s first attempt to convince US chemical to invest in penicillin was UNSUCCESFUL

BUT…

December 1941: America entered the war after the Japanese attack on pearl Harbour ∴ Florey’s second attempt to convince the US chemical firms to invest in mass production of penicillin was SUCCESSFUL

1943: Mass production of penicillin starts in Britain

1944: Penicillin was used to treat soldiers on D-DAY ∴ many lives were saved

 Factors in the Development of Penicillin:

Chance: Alexander Flemings discovery of penicillin BUT could argue that it was Fleming’s medical research and ability that led to the discovery

War and Government: The US and British government put large sums of money into mass-producing penicillin and without the governments, penicillin would NOT have saved as many lives. Obviously, the war played a factor BUT Howard Florey said they were not doing their research for war; they were doing for the development of science. 

Communications: Transatlantic travel was used to fly Howard Florey over to America to convince the US chemical firms

Individuals and Florey’s Research Team:

• Fleming: carried out medical research which helped him identify penicillin in his lab (even though he failed to recognise its wider use in saving lives)

• Howard Florey and Ernst Chain: Extremely determined after the first unsuccessful attempt at convincing US chemical firms in 1941. Ernst chain read Fleming’s articles on penicillin in 1938 and devised the Freeze-drying strategy to produce penicillin ∴ he was important

HOWEVER, without the other factors, the development of penicillin could not have been possible. Although, Ernst Chain stated that even without Fleming, they would still have carried out their work (because of their love for science), but it would have taken longer.

 Roles in Medicine

Role of Government:

• Roman medicine: Public Health
• Pasteur’s Research Team: Funded by the Government because France wanted to win prestige over Germany after they had just lost in the Franco-Prussian wars
• Edward Jenner: Vaccination was made compulsory and strictly enforced in 1872
• Penicillin: US and British governments put large sums of money into mass production of Penicillin

Role of War:

• Mass development of Penicillin
• Pare (created the ointment for treating gunshot wounds during the Italian wars)
• Pasteur and Koch rivalry: They were spurred on by the Franco Prussian wars as each one wanted to win prestige for their country

Role of Chance:

• Alexander Fleming’s chance discovery
• Pare: ran out of boiling oil by chance during the Italian wars
• Pasteur’s Experiments: Charles Chamberlain (member of Pasteur’s research team) left the liquid culture exposed to air by chance AND Joseph Meister (the young boy) came to Pasteur after he had been bitten by a dog ∴ Chance

 Revolution of Surgery (19th Century): 

Anaesthetics:

Nitrous Oxide:

• Horace Wells was the man who discovered it
• He discovered it at a fair in 1845 where he saw it made people feel no pain and laugh

• Cons: when testing it, he found that some people are immune to it

Ether:

• William Morton (An American doctor) persuaded John Warren (the Head of Boston Hospital) to carry out a public operation using Ether. John Warren then successfully removed a tumour from the patient without the patient feeling pain while under Ether
• This public operation took place in 1846 ∴ Ether was discovered as an anaesthetic in 1846

• Cons: it was inflammable, irritated lungs when inhaled and smelt bad ∴ it was disliked by many doctors including James Simpson (see chloroform)

Chloroform: 

• James Simpson and two other doctors found out about the effects of Chloroform. It was quicker and less was needed ∴ was successful

• This happened in 1847

• It was extremely popular with surgeons UNTIL 1900 where people realized it could damage the liver ∴ surgeons started using Ether again

 Factors, which led to the discovery of Anaesthetics:

• Need: Many people were still feeling pain during operations in the 18th century and ∴ many died from the shock of the operation ∴ Anaesthetics were needed

• Individuals: i.e. Horace wells, William Morton: he persuaded the Head of Boston to carry out the public experiment ∴ he was determined and James Simpson carried out research into the effects of chloroform

• Development of Science: (see medicine on the brink page) i.e. Chemistry improved, physics improved, better engineering and development of technology and medicine became a better profession ∴ people were taught better

Opposition to Anaesthetics:

• People were worried about overdosing and other side effects (i.e. Ether caused explosions as it was flammable)

• Members of the Church in Scotland were outraged at the use of Chloroform during childbirth as the bible stated that women should feel pain during childbirth

• They were also opposed because surgeon was in COMPLETE CONTROL of the patient ∴ He/she could do dodgy things

• Some officers in the army disliked the use of anaesthetics claiming they were ‘Not manly enough’

Why was Anaesthetics Eventually Accepted?

• Because Queen Victoria had used Chloroform during her childbirth ∴ Anaesthetics became socially acceptable as she said it was delightful. She said this in 1853.

 Antiseptics:

Background info: This was a result of the problem of infection. The period of surgery between1846 to 1870 is known as the Black Period. It is called the Black Period because surgeons carried out operations using anaesthetics in UNHYGENIC CONDITIONS ∴ many patients died from infections after the surgery

Joseph Lister:

• He had read Pasteur’s work on the Germ theory and realised infections killing patients were caused by germs

∴ He decided to use CARBOLIC SPRAY to kill any germs present. He sprayed it in the air, on the patient, the instruments and the surgeon’s hands ∴ the DEATH RATE FELL

Factors that led to the Discovery of Antiseptics:

Need:

• Many people were still dying during the Black period of Surgery as surgeons relied on anaesthetics and did not have an idea of cleanliness before Pasteur’s germ theory ∴ many patients died from infection after the operation

Individuals:

• Joseph Lister:

• He made a connection between carbolic acid used in the sewers to being used in the operating theatres.
• He also read Louis Pasteur’s germ theory research.

Development of Science:

• An increase in chemistry meant Lister could spray carbolic acid (carbolic spray) due to the development of the steam pump!

Pasteur’s Germ Theory:

Joseph Lister did research on Pasteur’s germ theory in 1864, which stated that germs were the CAUSE OF DISEASE. ∴ it led Joseph Lister to realise that people were dying from infection because of germs.

Why was Antiseptics Opposed?

• LAZY doctors and nurses disliked it because they had to work harder in sterilising equipment etc

• Many people still did NOT believe in the germ theory because it challenged the spontaneous generation theory (Theory that germs were the result of disease NOT the cause of disease)

• The antiseptics were UNPLEASANT for doctors (i.e. the smell)

• It cost time and money

 Aseptic Surgery:

Background info: It advanced from antiseptic surgery, which had its drawbacks because it often irritated lungs and burnt skin. Aseptic surgery is a means of keeping germs away, rather than trying to fight germs. Aseptic surgery is used today in the operating theatre and was developed by German scientist, Ernst Bergmann. 

Ernst Bergmann:

• He was a German scientist
• He developed aseptic surgery by passing steam over the instruments and therefore killing all the germs.

William Halsted:

• He was an American Surgeon
• He asked an American rubber company to produce rubber gloves to be used in the operating theatre after the chemicals that were used to sterilise her hands were causing skin irritation. Halston then issued for caps, masks and gowns to be worn.

 Public Health:

Cholera Epidemic 1831-32:

• 1831: Local health boards were set up to prevent cholera
• ∴ 1831-1832= 21,000 people in Britain died of cholera

19th Century views on Cholera:

• They believed it spread by:

• Miasma: i.e. spreads in the air
• Contagion: i.e. contact with another person

Reasons for Improving Public Health after the Cholera Epidemic (Which led to the 1st public Health act in 1848):

Yes:

• Because    recorded the statistics for death and showed that disease was worse near water-born areas

• Edwin Chadwick published a report in 1842 which stated that improving people’s health will SAVE THE COUNTRY MONEY by reducing sickness in factories

• There were reports of a return of cholera ∴ YES side overweighed the NO side

No:

• The cost was too much as poor people did NOT pay tax

• Laissez-Faire meaning people wanted to Government NOT TO INTERFERE in public health

•  ∴ As a result of this the 1st public Health act in 1848 was set up, although this health act failed as it was NOT CUMPULSORY.

Need for State Intervention into Public Health:

• John Snow: He published a report showing that Cholera was a water-born disease in 1854 ∴ people who drank from the Thames caught cholera but those who drank from springs did not

• Louis Pasteur’s Germ Theory, 1864: He showed that germs were the CAUSE OF DISEASE ∴ there was a need for cleanliness

• Second Public Health Act, 1875: 

• Brought together all previous laws
• Councils needed provide clean water, drainage and basic sanitary conditions

 Reasons for the NHS (set up in 1945):

• Wallstreet Crash

• World War II (most important reason):

• There were food shortages in the war so the Government stated children should be fed well!
• Government set up an emergency health service to help with the casualties from the air raids ∴ it proved to be very successful
• Many evacuees did not know about health i.e. (urinating on streets)

• The Beveridge report in 1942:

• Stated that the Government should provide Healthcare for ALL members of society not just the rich!