Medicine

• Growing population (more waste + clean water)

• Waste in streets (no sewers --> public privies and cess pits)

• Human waste seeps into drinking water

• Animal waste --> butchers throwing animal body parts in street

• Rivers take waste away but also used for drinking water

• Commercial business waste --> Leather

• Lead/wood pipes for fresh water

• Privies in some houses or public privies

• 1388 Law --> no throwing rubbish into streets BUT no law to enforce it.

• Tradesmen encouraged to keep places clean

• Location --> away from towns

• Knowledge --> monks could read and write so learnt from ancient ideas

• Routines --> washing/eating/rest (bath once a month)

• Monasteries were next to clean drinking water

Because cleanliness = holiness

• Blood letting (withdrawal of blood) --> most common

• Trepanning (drilling a hole in the skull) --> let the demons out (for people who actually had epilepsy)

• Amputation --> cauterisation afterwards using a hot iron to burn a wound to stop the flow of blood

• Lack of training --> barber surgeons

• No understanding of bacteria or dirt carrying disease

• No effective pain killers

• Couldn't help patients with deep wounds

• Sometimes thought pus in a wound was good

• Observation

• New ideas circulated from books from the Islamic world

• Battlefield surgeons tried new techniques

• Religious duty

• Individuals

• Stability

• Knowledge

• Prophet Muhammed encouraged medical learning

• Sickness was seen as something to be treated

• -"For every disease Allah has given a cure"

• Al-Razi

• Ibn Sina

• Wrote 150 books

• Challenged medicine

• His ideas were later used across Europe

• Wrote encyclopaedia of medicine

• Discussed conditions like obesity and anorexia

• Distinguished between measles and smallpox

• It was ruled by a single caliph

The pursuit of knowledge

• Librairies

• Many Greek texts were translated into Arabic

• A hospital in Baghdad (with a medical school and librairies in it)

Treating patients, not just caring

• Prayer

• People went on pilgrimages to get better

Education

The pursuit of new ideas

• A monk

For suggesting doctors should do original research

• 700

• They were clean and had good food

• Had specialist ones for people with mental illness or lepers

Books by ancient scholars like Galen

blood, phlegm, yellow bile, black bile

• That imbalance caused illness

• Focus on diet to improve balance rather than praying

• Look at the symptoms and make a judgement

• Focus on what you could see

• Hippocratic Oath "Do no harm"

• Doctors still make this oath today

He had no real understanding of the human body

He believed in the use of opposites.

Liver circulates blood and then burns out.

Discovered that arteries carried blood

• Believed in 4 humours

• Believed that blood was created in the liver

1300-1600

• People inspired to criticise ancient texts

• Educated people wanted to discover, not just accept what the church said.

• Printing press invented in 1451 --> books were cheap and ideas spread quickly.

• New weapons --> gunpowder = new types of wounds.

• New lands discovered --> bought back new medicine.

• Paré

• Harvey

• Vesalius

• Jenner

• Hunter

• Miasma + 4 humours causing illness

• Punishment from God

• Bloodletting continued

• Superstition continued --> King's touch could cure disease

• Herbal remedies continued

• Barber surgeons + wise women continued

• Opium used as anaesthetic

• New treatments discovered --> Quinine (a bark from South America) for malaria

• Lemon/limes to treat scurvy (vitamin C)

• Trained Doctors (still used some traditional methods though)

• Showy, travelling salesmen who sold medicine

• Fake doctors

• New hospitals built --> 5 in London with different wards for different diseases

• Medical schools to train doctors

• More evidence based approach to illness, not a punishment from God

• 1776 Edinburgh hospital had a pharmacy and gave free medicine to the poor

• 1746 STD hospital in London

• -1749 Maternity hospital set up in London

An epidemic in 1665 that killed 100k in London

• Bleeding with leeches

• Smoking/ smelling vinegar and roses to avoid miasma

• Escaping --> King Charles and his court escaped

• Offered ineffective treatments

• Wore a mask with herbs to avoid breathing in miasma

• No knowledge of bacteria

• Ineffective treatments and avoiding miasma --> using frogs, pigeons, and snakes to draw out the poison

• Largely confined to London

• More organised this time --> better quarantine to stop spread, law passed in 1666 which ended trade and boarder closed with Scotland to limit disease entering from Britain

• Officials recognised link between dirt and disease, so more effort to clean streets

• Better disposal of bodies --> mass plague pits

• Gatherings of crowds --> plays and games were banned

• Illustrated textbook giving accurate depictions of the human body

• Showed Galen's errors --> there was a difference between an ape and a human breast bone.

• Challenged Galen's beliefs that Human and pig anatomy were similar

• The comprediosa which was very popular in the 1500s

• As he dissected stolen dead bodies of criminals, he showed how to do proper human dissections and famous anatomists followed his approach

• He did not find any new medical cures

• Ran out of hot oil to cauterise wounds on the battlefield and improvised with egg white, turpentine and rose oil --> worked well and less painful

• Bought back Galen's use of ligatures to stop bleeding

• Invented Crow's beak clamp to stop bleeding temporarily

• Published "Works on Surgery" in English and French

• Designed false limbs for soldiers

• William Clowes used Paré's work to inform his own

• Clowes was Queen Elizabeth's surgeon

• Dissected lizard and human hearts

• Understood the heart's role as a pump

• Experimented by pumping blood the wrong way, proving blood could only be pumped one way

• Proved blood circulated around the body, not made in the liver (challenged Galen)

• Fundamental understanding of how body works --> in long term leads to blood transfusions

• Took a long time for people to accept

• People liked blood letting so it wasn't accepted well

Smallpox

• Inoculation (giving a small dose of the disease through crushed up smallpox scabs) --> didn't always work, could still kill and pass onto others

• Poor couldn't afford

• It was popular --> made doctors rich

• Cowpox was a milder version of smallpox that made you immune to it

• Learnt this from milkmaids

• Experimented on an 8 year old boy

• Wasn't taken seriously as he wasn't a city doctor

• Doctors tried his technique but made mistakes which made some people ill

• Royal Family was vaccinated --> Jenner given £10000 to do research

• 1800s --> technique used across America + Europe

• 1853 --> British government made smallpox vaccine compulsory

• Surgeon to King George III

• 1771 wrote Natural History of Teeth

• 1786 wrote a book on Venereal Disease

• Wrote books on disease, cancer and circulation of the blood

• Collected + studied 3000 anatomical specimens --> stuffed animals and diseased organs.

• Pumped wax into blood vessels to study circulation

• Demanded careful observation in surgery

• Gave himself gonorrhoea germs

• Saved a man's leg through surgery rather than just amputating

• Taught 100s of other surgeons including Edward Jenner in his SCIENTIFIC approach

• Inspired young surgeons to become great medical teachers and professors in both Britain and America

• No effective pain relief so it was terrifying and had to be done quickly

• The painkillers that were available were difficult to measure (opium) or not appropriate (alcohol —> caused heavy bleeding)

• Early confusion about amounts of pain relief needed

• Hannah Greener died after a toenail operation —> wrong amount

• Some surgeons thought soldiers should put up with the pain

• Pain seen as God’s will

• Queen Victoria used it for childbirth

• Made it fashionable and acceptable

• Still high death rate from infection though

• Nitrous Oxide “laughing gas” used in 1844 when American dentist Horace Wells used it to remove teeth

• Ether —> effective but had dangers, used by an American dentist 1842, used to amputate a leg in 1846 —> difficult to inhale and highly flammable

• James Simpson in 1847

• Most effective and safest

• Surgery carried high risk of infection

• Confusion over why infection happened —> where did microbes come from and what did they do?

• Surgeons tried to keep patients healthy and the wound clean —> if it became infect they used cauterising or acids to burn away affected tissues

• The idea that decay caused microbes and that all microbes were the same

• The microbes just appeared out of nowhere

• Published in 1861 by French scientist Louis Pasteur

• Proved spontaneous generation wrong

• Proved germs caused decay

• Carried out Swan Neck Flask experiment to show how liquids went off when exposed to air

• Spray Carbolic acid on wounds, hands and equipment

• 1865 mended the fractured leg of a young boy and didn’t have to amputate because he wrapped the wound in bandages soaked in carbolic acid. Boy recovered in 6 weeks

• Didn’t understand complexity of microbes though —> still operated in street clothes

• Many unwilling to be proved wrong about old theories

• Many didn’t like using Carbolic acid as it dried the skin, irritated the lungs and took the nurses a long time to prepare

• Used Koch’s research on identifying specific bacteria to develop vaccines diseases like Anthrax and Cholera

• German bacteriologist - founder

• Developed methods to identify specific bacteria by staining and photographing microbes

• Used mice to prove that specific bacteria caused specific illnesses

• Identified microbe for Anthrax

• Developed methods to allow scientists to identify specific bacteria

• This allowed them to develop vaccines

• Koch’s work was informed by Pasteur’s initial germ theory

• He applied Pasteur’s theory to human diseases

• Read Pasteur’s work and applied it’s theories to his surgical work

• A period of great change (1750-1900) in Britain

• Britain changed from being agricultural to industrial

• Population grew by 50%

• Thousands of people moved to cities to work in factories —> this caused problems

• Typhoid

• Tuberculosis

• Cholera

• Miasma

• Before Germ Theory —> spontaneous generation

• Beliefs changed due to Germ Theory and improvements in public health/more government action and individuals such as Chadwick, Snow and Bazelgette

• Rapid industrialisation —> overcrowding, poor/back-to-back housing, lack of toilets, contaminated drinking water, no rubbish collections, street cleaning of sewers

• 1831 —> 50K killed

• Then further outbreaks

• Carried by water but people thought it was in the air

• People knew there was a link between disease and poverty but not why

• Crowded areas

• Poor sanitation

• unhygienic conditions

• Central boards of health set up to improve PH in towns

• Local boards of health —> didn’t do much

• Towns were encouraged to spend money on cleaning up the streets (most didn’t but Liverpool and Birmingham did)