Choose ONE from the boxes above. What was his/her contribution in the history of medicine?
b i) William Harvey, an English physician, pioneered the theory of circulation of the blood. The way the blood travelled through the body had always baffled researchers but now Harvey had discovered exactly how it worked. He discovered that blood circulated the body and was not used up like Galen had theorised previously. Furthermore, he said that it was pumped round by the heart, not the liver, and it only moved in one direction. In his book he included numerous diagrams of experiments that he had performed to prove his theory. One such experiment was one that proved with no doubt that there were valves in arteries to stop it flowing backwards. This experiment could be performed by everyone and it was an excellent way of proving his theories. His other stipulation, that blood was not used up, finally paved the way to the practice of bloodletting being abandoned. Whilst Harvey’s discovery of the circulatory system was the result of not only his work but that of Versailles and others, it was he who proved all of the theories, brought them all together and, more importantly, provided the final answer. His work still remains to true to this day and this makes his contribution to modern medicine one of the greatest.
How far do you think his/her work was influenced by the ideas of the Renaissance or Scientific Revolution.
ii) Perhaps one of the most important inventions of the Renaissance was the printing press. For the first time, books could be published quickly and effortlessly, making the age-old practice of laboriously copying out a book by hand obsolete. This meant that medical pioneers such as Harvey and Versailles could have their works published in mass to allow students to learn from their theories much more easily. The Renaissance also brought a new sense of excitement at the prospect of travelling. Voyages of discovery brought back exotic new drugs and remedies that the new field of medicine could make use of. Most important to Harvey was the fascination in highly detailed portrayal of people and objects in art. This meant that physicians such as Harvey could employ an artist who could record exactly their experiments with highly detailed diagrams and sculptures. This greatly aided the sharing of ideas and theories such as Harvey’s and it ensured that they were understood and supported by others. As mentioned above, the printing press played an important part in Harvey’s success and the printing press was also partly due to the Scientific Revolution that was happening at the same time. This also ensured that dissections could be performed to prove his theories and widen his knowledge and the knowledge of other physicians. Lastly, it meant that he could use experiments as mentioned above so that people could check his theories and see for themselves that he was correct. These experiments were often influenced by modern technology, such as the water pump. Harvey was influenced enough by the Renaissance and the Scientific Revolution to give him the perseverance necessary to put his theories forward and show to people that they were correct. The continuing interest and excitement in medicine also ensured that he was motivated to continue his studies to better his field.
Study source C and use your own knowledge.
Explain:
(i) Why Lister’s ideas and techniques can be described as pioneering. (5)
(ii) Why Lister’s ideas were ridiculed at the time. (7)
c i) In 1867 a Scottish surgeon called Joseph Lister was working in a Glasgow hospital. Here he discovered that up to 50% of patients died from their post operation wounds. Lister determined from Pasteur’s research that germs where the cause of this. Often patients preferred a doctor with dirty robes because this was a guide on how many operations he had performed. Surgeons knew nothing about germs, these tiny organisms went unnoticed for hundreds of years, causing infection and gangrene, sometimes even death. So surgeons wore old dirty, bloodstained clothes during the operation. They did not wash their hands or knifes. Some surgeons even carried their stitching thread around wrapped around the buttons of their filthy coats, so it wasn’t surprising that so many patients died of infection. From reading the works of Pasture and studying at university Lister knew all of this, and began to study his idea. Lister finds out that each surgeons hands are covered by millions of bacteria. Now that Lister knew all of this he could begin searching for a germ killing agent, he tried many different formula’s before he found Carbolic Acid. Carbolic Acid is very strong, at first Lister soaked the bandages in the substance and he found that the wound didn’t go bad because the Carbolic Acid was killing off the germs. Then Lister tried washing his hands and instruments in the Acid before an operation and found that it had a similar effect, he insisted that all doctors do the same. For easy dispensation Lister invented a Carbolic Acid Sprayer, as well as covering the bandages in the substance he encouraged doctors to spray the wound and the room that the patient was to be treated in. One of Listers main problems was persuading people to believe his theories, he was laughed at by many, after all he had to convince doctors that it wasn’t silly to spray something that they couldn’t see. The only down side to his Carbolic Acid was its strength, it was so strong that prolonged exposure or large amounts of it being sprayed could cause burning of the skin an irritation of the eyes. However in the end Listers theories where proven right and his methods worked, we know this because nearly all of Listers patients survived the operations and their wounds never went bad. Since then Lister’s ideas have been modified to the modern disinfectants that are used in hospitals today, all equipment and rooms are kept clean and sterile, while all surgeons and nurses wash their hand and wear gloves and masks. We owe all of what cleanliness that exists in hospitals today down to Lister and Pasture
c ii) Lister’s ideas where ridiculed when they where first announced, Lister was trying to convince surgeons and people of the world that what was making their patients die after operations was something called “germs” that where invisible to the human eye.
Lister partly brought the ridicule upon himself by admitting to his mistakes e.g. when he changes things, always being ready to admit when he was wrong. Others therefore thought that his ideas where no good. In 1867 Lister wrote a book called “Antiseptic Principle in the Practice of Surgery”. In this book he describes two wards in Glasgow Royal Infirmary as “...the two large wards for accident and operation cases were among the unhealthiest of the Glasgow Royal Infirmary” he continues to describe the patients of wounds in the ward “...whenever the beds contained cases with open sores , gangrene was sure to show itself.” Lister says how after the introductions of Carbolic Acid, wounds and abscesses no longer poison the atmosphere, and that during the last nine months, not a single case of gangrene has occurred in them.
Study Source D and use your own knowledge.
How and why did the discovery of anaesthetics bring about a increase in the success rate of operations? (7)
Anaesthetics weren’t discovered until the 17th Century, infact there where no good painkillers. Surgeons cut off arms and legs with the patients screaming in pain. Often patients died of the shock of pain during the operation. During the operations the patient often had to be held down by the surgeons assistance’s. The only type of pain killer used at the time was alcohol, which only dulled the pain. However this had very little effect when the pain was very strong. Before the 19th Century most people were conscious throughout an operation. This meant that surgeons had to work very fast. A slow operation meant certain death from pain and shock, so some operations that take two hours now took two minutes then. Some surgeons refused to carry out operations if they seemed too fiddly or meant having to cut deep inside a person.
In the 19th Century new painkillers where invented, all where gases, they where called anaesthetics. The three main one’s where Nitrous Oxide, Ether and Chloroform.
Nitrous Oxide or laughing gas, was discovered in 1799 by a English chemist called Sir Humphey Davy, however its wasn’t used by surgeons until the 1840’s. It was a fairly good painkiller, if you breathed it in, in small amounts it made you laugh, it also made you less sensitive too pain. Unfortunately surgeons soon discovered drawbacks to the gas, it didn’t effect some people and they stayed awake .
Ether was another gas that sent you off to sleep. It was invented by an American surgeon John Warren in 1846 whilst he cut a tumour off a patient’s neck. The patient didn’t feel a thing. A few days later a successful operation on a mans leg was prefomed by Robert Liston using Ether, the doctor went on to perform many more operations using the gas. Ether was more successful then laughing gas, it never failed to sent the patients off to sleep. Yet it had its bad points too. Firstly Ether often made patients very sick after the operation, or brought on a very bad cough. It also had a very bad smell and could easily catch fire!
Chloroform was the most used anaesthetic of the 19th Century, like the others it was a gas breathed in by the patients. A Scottish Obstetrician (doctor specialising in childbirth) called James Simpson first used it on women finding labour difficult and painful. Soon Chloroform was being used in many operations. Chloroform seemed better than other anaesthetics, it did not make people sick and it was safe to use near flames and a small amount knocked people out quickly. Anaesthetics where wonderful, for the first time in history, patients could operations without pain. Doctors where now willing to operate more often than before, they were able to cut deep inside the body and perform long operations, with the knowledge that the patients would die as easily as before, doctors could also take more care over the operations.
Which do you think was more important for the development of surgery:
(i) the discovery of anaesthetics,
(ii) antiseptic surgery,
(iii) improvements in anatomy and physiology,
(iv) war?
Give detailed reasons for your answer (9)
The discovery of anaesthetics was a revolution in medicine, now doctors could perform complex operations without the worry of the patient dying of shock or pain. Also doctors could go deeper into the body and perform longer and “fiddlier” operations than ever before.
Antiseptic surgery is the prevention of germs entering the body during operations by using antiseptic’s to kill bacteria. Germs where first discovered by Louis Pasture in the 1800’s. Pasture was studying the microbes that lived in Beer, Wine and Milk. He found that when milk was heated and then cooled rapidly(pasteurising), people who drank it did not become ill, from this information he had received he realised that the microbes where the cause not the result of diseases. He called these causes of illness “germs”. Around this time in Scotland a surgeon was studying Pasture’s ideas and he began to make a effective mixture that kill’s germs in operating theatres, and he came up with a solution. By using Carbolic Acid Lister found that it killed all of the germs and prevented infection of wounds.
Andreaus Vesalius was one of the leading people in the improvements in anatomy and physiology, he was one of the first people to go against Galen and his ideas. Vesalius benefited from the scientific and artistic revolution that was happening at the time in Italy, artists like Leonardo da Vinci where making complex drawings of the human body. Vesalius was taking a great risk with what he was doing, because by performing these dissections he was challenging the powerful Catholic, who had passed laws on dissection in 1300 making them illegal to perform on humans. The reason the church was against this great learning that was happening was that it contradicted what the Bible stated in Genisis(which incidentally all lies). When Vesalius first began his career in the study of medicine he had to secretly steal the skeletons from the gallows.
During the many wars that where happening during the 1500-1600’s a change in medicine was forced upon the shoulders of the doctors, new medication and treatment had to be made for the treatment of wounds that the soldiers had. In a cruel twisted was this was the perfect time to try out new remedies. Ambroise Paré made significant progress in gunshot wound treatment during the wars.
Antiseptic’s where one of the biggest changes in the development of surgery in medical history. If I was to choose among the greatest development to surgery, Louis Pasteur would certainly rank at the top. He solved the mysteries of rabies, anthrax, chicken cholera, and silkworm diseases, and contributed to the development of the first vaccines. He set the stage for modern biology and biochemistry. He described the scientific basis for fermentation, wine-making, and the brewing of beer. Pasteur's work gave birth to many branches of science, and he was single-handedly responsible for some of the most important theoretical concepts and practical applications of modern science. The germ theory was the foundation of numerous applications, such as the large scale brewing of beer, wine-making, pasteurisation, and antiseptic operations. Another significant discovery facilitated by the germ theory was the nature of contagious diseases. Pasteur's realised that if germs were the cause of fermentation, they could just as well be the cause of contagious diseases. This proved to be true for many diseases such as potato blight, silkworm diseases, and anthrax. After studying the characteristics of germs and viruses that caused diseases, he and others found that laboratory manipulations of the infectious agents can be used to immunise people and animals. The discovery that the rabies virus had a lag-time before inducing disease prompted the studies of post-infection treatment with weakened viruses. This treatment proved to work and has saved countless lives.