History 9-1 Edexcel GCSE - Medicine Through Time

Most people were taught their education and medical knowledge by the Church

Only rich people could afford to go to schools

The Church taught that God caused disease as a punishment for sin or to test their faith

There was no alternative so everyone believed this and didn't search for other explanations

Astrology = using the planets and stars to diagnose and treat disease

The Church discouraged dissection so there was not a great understanding of the body

Monks and priests wrote most of the books that people read

The Church approved of rational explanations for disease and promoted Galen's work

Many monasteries were set up as hospitals

Four Humours = blood, yellow bile, black bile and phlegm that caused disease when they became unbalanced

Theory of Opposites = balancing a humour by prescribing a treatment that had the opposite characteristics to the humour that was unbalanced

Galen = a Greek doctor who wrote medical books, developed Hippocrates' ideas, proposed the Theory of Opposites, drew detailed diagrams on the human body and carried out dissections

Hippocrates = a  Greek doctor who wrote medical books, proposed the Theory of the Four Humours, searched for a physical reason for illness, wrote the Hippocratic Oath to guide doctors and relied mostly on observing symptoms in detail and recording it to help his medical research

Galen and Hippocrates are considered the most influential people to the basis of medicine as no one had carried out any effective research before them and disease was highly common

Miasma = disease was transmitted by bad air. This related to God because bad smells indicated sin

Bloodletting = cutting a vein, using leeches or cupping to draw blood from the body and balance the blood Humour. Usually carried out by barber surgeons as they were the cheapest

Purging = making a patient vomit or go to the toilet to balance the Humours. Laxatives were mixed by apothecaries or by wise women

Religious methods of prevention consist of chanting incarnations, self punishment (flagellation), carrying charms and living a good christian life

Rational methods of treatment consist of bathing/washing, not overeating, excising, blleding/purging, purifying the air and keeping streets clean

Religious methods of treatment consist of praying, fasting, going on pilgrimages and going to mass

The most common traditional treatment was drinking medicines which were made by apothecaries

Barber surgeons = received no medical training, carried out all types of treatment, did basic and unsuccessful surgery and were very cheap

Care in the home = most people were treated at home by the village wise woman whoc woul made remedies and do it for free

Apothecaries = received training with no qualifications, mixed herbs to make remedies and cost money

Physicians = medically trained and qualified, diagnosed and treated disease and were very expensive and not widely used. They consulted urine charts and zodiac charts and sometimes sent patients to apothecaries or barber surgeons

Hospitals = most were used as hotels for travellers, people with incurable diseases were not admitted, kept very clean, given lots of food and rest and were run by the church. Some were built specifically for a certain disease and were mainly used for recovery rather than treatment

Bubonic plague = most common type where buboes developed around the lymph nodes

Pneumonic plague = pneumonia developing in the lungs

Septicaemic plague = blood poisoning

Transferred by fleas living on black rats from trading ships

Thought to have been caused by God, alignment of planets, miasma, volcanoes, Four Humours or outsiders

Methods of prevention were praying, fasting, cleaning up rubbish, smelling bad smells, carrying herbs and not letting unknown people enter the village

Symptoms were swelling of lymph nodes, fevers, chills, headaches, vomiting, diarrhoea and abdominal pain

Treatments were praying, cutting open buboes and taking cold baths

Fewer people believed in supernatural/religious causes of disease (reduced influence of church)

More rational explanations were suggested

Miasma and Four Humours were still popular theories

Physicians stopped using astrology and urine charts to diagnose disease

Thomas Sydenham:

• doctor in London in the 1660s and 1670s
• published Observationes Medicae in 1676
• observed and recorded symptoms in detail
• promoted the idea that a disease did not depend on what the person was like
• treated the whole disease rather than treating individual symptoms
• known as the English Hippocrates

Printing Press:

• invented in 1440 by Johannes Gutenberg
• allowed exact copies of a text to be produced in a short space of time
• scientific ideas could be shared faster across a wider area
• reduced Church's control as they no longer published the books
• hundreds spread across Europe
• main cause of publishing more books

Royal society:

• shared scientific knowledge
• set up in 1665
• published Philosophical Transactions 1665 to allow scientists to share ideas
• allowed scientists to work together to improve understanding and efficiency of work
• King Charles II approved of it and helped gain in credibility

Hospitals:

• were used more to treat the sick rather than house pilgrims
• 1536 - dissolution of the monastries - most hospitals closed as they were in churches
• charity funded hospitals were set up
• more pest houses appeared as an alternative

Community care:

• physicians were still too expensive for most people
• cared for by a female member of the community at home

Changes in treatment and prevention:

• more emphasis on miasma by cleaning streets
• regularly changed clothes
• new herbal remedies from other countries
• ideas were slow to be accepted and did not have evidence

Apothecaries:

• still not fully trained and inferior to physicians (cheaper)
• better trained than before 

Physicians:

• received top training but only used textbooks, not practical experience
• better access to a wider variety of books
• new ideas of anatomy came about

Vesalius:

• carried out public dissections
• published On The Fabric Of The Human Body in 1543
• improved understanding of human body
• proved Galen's work incorrect
• inspired others to carry out observations and dissections
• work was widely published throughout Europe

Causes (beliefs):

• miasma was the most common
• less people believed in Four Humours

Treatment:

• people were quarantined
• many used herbal remedies from apothecaries
• theory of transference - tried to transfer disease to another animals
• tried to sweat the disease out

Government action:

• large gatherings banned
• streets cleaned often
• dogs and cats killed
• days of fasting and public prayers
• the dead were buried in mass graves

Lecuturer of anatomy and James I's doctors

Carried out publuic dissections

Discovered blood circulation by dissecting the body to show the direction of blood flow

Proved blood cannot be produced by the liver

Influenced by new technology that helped him to compare it with the body

Discovered one way valves in the veins and that blood only flowed in one direction

Proved parts of Galen's work wrong by working on Vesalius' ideas

Passed on knowledge so it was taught in medical schools

His work gained publicity and attention as he was a royal physician

Published An Anatomical Account of the Motion of the Heart and Blood in Animals in 1628

spontaneous generation = decaying matter produces microbes

microscopes were not well developed so germs could not be seen easily

miasma was less popluar than in the Renaissance period

1878 - Pasteur publishes Germ Theory - proved spontaneous generation incorrect by proving that microbes cause decay

Robert Koch identified the TB microbe (1882) and the cholera microbe (1883)

helped to prevent future diseases

Koch grew the bacteria on agar jelly and stained it under a microscope to obtain better images

Pasteur - little impact - not a doctor - many still believed in spontaneous generation

Koch - more impact - took time for government and doctors to accept it

Florence Nightingale:

• led a team of nurses in Crimea (1854-56)
• believed in miasma so emphasised hygiene, fresh air and training for nurse
• lowered mortality rate in one hospital from 42% to 2%
• set up a nurse training school in London

hospitals in 1856:

• only the rich could afford good treatment
• poor worked in workhouses
• overcrowded and dirty

hospitals in 1875:

• better training for nurses
• cleaner and quiter
• specialist hospitals and hospitals in all places

before 1800 - alcohol and opium were main anaesthetics

1844 - laughing gas in dentistry - didn't work

1846 - ether - successful - lasted a long time - made patient sick

1847 - chloroform - James Simspon - negative effect on heart - effective

people disagreed with interfering with God's plan for pain

1861 - half of patients die of infections after surgery

1865 - Joseph Lister soaks bandages in carbolic acid

1866 - Lister cleans wounds and equipment with carbolic acid

1867 - Lister states his wards have been infection free for 9 months

imspired others, surgery became pain free and more complex surgery was easy to perform

Pasteur discovers that a weakened version of a microbe can create immunity

called vaccination

inspired others to make different vaccines

government disagreed with using money to improve living conditions

several epidemics linked living conditions with disease

1875 - Second Public Health Act - everything was compulsory

clean water

sewers - new one built in London in 1875

public toilets

inspect houses for cleanliness and overcrowding

Jenner collected data and discovered that people with cowpox were immune to smallpox

1790s - Jenner infected people with cowpox

they never developed smallpox

1798 - Royal Society refuse Jenner's ideas

publishes them in An Enquiry into the Causes and Effects of the Variola Vaccinae

by 1800 - 100,000 people had been vaccinated worldwide

1840 - governemnt funded vaccinations - doctors lost money

1852 - vaccinations made compulsory

1979 - smallpox wiped out worldwide

no scientifical explanation as to why it worked

1st epidemic in London = 1831

2nd epidemic in London = 1848-49

3rd epidemic in London = 1854

caused by miasma and spontaneous generation (Germ Theory not published)

1848 Public Health Act - not compulsory - supply clean water - not all towns did so

msotly affected the poorest

diarrhoea and vomiting which caused dehydration and death

John Snow believed it was caused by contaminated water

made a map of deaths and water pumps and find correlation with a pump on Broad Street

leaking cess pit

removed handle - deaths dropped - 1855 - presented ideas to government - encouraged a new sewer

no scientific evidence - ideas not widely accepted

19th century - Mendel showed that characteristics are passed between generations

20th century - electron microscopes and x rays allow detailed pictures of cells

found DNA in every cell which controls a human's genes

James Watson and Francis Crick looked for genetic codes of DNA

used x rays and microscopes at King's College Hospital in London

found the double helix structure of DNA in 1953

Watson led the Human Genome Project in 1953 to find and map every single human gene

allowed a better understanding of genetic conditions such as Down's syndrome

allowed better predictions of who was likely to contract a disease

however, no way of curing, treating or preventing genetic conditions 

lifestyle factors increase risk of disease

doctors use books, their own knowledge, medical testing and science to diagnose a disease

use laboratories to look at cells underneath microscopes (e.g: blood/skin)

use x rays and endoscopes to clearly see inside the body

use monitors to look at a disease over time

new technology:

• microscopes - see cells
• incubators
• radiotherapy/chemotherapy - cancer
• x rays, MRI, CT and ultrasound scans - detailed picture of the affected part of the body
• endoscopes
• pacemakers - control heart beat
• dialysis machine - filter kidneys
• insulin pumps - control blood sugar concentrations
• blood monitors - diabetes

Paul Ehrlich searched for a magic bullet - chemical compound that attacks and kills microbes

tried to find a magic bullet for syphillis

1909 - Dr Hata joins the team and finds Salvarsan 607 - the only one that worked at the time

1932 - Gerhard Domagk developed Prontosil  - cures blood poisoning

chemicals in prontosil were used to make other magic bullets for pneumonia, scarlet fever and meningitus

suregons now use tiny cameras and small incisions in surgery to reduce recovery time

surgery can also be robotic to make it more precise

antibiotics destroy bacteria to prevent the growth of a disease internally

scientists used the chemical structure of previous antibiotics to make their own rather than growing them which takes time

NHS:

• set up in 1948 as a free health service funded by taxes that can be used by anyone
• GPs hospitals, dentists and emergency/recovery care
• improved the access to health care for everyone
• different places in Britain had different quality of treatment

many people could not afford vaccinations previously

government began to fund them

1942 - diptheria vaccine

1962 - measles vaccine

government have funded testing and vaccines, disposed of public rubbish and sewage, reduced air and water pollution, banned smoking in public places and improved health and safety in work and education

1928 - Fleming noticed that mould killed bacteria in his Petri dish

tested it on other bacteria and it proved effective in killing them

1929 - publishes his work but it is not given any consideration

1939 - Ernst Chain and Howard Florey continue research

used milk churns and mice to grow and test penicillin

proved effective on the mice

UK didn't manufacture it but US began small scale production in 1941

proved to be effective in WW2 so US began mass production in 1942 and UK followed in 1943

Chain, Florey and Fleming earned the Nobel Prize together in 1945

persistant cough, breathlessness, tiredness, chest infections

surgery - remove the tumour or replace the lung

radiotherapy - shrink the tumour or prevent its growth

chemotherapy - shrink the tumour or prevent it returning

CT shows tumour and a sample of cells are collected and then tested

1965 - TV advertising of cigarettes is banned

tax is placed on tobacco and campaigns are launcged to educate people on the risks

2007 - smoking is banned in public places

shops banned from displaying them

packets contain graphic images of dangers