EASTER REVISION: MEDICINE THROUGH TIME AND SURGERY

Roman and Medieval Medicine

Galen

Roman Public Health

Sewers

Aqueducts

Public Baths

Fountains

Theory of the Opposites developed

Dissected animals

Ideas adopted by the Catholic Church

HippocratesClinical Observation

Case Studies

Hippocratic Oath

Strong Government

Funds raised through taxation

Theory of the Four Humours

Catholic Church

The Black Death

Causes Cures

Black Bile Yellow Bile

Blood

Phlegm

Movement of the planets-astrology

Cats and Dogs

Miasma

GodJews

Army Hospitals

Strong Government

Live Chicken

FlagellantsPray

Run for the hills

Regression?

Adopted Galen’s ideas

Banned dissection Early hospitals (St

Barts)

Started medical training for physicians

Jobs

apothecaries

Physicians

Barber surgeons

Women

Bloodletting

Bloodletting

350 texts

Galen’s ideas used at the first medical school in Salerno

Herbal remedies

Physicians often used a handbook called a vademecum

Imbalance of the four humours

Galen• Built on the ideas of Hippocrates’ Four Humours• He added to the Theory by including his own ideas on

‘Opposites’• He dissected animals to improve his knowledge of anatomy and

claimed to have dissected humans• Claimed there were holes in the septum of the heart, one

kidney was higher than the other, and humans have two jaw bones, like an ape.

• He recorded his work in over 350 texts. • He claimed that the body fit together so well that it must have

been designed

The Church• Christianity (Catholicism) was very important to people’s daily lives in Medieval England and across Europe. People believed very strongly in religions and accepted the Church’s authority over their lives.

• The Church accepted and promoted the ideas of Galen because his ideas fit with the Catholic belief that God created humans.

• This meant that Galen’s ideas were unchallenged for over 1,000 years. Human dissection was also forbidden.

• Monasteries had libraries which held medical texts. Monks were educated and could read and write. This meant that important medical knowledge was not lost and could be used to train doctors. The church controlled training of doctors.

Public Health• The Romans understood that disease increased if you lived near places with bad air. They built their towns away from marshes and swamps.

• The Romans brought three main public health developments:

1. Public Baths

Citizens were encouraged to keep clean. Admission was cheap to enable most people to attend. The baths also included public toilets. Waste was removed by a sewage system.

2. Sewers

Every major town was built with a sewer system to remove waste from the towns and stop disease.

3. Water supply

Aqueducts bought fresh water to the towns.

Public Health• Three main factors brought about these developments:

1. Strong government

Laws were passed to enforce sanitation standards. Taxes were collected to pay for public health systems and resources and man power were organised.

2. The Roman Army

Provided the need for good public health – to have strong citizens for the army. When not fighting, the men were used to build public health systems.

3. Communication

Central control from Rome kept Britain up to date with new ideas.

Public Health• Medieval towns were for more crowded and dirty that Roman towns.

• The public health systems that were put in place by the Romans, and libraries holding medical texts were destroyed after the Romans left England. War and fragmented society meant that public health systems were left to decay.

•The Catholic church was very conservative (did not like change) so people were uneducated, therefore fall back on old superstitious practices, whilst public health and strong central government cease to effectively function.

Medieval treatment• Trained physician: £££!!Trained at medical school and passed exams, diagnoses using urine and astrology. Gives treatments based on Galen. Does not treat you himself, sends you to an apothecary or barber surgeon.

• Apothecary Trained but not qualified, mixes ingredients tor produce medicines. Also mix up their own medicine. • Barber surgeon Carries out blood letting and some basic surgery. Very low success rate. Not trained, will also cut your hair. • Housewife physicianUsed traditional remedies, known as a local wise woman. Used some herbs and some charms.

Medieval treatment• People believed that illness was a punishment from God, they did not try to cure the patient. Instead only their symptoms were treated.

• Medieval treatments were based on superstitious beliefs. Charms and astrology were used to try to treat diseases.

Annoying God – the plague was his punishment.

Looking at a victim – the disease was spread by eye contact.

Breathing bad air (miasma) – medieval towns were very smelly and the smell was supposed to contain diseases.

Drinking from poisoned wells – Germans believed the Jews were poisoning drinking water to kill off non-Jews.

The position of the planets – the relationship of the planets and the movement of the Sun affected health.

An imbalance of the body’s four humours – Galen can’t be wrong!

Touching a victim.

What did people believe

caused the Black Death?

Drink 10-year-old treacle.

Eat arsenic powder.

Sit in a sewer – the bad air of the Plague will be driven away by the worse air of the drains.

Eat crushed emeralds.

Strap a live chicken (shaved) to the Plague sore.

Kill all the dogs and cats in town.

Let the blood out of the patient.

Put herbs on the fire to make the air smell sweet.

Run for the hills.

How toprevent theBlack Death

Go from town to town flogging yourself with a whip.

Videos

• http://www.youtube.com/watch?v=ih7HJoB_ZO8

• http://www.youtube.com/watch?v=4O9uYUjsJZs

• http://www.youtube.com/watch?v=F2a3o1-FuvY&playnext=1&list=PL032E815501877778&feature=results_main

Continuity Change

• Galen’s ideas were still used and adopted by the Catholic Church

• People still believed in supernatural causes-Gods

• Bad smells were thought responsible for causing disease-miasma

•Many ideas were lost•Public health structures were destroyed•There was no strong government•The Black Death of 1348

What text best describes Ancient and Medieval

Medicine? Can you give examples of the following

words from your knowledge?

PROGRESSION

REGRESSION

CONTINUITY

CHANGEEVOLUTION/REVOLUTION

Medieval Medicine Quick Quiz1. What was the theory that Galen

developed called?2. What period did Galen work during?3. Give four examples of Roman public

health?4. Bad air/smells were called what?5. When did the Black Death happen?6. Give an example of a cause of the Black

Death according to medieval people?7. Give an example of a cure for the Black

Death according to medieval people?8. For what four reasons is Hippocrates

important9. What organisation grew in power

during the Middle Ages?10. Why did Galen’s ideas fit in with the

ideas of the Catholic Church?

11. What race/religion did some blame the Black Death on?

12. Someone who may cut your hair and also operate on you was called what?

13. Someone who mixed potions was called what?

14. What was a trained doctor called?15. Who did most people rely on for

treatment?16. When things get worse what do we call it?17. Where were early hospitals set up?18. What kind of treatment did they provide?19. Give an example of an early hospital?20. What were people called who whipped

themselves as punishment for the Black Death

Renaissance Medicine

Individuals

William HarveyPare

Vesalius

Factors

Experimentation

Individual Genius

War

Technology

Heart Pumps blood around the body

Fabricus

Anatomy

Corrected 205 of Galen’s ideasLigature

Digestive mixture

Impact

Many still relied on wise women or women of the household Many ideas

were about anatomy not curing illness/disease

Harvey could not see capillaries as microscopes were strong enough

Causes/Cures

Ligatures

Printing Press

Water Pump

Microscopes

VesaliusHarvey

Pare

Vesalius dissected

Religion

Herbal Remedies

Wise women/women

Theory of the Four Humors/Theory of the Opposites

Locking up orders (1665 Plague)

It took over 40 years for Harvey’s ideas to be accepted

Videos

• http://www.youtube.com/watch?v=qOhh-8mgTFk

• http://www.youtube.com/watch?v=e049-TgXaQ0

• http://www.youtube.com/watch?v=8A5PS87Di78

Continuity Change

•Herbal remedies that were passed from one generation to the next•People were conservative and reluctant to change•Many people were still very religious•Woman of the family still treated minor illnesses•Few people could afford to see a trained physician

•Much less control of medicine by the church•New plants were discovered when new lands were discovered•Ideas of Vesalius, Harvey and Pare•The mechanical pump was invented•The printing press was invented-communication!

What text best describes the Renaissance? Can you give examples of the following

words from your knowledge?

PROGRESSION

REGRESSION

CONTINUITY

CHANGEEVOLUTION/REVOLUTION

Renaissance Medicine Quick Quiz1. What does Renaissance mean?2. Who do we associate with the Fabric

of the Human Body?3. What technology inspired William

Harvey?4. Give an example of a Renaissance

centre of learning?5. What was Pare’s job?6. What is cautery or cauterisation?7. What did Vesalius do that hadn’t been

done before?8. What ‘a’ describes what most medical

discoveries of the Renaissance relate to?

9. Whose authority was challenged during the Renaissance?

10. What orders were given during the 1665 Black Death and are an example of public health?

11. Give an example of technology during the Renaissance?

12. Why was Pare’s ligature not used more widely?

13. Why couldn’t Harvey prove his idea about capillaries?

14. People who don’t like change are called what?15. What society was founded during the

Renaissance?16. How many of Galen’s mistakes did Vesalius

correct?17. The microscope is an example of what type of

improvement during the Renaissance?18. Why was the printing press so important?19. Why was the Renaissance of limited

importance?20. Harvey was alive during the Stuart period in

England-true or false?

19th Century Medicine

Individuals

Public Health

Causes/Cures

Diseases

King Cholera (1832)

Tuberculosis

Diphtheria

1875 Public Health Act-local authorities given powers to enforce regulations

1866 Sanitary Act-all towns had to appoint inspectors

Laissez Faire

Germ Theory Spontaneous Generation

Edward Jenner

Florence NightingaleLouis Pasteur

Robert Koch

Smallpox vaccination

Professionalization of nursing

Germ Theory

Chicken cholera vaccine

Anthrax vaccination

Vaccination

Factors

WarExperimentation

Government

Individual Genius

PasteurJenner

Smallpox vaccination

Public Health Acts

PasteurJenner

Boer War

Crimean War

NightingaleFranco-Prussian War

Competition between Koch and Pasteur Elizabeth Garret

Anderson

Videos

• http://www.youtube.com/watch?v=65rPhLeEXpc

• http://www.youtube.com/watch?v=jJwGNPRmyTI

• http://www.youtube.com/watch?v=Wo-ewybcG-Y

• http://www.youtube.com/watch?v=Ffrq1lIfE1o

Nineteenth Century Medicine Quiz1. When was the germ theory?2. Who do we associate with the

germ theory?3. What did people think caused

disease before the germ theory?4. What was the idea that

governments didn’t get involved called?

5. Who do we associate with the anthrax vaccination?

6. Who do we associate with the smallpox vaccination?

7. Why was government important in developing the smallpox vaccination?

8. What disease was known as ‘King’?9. What did the Sanitary Act say?10. What did the Public Health Act say?

11 How were nurses known at the start of the 19th century?

12 Who developed nurse training schools?13 What war did Nightingale make her

improvements during?14 During what war did the government

notice many recruits were not healthy enough?

15 What war encouraged competition between Pasteur and Koch?

16 Who was the first English female doctor?

17 Who do we associate with the chicken cholera vaccine?

18 Apart from cholera, name another terrible 19th century disease?

19 What was the GMC?20 What were hospitals that treated the

sick called?

Public Health in

the Nineteenth

Century

Edwin Chadwick

Report in the Sanitary Conditions of the Labouring Classes

John Snow

Identified cholera was water borne-Broad Street Map

Key Individuals

Joseph Bazalgette

Designed London Sewer network

Attitudes

Laissez Faire-didn’t believe it was governments job to get involved

Gradually Laissez Faire attitudes began to change

Public Health Acts

1848 Public Health Act-allowed towns to set up a Board of health and medical officer. Organised removal of rubbish and build sewers. BUT IT WAS NOT COMPULSORY!

1875 Public Health Act-local councils were responsible for clean water; paved streets; rubbish removal; building of sewers and housing quality-IT WAS COMPULSORY!

Key Events

1858-The Great Stink-persuaded London to build a sewer-smell offended politicians

1867-working class men get the vote-this put pressure on government to take action

1832-cholera outbreak-King Cholera

What text best describes the nineteenth century? Can you

give examples of the following words from your

knowledge?

PROGRESSION

REGRESSION

CONTINUITY

CHANGEEVOLUTION/REVOLUTION

20th Century Medicine

Public Health

Individuals

Factors

Alexander Fleming

Florey and Chain

Watson and Crick

Emile Behring

War

Experimentation

Individual Genius

Government

Causes/Cures

WW1 WW2

Penicillin developed

Plastic Surgery

Development of the NHS

Anti-smoking adverts

NHSVaccinations

Watson and Crick

Florey and Chain

Behring 1911-National Insurance

DNA

Magic Bullets

Science and Technology

Prevention

Transplants

Antibiotics

X-rays

What text best describes the 20th century? Can you give examples of the following

words from your knowledge?

PROGRESSION

REGRESSION

CONTINUITY

CHANGEEVOLUTION/REVOLUTION

Videos

• http://www.youtube.com/watch?v=CIkUtfJ0yY• http://www.youtube.com/watch?v=OiiFVSvLf

GE• http://www.youtube.com/watch?v=mCrHlAe

maFw

Surgery

Pain

Infection

Blood loss

Chloroform

Used by James Y Simpson by 1847Opposition

Made patients vomitProblems

Irritated the lungs

Flammable

Religious people felt it was interfering with God’s planEffects were not

fully understood

Doctors felt it was easier for patients to die

Number of patients who died increased-Hannah Greener

Joseph Lister

1865-experiments with carbolic on a 11 year old boy

Introduces catgut instead of silk ligatures

Carbolic

Opposition

Doctors were unconvinced and joked about Mr Lister’s germs

Operations were slower-led to blood loss

Nurses resented the extra work

Lister keeps changing his methods

Pare-ligatures

1901-Karl Landsteiner-identifies blood types

1915-Richard Lewisohn-adding sodium citrate prevented blood from clotting

Richard Weil-finds blood can be stored in refrigerated conditions

1917-Battle of Cambrai-first blood banks

Videos

• http://www.youtube.com/watch?v=iWDqicC66nM

• http://www.youtube.com/watch?v=T73PYNyyeiI

Surgery Quiz1. What were the three barriers to

successful surgery?2. How was the problem of pain

overcome?3. Who do we associate with

chloroform?4. What was the name of the girl who

died of a chloroform overdose?5. What operation was she having?6. Why did many people oppose

chloroform?7. Who did a lot to popularize

chloroform?8. Who created a chloroform inhaler?9. How was the problem of infection

solved?10. Who do we associate with carbolic

spray?

11. What was his other achievement?12. Give a reason why people didn’t resisted

carbolic?13. What did doctors joke?14. How old was the boy Lister

experimented on?15. Who suggested there were blood

groups?16. What needs to be added to blood so it

doesn’t coagulate?17. Who discovered this?18. Who discovered blood could be stored

in refrigerated conditions?19. When were blood banks first used?20. Give an example of a medical journal?

Factor Examples

Government •Smallpox vaccinations were made compulsory by the government•17th Century-Lock Up orders; government orders all cats and dogs to be killed•Public Health and Sanitary Acts cleaned up British cities•The NHS was introduced by the Labour Government•20th Century-government gets more involved-anti-smoking adverts

Science and Technology •Printing Press improves communication during the Renaissance•Water Pump gives Harvey his idea that the heart acts like a pump•Microscopes help see germs

Individual Genius •Numerous examples-Galen; Pare; Harvey; Fleming; Pare; Koch; Nightingale; Florey and Chain; Watson and Crick;

Experimentation •Vesalius experiments by dissecting•Jenner experiments on a small boy•Florey and Chain experiment to mass produce Penicillin

War •Pare creates his digestive mixtures and ligatures during wartime•Franco-Prussian war creates competition between Pasteur (French) and Koch (German)•Crimean war-Nightingale improves death rate from 42% to 2%•WW1-X-Rays used; blood banks used for the first time at the Battle of Cambrai; early plastic surgery

Chance •Jenner discovers milkmaids who contract cowpox do not get smallpox•Fleming discovers Penicillin is an antibiotic

Medical Training

Medical schools were set up in the 12th century-most training based on Galen’s ideas

In the Middle Ages Physicians were the only trained doctors

During the Renaissance dissections happened-not always legally!

1815-The Society of Apothecaries and the Royal College of Surgeons introduce exams

In 1858 all doctors had to be registered with the GMC

After 1864, there was more emphasis on using microscopes and practical experience

During the 20th century doctors have begun to specialize

During the 20th century doctors take university degrees and study for several years

Doctors get on the job training

Hospitals-sort these statements into the correct chronological order?

1 There were 18 voluntary hospitals in London-how you were treated depended on how much money you had! Many old, sick or disabled entered the workhouse. Poor Law Unions were eventually pressurized to build hospitals

2 Hospitals were for specific illnesses such as leprosy and were run by monks and nuns. The focus was on caring for not curing

3 The NHS was created4 There were hospitals established to look after soldiers

throughout the empire and run by the government