MedicineRevisionBooklet

www.stchistory.com

NB:SomeinformationhereisforbackgroundegPrehistoric/Egypt

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HowdoIrevise?Somerevisionideas:-makecolourfulmindmaps-typeupasummaryofyournotes-makeatimeline(onpaperoronTimetoastonline)-makeflashcardsofdates,keypeople,wordsetc(onpaperoronGetRevisingonline)-storyboardanevent,e.g.Jenner'sdiscoveryofvaccination-makeaconceptmapforaneventshowingwho,what,when,whereandwhy-writeanA-Zofthetopic-writeastoryfromthepointofviewofaninanimateobject,e.g.thepoliticaldealfromthepointofviewofHindenburg'spen-recordyournotesandputthemonyouriPod/phone(Audicityiseasytouse)-createsongstorememberkeyfacts(lookupHistoryTeachersonYouTube)-teachabitofthetopictosomeonewhoknowsnothingaboutit,getthemtotakenotessoyoucanseewhatyouforgottoinclude-writeaquiz/makeagametoplay(onpaperoruseGetRevisingonline)-getthebigmarkerpensoutandmakeposterstostickaroundyourroom-prepareapresentationonyourtopic-writethestoryout,cutitupandputitbacktogether-skimreadthesourceandsummariseitinafewsentences,summarisethatuntilyougetoneword-writekeywordsfromthestoryonpost-its,stickthemtothingsintheroom,walkaroundtheroomtellingyourselfthestoryuntilyoucanimaginethewalkandtellthestoryinyourhead-makeanactivity/writeastoryforteachingthetopictothelowerschoolSomesillyideasyouneedgenuinehistoricalreasoningfor:-Whowouldwininafightbetween…-…islike…because…(ForrestGumpstyle)-linktwoideastogetherinfivesteps,e.g.theFourHumoursandGermTheory-giveyourselfsixtysecondstoproveapoint,e.g.thatGalenmadethebiggestcontributiontotheHistoryofMedicine-relateatopictoafilmorbook-ifoneofthepeoplefromHistorywerearrested,howwouldtheyjustifytheiractions?-whatwouldhavehappenedif…?(virtualhistory)-putyourmusiconshuffle,relatethatsongtothetopic-makeTopTrumpsfor6people/inventions/events,howwouldtheybescored?-makeagraphshowingtheexperiencesofpeopleovertime,diditgetbetterorworse?

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MedicineThroughTimeYoumustknowthecharacteristicsofeachtimeperiodandthecontributionsoftheindividualswithinthosetimeperiods.Youneedtobeabletoexplainwhyindividuals/inventionscausedmedicinetoimprove.Youalsoneedtounderstandthedifferentthemesacrossthetimeperiodsthatcontributedtothedevelopmentofmedicine.Foreachtimeperiod,thereisadetailedversionofyourclassnotes,aswellasaspiderdiagramofthemainpoints.Torevisecontent,highlightthemainpointsforthetimeperiod(causeofdisease,treatments,publichealthmeasures,importantdiscoveriesetc),findthefactors(youcouldcolourthemindifferentcolours,scientiststhinkcolourfulthingsareeasiertoremember)andfindtheexamplesofimprovementsinmedicine.Attheendofeachtimeperiodareafewquestionsfromrealexampapersandalinktoafactsquizonline.Makesureyoucananswereachofthembeforeyougointotheexam.Factors:ChanceGovernmentReligionIndividualsWarScienceandnewtechnology

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PrehistoricmedicineMedicinefrom‘beforewrittenrecords’.Mostoftheevidencecomesfromcavepaintingsandthebonesofthepeoplewholivedthen.Thepeoplelivinginthistimehadahealthydietandwerespendingtheirlivesfollowingtheirfoodsupply.Whentheybegantosettle,theyfoundedfarms.Lifespanswereshort,fewpeoplelivedpast40.Thereisevidenceinbonesofpeoplesufferingarthritisandofbrokenbonesbeingsetwithwoodsplintscoveredinmud.Infectioninopenwoundswouldhavebeenaproblemandtherewasnowayofsealingdeepwounds.Prehistoricpeoplewouldhaveasmallamountofknowledgeoftheinsideofthebodyfrominjuriescausedwhenhuntingandfrombutcheringanimals.Causeofdiseasewasbelievedtobeevilspiritslivinginsidethehead.Theyusedtrepanning(removingapieceoftheskullwithaflint)tolettheevilspiritsout.Oftenthepieceofbonewastiedaroundtheneckasaluckycharm.Somepeoplemusthavesurvivedtrepanningbecausetheholeintheskullstartedtoseal.Illnesswastreatedbywitchdoctors/medicinemen.Theytreatedpeoplewithherbs,magicandchantingtotrytoscaretheevilspiritsaway.

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Prehistoric medicine (5000 BC – 3000 BC)

Medicine men treat people with herbs and magic

Evil spirits cause disease

Trepanning – cutting holes in skulls with flint to let the spirits out

We know people survived because their skulls grew back

Danger in everyday life but they had a healthier diet

Fractures and breaks treated with mud splints

Prehistoric = before written records

Knowledge comes from archaeology

Public health came by accident, e.g. by burying waste to stop the spirits getting it

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EgyptianmedicineEgyptiansbelievedthatpeoplebecameillbecauseofevilspiritsandangrygods.Egyptiandoctorsusedherbsandmagictotreattheirpatients.Theyoftencouldn’tstopdiseasesspreadingsostillusedprotectivecharmsandmagic,especiallywhentheyweredesperate.AllpeopleinEgyptwerepreparedfortheafterlife.Mummiesweremadeofimportantpeople,suchasthePharaoh.Youneededamummybecauseintheafterlifeyoursoulneededtofindyourbody,soitneededtobetreatedcarefully.Toembalmthebodiesoftheveryrich,firstthebrainisremovedfromtheheadandtheskullcleaned.Theintestines,heart,liver,stomachandlungsareremoved.Theheartiscleanedandputbackinsidethebody(theyneededtheirhearttobeweighedtoallowthemintotheafterlife,ithadtoweighlessthantheFeatherofTruth,ifitdidn’ttheheartwouldbeeatenbyamonsterandthedeadpersonwoulddisappearforever)andtheotherorgansputintocanopicjars.Thebodyiswashedandcoveredinatypeofsaltcallednatronandlefttodryoutfor40days.Thentheskinisrubbedwithoilandwrappedinlinenbandages.Thebodyisputintoacoffininsideaburialchamberwiththejarsoforgans.MedicinewasabletoimproveinEgyptbecause:-theEgyptianswererich.TheytradedcropsfromthefertilesoilaroundtheRiverNileandusedthemoneytopayforspecialistdoctors(e.g.thePharaoh’sdoctor)andnewbronzemedicalinstruments.ThePharaohalsomadesurethateventhepoorestEgyptianshadaccesstomedicaltreatment.-theEgyptianstraded.EgyptianmerchantstradedwithcountriessuchasIndiaandChinaandsomeAfricancountries.Themerchants’shipspickedupherbsandplantsinthesecountriesandbroughtnewcuresbacktoEgypt.-theEgyptiansdevelopedwritingandpaper.TheEgyptianscouldrecordtheirmedicalcureswithhieroglyphicsonpapyrusandpassthemonaccurately.-theEgyptiansmummifiedtheirdead.Whenembalmingbodies,theEgyptianstookoutpartsofthebodymeaningtheycouldlearnabouthumananatomy.Thisisespeciallyimportantbecausehumandissectionwasillegal.-theRiverNilefloodedeveryyear.Aswellasmakingfarmersrich,theRiverNileinspiredthemtocomeupwithBlockedChannelTheorybasedaroundtheideathatifthechannelsintherivercouldblockwhentheriverflooded,thesamethingcouldhappeninourbodies.Thismeantdoctorsexaminedbodiesreallycloselylookingforblockagesandusedtreatmentssuchaslaxativestogetridoftheblockages.Thisisimportantbecauseitisarationalcauseofdisease,asopposedtotheirrationalideasaroundcurescomingfrommagic.

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Change: recording ideas, Blocked Channel theory, influence of the government Continuity: supernatural cause of disease, religion and herbs used to treat people

Egyptian medicine (3000 BC – 1500 BC)

Pharaohs paid for doctors and health care for the poor

Money made from trade paid for specialist doctors

Trading with countries like China brought new herbs and treatments

Irrigation in the River Nile brought Blocked Channel Theory

New surgical tools were made out of bronze

Hieroglyphics and papyrus were invented and ideas were recorded Bodies were

mummified so people could see human organs

Gods caused disease – Sekhmet and Imhotep

Patients were treated with herbs and supernatural cures

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GreekmedicineTheGreekshadgodsforeverything.ThegodofhealingwascalledAsclepiusandhehadtemplesofhealingcalledAsclepions.PeoplewhowereillcametotheAsclepiontoprayforacure(theybelievedthatillnesswasapunishment)andfirstofallgiveofferingsandsacrificestothegods.Theywouldwashinthetholosandsleepinatemplecalledanabatonovernightwheresnakeswouldslitherovertheirbodiesandcurethem.TheGreeksusednaturalaswellassupernaturalcures.OneoftheirlogicalcureswastheTheoryoftheFourHumours,inventedbyHippocrates.TheGreeksbelievedthefourelementsthatmakeuptheworldwerelinkedtothefourseasonsandthefourliquidsinthebody.Whenthehumourswerebalancedinthebodyyouwerewell,butwhenthehumourswereunbalancedyouwouldbecomeill.Doctorstriedtoremoveexcesshumourstobalancetheperson(theydidNOTusetheoppositehumour,thatwastheRomans!).Doctorsencouragedabalanceofeverythinginlifeandbegantoencouragebasicpersonalhygiene.FourHumours,theircharacteristicsandillnesses:-yellowbile–hotanddry–feversandvomiting-blood–hotandwet–dysentery,nosebleeds-phlegm–coldandwet–sneezingandcolds-blackbile–coldanddry–dryskinandvomitingHippocratesbegantoinventrationalideasonmedicine,ratherthansupernatural.HeinventedtheHippocraticOath,whichsaidthatdoctorsshouldtreattheirpatientswithrespect,somethingthatisstillusedtoday.TheHippocraticCorpusareacollectionofbooksattributedtoHippocrates,althoughtheyweren’tallwrittenbyhim.Heexplainedtheimportanceofobservingpatientsandrecordingeverything.HeinventedandusedtheTheoryoftheFourHumourstoexplaindisease.HefoundedamedicalschoolonKosandonlyallowedoperationsifthepatienthadagoodchanceofsurvival.SurgeryinGreektimesinvolvedironandsteelinstruments.Operationsweremostlydoneontheskin,notinsidethebody,withtheexceptionofdrainingthelungsifthepatienthadpneumonia.TheGreekswereabletoimprovemedicinebecausetheywererichandsorichpeoplehadthetimeandmoneyforeducation.TheGreeksbecamefamousfortheirthinkingonthings,e.g.philosophyandmaths.Theirtradingalsobroughtnewideasfromabroad.Doctorsalsoencouragedobservationandrecordingsymptomsandcures.Doctorsrecordedeverythingapatientdid,includinghiccupping.TheGreeksalsousedthemedicalschoolatAlexandria,whentheyhadconqueredtheEgyptians.AtAlexandria,therewasalibraryandmedicalschoolandthedoctorswereallowedtoperformhumandissections,whichhelpedthemtoimprovemedicine.

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Change: Four Humours, Alexandria, natural treatments Continuity: religious causes of disease and religious treatments

Greek medicine (1500 BC – 400 BC)

Unbalanced humours and Gods caused disease, e.g. Asclepius

Diet, exercise and personal hygiene were encouraged

Diseases could be treated in temples of healings - Asclepions

Hippocrates – Humours, oath, observation and recording

Four Humours – body split into four humours than needed to be balanced to stay healthy

Alexandria – massive medical library, place for human dissection

New natural and more logical treatments

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RomanmedicineTheRomanEmpirewasreallyimportanttoRomanmedicineandwayoflife.ItmadetheRomansrichandsotheycouldaffordtopayfordoctors.TheyalsolivedinbigcitiesthatwerecrampedandcausedpublichealthproblemsthattheEmperorsneededtosolve.Thegovernmentplayedanimportantrolebecausetheywereinfluentialandcentralisedandsoideasspreadquickly.ThearmywerestationedallovertheEmpireandtheRomanstriedreallyhardtokeepthemhealthy.Alotoftheirmedicaladvancescamefromtryingtokeepthearmyhealthy.Thearmyalsoinvadedalotofplaces,likeAlexandria,andtookideasfromtheplacestheyinvaded,likeGreekreligioustreatments.Romansusedreligioustreatmentswhentheyweredesperate.Romegottheplaguein295BCandtheyturnedtoAsclepionstocureit.Romehaddoctors,whowerefrequentlywomen.TheyweretrainedinplaceslikeAlexandria.Somedoctorswerepaidtostayincitiesandtreatthepoor.Romandoctorstreatedpeoplewithmedicinesmadefromherbs,andlikethecivilisationsbeforethem,religionwasoftenmixedintoo.Theyalsosuggestedagooddietandexercisewouldimproveyourgeneralhealth.TheRomansalsobelievedinGalen’smiasmatheory–thatdiseasecamefrombadsmellsintheair.GalenwasthemostinfluentialRomandoctor.PeoplewerestillreadingandusinghistreatmentsandideasintheMiddleAges.HewasborninGreeceandtravelledthroughAlexandria’sgreatlibrary(hedissectedhumanbodieswhilstthere)andwenttoworkinaRomangladiatorschool.HethenwenttoRometobecometheEmperor’sdoctor.WhenhefirstgottoRome,heheldapublicmedicaldissectionofapigwhereheprovedthatthebraincontrolsthebody,nottheheart,bycuttingthethroatofapigtostopitfromsquealing.HecontinuedsomeofHippocrates’ideassuchascarefulobservationofapatientandrecordingeverythingthathappenedtothepatient.HedevelopedHippocrates’ideasoftheFourHumourintotheTheoryoftheOpposites,whereyouusedtheoppositehumourtocureillnesses–suchashotspicesforacoldwhenyouhaveanexcessofcold,wet,phlegm.SomeofGalen’sideaswerewrongandcamefromdissectinganimalsratherthanhumans,forexamplehewronglysuggestedthatwehavetwojawbones,whichistrueofdogsandnothumans.However,hewrote60booksonmedicalsubjectsandthepeoplewhocameafterhimcontinuedtoteachthathisideaswerealwaysrightforthenext1500years.TheRomans’greatcontributiontomedicinewaspublichealth.Theybelievedinpracticalsolutionstoproblemsanddidalottotrytocuretheproblemofthespreadofdiseaseinthecities.AcrosstheEmpire,theRomansbuiltsewerstotakeawaywaste,

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aqueductstobringfreshwatertothecities,publictoiletsandwaterfountainsandbaths.ThebathsweredesignedtobesocheapthateventhepoorestRomancouldaffordtogothere.Bathswerebuiltlikemodernspaswhereyoucouldhavemassages,batheindifferenttemperaturesofwater,takepartinsportandhavedinnerwithyourfriends.TheRomanspassedpublichealthmeasurestodirectlyhelptheirarmy,forexampletheysaidthatarmycampsshouldn’tbeclosetoswampsbecauseittendedtomakethesoldiersill.

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Change: hospitals, miasma, Theory of the Opposites, public health measures Continuity: religion, exercise, taking ideas from Greece, Alexandria

Roman medicine (400 BC – 500) Alexandria – massive

medical library, place for human dissection

Gods and the imbalance of humours caused disease

Public health systems built – aqueducts, sewers, public baths

Centralised government could pass on ideas and invade new countries

Took some ideas from Greece when invaded

Roman Army hospitals built to keep them healthy, moved from swamps

Miasma theory – bad air

Exercise and healthy eating encouraged

Galen – books, recording and observation, Theory of Opposites

Theory of Opposites – treat imbalance of humours through the opposite humour

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MedievalmedicineTheRomanEmpirefellin500AD.AftertheRomans,theearlyMedievalperiodwasfilledwithfightingbetweentribesandalltheRomanpublichealthmeasuresdisappeared.Gradually,theChristianchurchtooktheplaceoftheRomangovernment,meaningGalen’sideaswerepromotedbecausehisworkcontainedideasontheintelligentdesignofhumansthatmatchedthechurch.Fightingbetweentribesalsomadetravellingdifficult,sonewmedicalideasweren’tspreadaroundandalotofthemedicalbooksthathadbeenownedwereburntorunabletobereadbythepeople.ThesituationdidimproveinthelaterMiddleAgesandwasn’tasbadintheMuslimworld.Medievaldoctorsmostlyusedherbalremediestotreatpeople,althoughtheywouldalsoinvestigatetheastrologyofthepatientandconsulturinecharts.Medievalpeoplebelievedinmiasma–thatdiseasewascausedbybadair,andinGalen’sTheoryoftheOppositesandwouldtreatyourexcesshumours.BarbersurgeonsbecamepopularintheMiddleAges.Theywouldcutyourhairandperformbasicoperationsonyourskinorperformbleeding.Theywerecheaperthaneducateddoctors.Quackswerealsocheaperthantraineddoctorsandwouldselltheirpotionsatmarkets.PublichealthcollapsedinMedievalEngland.TheRomansystemswereallowedtofallapartanduntilthelaterMiddleAgestherewerenoregulationsonwhatcouldbethrownintheRiverThamesandwhererottenfoodandsewageshouldgo.Thismeantbutchersthrewtheirwasteintotheriver,sewagefloweddownthemiddleofstreetsintotheriverandwellsandcesspitswereoftennexttoeachother.InthelaterMiddleAgeslawswerepassedthatmadelitteringillegalandpaidteamsofmentocleanupthestreets.MedievalhospitalswererunbytheChristianchurchandoperatedinlinewithChristianteaching.Hospitalsweren’tusedtotreatthesick,astheyaretoday,insteadtheywereusedtohelppeoplesuchastheelderlyandorphans.Theyencouragedhealingthroughprayerandsohospitalsdidn’ttakepregnantwomenorsickpeoplewhomightdisrupttheprayerthepatientsweredoing.Lepersweretreatedinleperhospitalsoutsideofthecitywalls.Almshousesgrewuptohousetheelderly.Monasteriesalsoofferedhospitalcare,withmedicinesmostlybeingmadewiththeherbsinthegardenofthemonastery.In1348,theBlackDeathcametoEnglandonshipsfromChinaandthecontinent.ItkilledbetweenathirdandahalfofthepopulationofEurope.Youcouldgetdifferenttypesofplague,butbubonicplaguewhereboils(orbuboes)appearonyourskin,andpneumonicplaguewhereplagueattacksyourlungs,werethemostcommon.Wenow

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knowthattheplaguewasbroughttoEnglandbytheOrientalRatFleasthatlivedontheshipsandintheclothesofthesailors,butwithoutmicroscopesoranunderstandingofgerms,Medievalpeopleweredesperate.Medievalpeoplecameupwiththeoriesoftheirownaboutwhatcausedtheplague,suchasearthquakes,deadlyfogsandthepoisoningofthewaterbyJews.Asdoctorsdidn’tknowwhatcausedtheplague,theyalsocouldn’tcureit,butcameupwiththeirowntreatmentssuchasallowingafrogtosuckoutthepoisonfromyourbody.BecauseEnglandwassuchareligiouscountry,peoplecalledflagellantsalsotravelledaroundEnglandpublicallywhippingthemselvesinthehopetheywouldstopthespreadoftheplague.

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Change: hospitals, influence of the Christian Church, astrology Continuity: religion, herbs, Galen’s ideas Regression after the fall of Rome but it got better as time went on!

Medieval Medicine (400 – 1350)

Fall of Roman meant collapse of central power

Wars being fought between tribes, travelling dangerous

Illness as a punishment from God, imbalance of humours or miasma

Christian Church became the biggest influence on people

Treatment through praying

Doctors examined urine and used astrology

Galen still being read in 1500 due to the Church

Medieval hospitals run by monks treated people spiritually

Few sick people were allowed into hospitals

Black Death – treatment through herbs and charms

Spread through the world quickly and killed millions

Barber surgeons became popular – treated skin complaints and pulled teeth

Islamic medicine

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RenaissancemedicineTheword‘renaissance’meansre-birthandtheRenaissanceperiodwasoneofare-birthofideasthatsawsomegreatleapsforwardinmedicine.Peoplestartedtoaskquestionsaboutthemedicaltreatmentsandtheoriestheyusedandstartedtoexperimentwithnewideas.Theperiodhadlotsofnewinventions.Theprintingpressallowedmedicalbookstobeproducedandprintedmuchcheaperandmoreaccuratelythanifamonkwascopyingabookout.ArtistssuchasLeonardoDaVincidrewrealisticdrawingsofthehumanbodyandhadhisdrawingsaccompaniedbymedicalexplanationswrittenbyanatomists.Theseallhelpedmedicalbookstobepublishedandideastobepassedon.TherewerethreeimportantmedicalmindsintheRenaissance:Vesaliusworkedontheanatomyofthehumanbody.HumandissectionwasstillbannedbytheChurchsohestolebodiesfromgraves,meltedthefleshfromthebonesandhaddetaileddrawingsdoneofeachbone.HeshowedthatGalenwaswronginsomeofhistheoriesandencouragedotherdoctorstoquestionwhattheyhadbeentoldwasthetruth,especiallyupsettingthechurch.Pareinventednewsurgicalmethodstotreatsoldierswoundedatwar.Beforehim,doctorshadcauterisedwoundswithboilingoil,butonedayonthebattlefield,PareranoutofoilandusedanoldRomanremedyofrose,eggandturpentine.Thesoldierstreatedwiththeointmenthealedmuchbetterthanthosewhohadboilingoilputintheirwounds.Parealsoinventedligatures(stitches)andusedsilkthreadtotieoffveinsduringamputations.Healsoinventedatypeofprostheticlimb.HewrotehisbookinFrenchsoordinarypeoplecouldreadit.Thiswasamoreshort-termsolutiontoaproblemthanHarveyandVesalius’longtermtheories.HarveywasanEnglishdoctorwhomadediscoveriesaboutblood.Heworkedoutthattheheartactedlikeapump,thatbloodflowedinonedirectionaroundthebodyandthatthehumanbodycontainedafixedamountofblood(itwasn’tbeingconstantlyburntupandrenewedasGalenhadbelieved).Heworkedouthisideasbyexperimentingonbothanimalsandhumans.Becausemicroscopeshadn’tbeeninventedyet,hewascriticisedforcomingupwiththeideathatthereweretinybloodvesselsinthebodyandsohisideasdidn’tmakemuchofanimpactuntillater.ThethreedoctorscameupwithideasandtheoriesthatquestionedGalenandpushedmedicineforward.Theydidn’t,however,findawaytocuretheproblemsoftheaveragepeopleandtheillnessesanddiseasestheyweredyingfrom,sothetheorieshadlittleimpactonthehealthoftheoverallpopulation.

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Theplaguereturnedin1665,thistimecalledtheGreatPlague.ItprobablycamefromHollandontradeshipsandhitLondon,Sunderland,NewcastleandSouthampton.Over70000peopleinLondondied,whentherewerearound400000peoplelivingthere.InLondon,theLordMayorpassedorderstodealwiththeplaguesuchas:-sealinghousescontainingtheplague,writingaredcrossonthedoorandleavingthedoorlockedfor40days,evenifsomepeopleinthehousewerehealthy-searcherswerepaid10ptodecideifapersondiedfromtheplague-funeralswerenolongerheldindaylightandpublicentertainmentwasbanned-dogsandcatswerekilled-fireswerelitinthestreetsandrubbishcleanedupTheplaguediedoutastheweatherbecameverycold.

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Change: new inventions, art, new ideas from individuals Continuity: miasma

Renaissance Medicine

(1350 – 1750)

Renaissance = rebirth

Rebirth of science, art and medicine

New theories but few actual treatments so not much difference for the poor

Miasma caused disease, influence of the Church was reducing

Printing press invented causing books to become cheaper and more available

Vesalius – dismantled the human skeleton and had accurate drawings made

Pare – ointment for wounds, ligatures, artificial limbs

Harvey – blood flow, measures the amount of blood in the body

Public health measures to deal with the Great Plague, 1665

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19thcenturymedicine NB–thereisalottorememberforthe19thcenturysothisisatimelineSurgeryintheearly1800softenkilledthepatients.Theysufferedfromshockastherewasnopainkiller,theyoftenbledtodeathandtherewerenoanaesthetics.Thebiggestproblemwasinfectionastheystillbelievedinmiasmasotherewerenomedicinestostopbloodpoisoning,thosethatsurvivedsurgeryoftendiedafterwardsasthesurgeonsdidn’tcleantheirinstrumentsorwashtheirhands.Publichealthwasalsoastruggle.BecauseoftheIndustrialRevolution,lotsofpeoplehadmovedfromthecountrysideintothetowns.Astheindustrialpopulationexploded,housingandworkingconditionsdeteriorated,epidemicsspread,watercarrieddiseaseandhouseswereovercrowdedanddamp.Thegovernmentalsopracticed‘laissez-faire’,thebeliefthattheyshould‘leavealone’thehealthofthepopulationbecauseitwasn’ttheirresponsibility(theythoughttheirresponsibilitywasthingslikethecountry’seconomyandthearmy).1677–microscopesinventedAnthonyvanLeeuwenhoekdevelopedsinglelensmicroscopesthatcouldsee‘animalcules’(tinyorganisms).In1830,JosephListerinventedamicroscopethatcouldmagnify1000times.1796–JennerdiscoverssmallpoxSmallpoxwasveryinfectiousandifitdidn’tkillyou,itwouldleavescarsalloveryourbodyfromblisters.BeforeJenner,inoculation(addingasmallamountofpusfromamildcaseofsmallpoxtoanuninfectedpersontotrytobuildaresistancetothedisease)wasusedinChinaandTurkey.AnEnglishwoman,LadyMaryWortleyMontaguhadherchildreninoculatedinTurkeyduringasmallpoxepidemicin1721andtheysurvived.Shewasveryinfluentialandsowithintenyears,therichinEnglandwerehavingthemselvesandtheirchildreninoculated,butitwasveryexpensiveandunpredictable,ifthedosewastoolargethepersoncaughtsmallpox.EdwardJenner,acountrydoctorinGloucestershirehadtrainedwithabrilliantsurgeonwhoencouragedhisstudentstopushtheboundaries.Jennerrealisedthatifyouhadcowpox,asmanymilkmaidsdid,youwouldn’tgetsmallpox.In1796,JennerinjectedJamesPhippswithcowpoxandthensixweekslatergavehimsmallpox,hesurvived.Hedidhisexperiment23timesbeforepublishingitas‘vaccination’(aftertheLatinforcow)in1798.Parliamentgavehim£30000toopenavaccinationclinicandin1852theBritishgovernmentmadevaccinationagainstsmallpoxcompulsory.Jennercouldn’texplainwhyhisvaccinationworkedsoittookalongtimeforpeopletobeabletoreplicatehisideaswithdifferentdiseases.Manypeopledidn’tlikeJenner’sideasandhewasoftenridiculedinnewspapers.Somepeopledidn’tunderstandJenner’sevidencesodidn’ttrusthisexperiment,hecouldn’texplainhowadiseasefromacowstoppedadiseaseinapersonsodidn’ttrusthim.

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Doctorsdidn’talwayswanttostartvaccinatingpeoplebecausetheyweremakingsomuchmoneyoutofinoculation.Also,doctorsdidn’tdothevaccinationsproperly,sometimesmixingupneedlesandsometimesusinginfectedneedlesinstead.WhenJennersubmittedhispapertotheRoyalSociety,theyrejecteditandwhengovernmentmadeitcompulsorytobevaccinated,peoplehateditevenmore.Peopledidn’tlikebeingtoldwhattodobydoctorsandsomerefusedtohavetheirchildrenvaccinated.1847–SimpsondiscoverschloroformIn1799SirHumphryDavydiscoveredlaughinggasasawayofnumbingpainandsuggesteditcouldhaveamedicaluse.In1846inAmerica,etherwasusedtoputpatientstosleepanditbecamepopularinEnglandtoo.But,ethermadepeoplecoughandvomitwhilstinsurgerysoitwasnotverypractical.In1847,JamesSimpsonfromtheSchoolofMidwiferyatEdinburghUniversitydiscoveredchloroform.Heinvitedsomeofhiscolleaguestotestoutdifferentchemicalsandtheywereallknockedoutaftersniffingchloroform.Hemostlyuseditwhenwomenwereinlabour,whichpeopledidn’tlikebecausetheybelievedwomenweresupposedtosufferduringchildbirth.Chloroformwasunpredictableandcorrectdosesweredifficulttoadminister,forexamplein1848HannahGreenerdiedafterinhalingtoomuchchloroformduringanoperation.Chloroformdidn’tmakesurgerysaferaswithpatientsunconscious,doctorsperformedmorecomplexoperationsthattookinfectiondeeperintothebody.However,in1857,QueenVictoriausedchloroformduringchildbirth,helpingittobecomemorewidelyaccepted.1854–FlorenceNightingalegoestotheCrimeaBeforeNightingale,hospitalshadnotbeenpleasant.Nursesinhospitalswereuntrainedandoftenpaidinginandthepoorwhowenttherewerenottreatedwell,whilsttherichwenttovoluntaryhospitalsthattheypaidasubscriptionto.Nightingale’sfamilywererichandinfluentialanddidn’twanthertobecomeanurse.ShebelievedthatbeinganursewasGod’splanforherandshewantedtohelpthepoor.ShehadtrainedinGermanyandbeenanurseinaLondonhospitalforrichwomenbutwhenwarbetweenBritainandRussiawasdeclaredin1854,amemberofthegovernmentaskedNightingaletogoouttoScutarihospitalintheCrimeaandsortouttheappallingconditionsinmilitaryhospitals.Shetook38nurseswithherandtook6monthstocleanthehospital.Thenursesfedthepatients,cleanedthebedding,hiredbuilderstorebuildpartofawardandreducedthedeathratefrom40%to2%.Topayforallthechanges,shewrotetothegovernmentandfriendsofherfamilyandofferedtopayfortheworkherself.ShereturnedtoBritainafter2yearsanationalhero(TheLadyWithTheLamp)andgaveareporttothegovernmentexplainingthechangesshecouldmakeinhospitalsinBritain.In1860,shewrote‘NotesonNursing’andsetupBritain’sfirsttrainingschoolfornursesatStThomas’HospitalusingthemoneyraisedinhernamewhileshehadbeenintheCrimea,makingnursingarespectedprofession.In1863shewrote‘NotesonHospitals’andshowedthemhowtomakewardsairyand

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brighttostopmiasma.MarySeacolealsoworkedintheCrimea.ShewasJamaicanandwenttoBritainhopingtogototheCrimeawithFlorenceNightingale.Shedidn’tgetaninterviewsopaidtogooutthereherself.Whenthere,shesetuptheBritishHotelwheresoldierscouldsleep,begivenhotfoodandlookedafter.Shealsowentontothebattlefieldandtreateddyingsoldiers.SeacoleandNightingaledidnotgetonandNightingaleaccusedSeacoleofrunningabrothel.1842–EdwinChadwick’sreportAfteraseriesofcholeraepidemics,thePoorLawCommissionemployedEdwinChadwicktomakeareportontheconditionsoftheworkersintownsandthepeopleinthecountryside.Hequestionedthousandsofpeoplebeforereleasing‘TheReportontheSanitaryConditionsoftheLabouringPopulationofGreatBritain’.Hebelievedthatmiasmawasmakingtheworkersillandspreadingdiseaseandmadesomerecommendations,suchas:-appointingmedicalofficers-cleaningthewaterandimprovingremovalofwastefromstreets-improvinghousingThegovernmentdidn’tbelievethiswassomethingtheyshouldbeinvolvedinanddidnothinguntil1848whenanewcholeraepidemichitEngland.Theyalsodidn’tfeeltheycouldaskrichtaxpayerstopaymoremoneytoimprovethepositionofthepoor.Underthe1848PublicHealthAct,theyrecommended:-settingupaBoardofHealthtoimprovelivingandhousingconditions-buildinghouseswithdrainsandtoiletsTheycouldimprovetheirtownsbyborrowingmoneyfromthegovernment,ratherthanmakingtaxpayerspayfortheimprovements.However,thiswasnotcompulsoryandmosttownschosetoignorethesuggestions.1854–JohnSnowlinkscholeratowaterIn1831,1832,1848and1854,choleraepidemicshitovercrowdedtownslikeLiverpoolandLeeds.In1831,itkilled50000people.Peoplewithcholeraturnedblackjustbeforetheydiedandthousandsdiedindays.Townscleanedupthestreetshopingthatitwouldstopmiasmaspreadingdisease,butitdidn’tworkbecausecholeraisspreadbywaterbeinginfectedwithsewage.JohnSnowwasadoctorworkinginSoho,London.IntheareaaroundBroadStreet,over700peoplediedofcholerainafewdays.SnowresearchedanddiscoveredthatthelinkbetweenallthevictimswastheBroadStreetwaterpump.OneofthewaysheworkedthisoutwasthroughawomanwhodiedofcholeraalongwayfromBroadStreetbecauseshewashavingwaterdeliveredtoherfromthepumpbecauseshepreferredthetaste,anotherwasbecausethelocalbrewerygavetheiremployeesfreebeertodrinkandtheyallsurvived.Snowremovedthehandlefromthepumpanddiscoveredthatapipefromatoiletwasleakingsewageintothewatersupply,causingcholera.Thisprovedthatcholerawasnotcausedbymiasma,butbybeingincontactwithpeoplewhowereill.The

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governmentstilldidn’tactonthisinformation.1858–theGreatStinkThesummerof1858wasparticularlyhot.Duringtheheatwave,theRiverThames,whichwasfullofrubbish,deadanimalsandchemicalsfromfactoriesandsmeltdreadful.ThegovernmentweremeetingonthebanksoftheThamesattheHousesofParliamentandaskedtobemovedbecausethesmellwassobad.ThiscausedthegovernmenttoactontheadvicetheyhadbeengivenbySnowandChadwickandemployedJosephBazalgette,anengineer,tobuildsewersaroundLondon.HedesignedpumpstopushthesewagetotheseaandBazalgettewasgiventheequivalenton£1bntobuildthesewers.Thegovernmentthenwentintoactionimprovingthelivesofthepoorinthecitiesbyintroducing:1870–compulsoryeducation1875–PublicHealthActmakingChadwick’searliersuggestionscompulsory,HousingActmakingitpossibleforthecitiestotakedowntheworstoftheslumhousing1876–foodanddrugregulationThiswasespeciallyimportantforthegovernmentasworkingclassmenhadbeengiventhevotein1867andthegovernmentneededtothinkofwaystogettheirsupport.Allthesecausedthedeathratetofallandpeople’sgeneralhealthtoslowlyimprove.1861–GermTheorydiscoveredBeforePasteur,scientistshadseengermsinsidebloodfromsickpeopleundermicroscopes.Itwasbelievedthatthediseasecausedthegermsandthetheorywascalled‘spontaneousgeneration’becausethegermsappearedoftheirownaccordwhensomeonewasill.Pasteur,ascientistnotadoctor,startedtoquestiontheseideas.Inthe1850s,PasteurdevelopedPasteurisationtostopalcoholturningsour.Hefoundamicro-organismthathecalledagermanddiscoveredthatifyouboiledthealcoholthegermswoulddie.Heusedthismethodwithbeer,milk,wineandvinegar.Toprovespontaneousgenerationwrong,Pasteurputidenticalliquidintwoglasscontainersandboiledthemtokillallthegerms.Hebentthespoutofoneofthecontainerssoaircouldn’treachtheliquid,whilstleavingtheotheropen.Heusedthistoprovethatgermsareonlyfoundinplacestheycouldreachandthatthegermsinfectedtheliquidandturneditsour.Hepublishedthisin1861asGermTheory.In1865,Pasteurprovedthatsilkwormswerekilledbyadiseasecausedbyagermintheair,provingthatwhathappenedinalcoholalsohappenedinanimals.ManydoctorsstruggledtobelievethatsomethingassmallasagermcouldharmsomethingasbigasahumansothetestsstoppedthereuntilKochcamealong.1867–ListerinventscarbolicsprayBeforedoctorsacceptedGermTheory,theydidn’tworryaboutinfection,leavingwoundsopenandnotwashingtheirhandsorequipment.In1847,IgnazSemmelweiss

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madethelinkbetweendirtyhandsandinfectionafternoticingthatwomenwhosebabiesweredeliveredbymedicalstudentswhohadbeenperformingdissectionsweremorelikelytodie.Hetolddoctorstowashtheirhandsbuttheydidn’tbelievehim.JosephListerwasworkingatGlasgowRoyalInfirmaryandthoughtthatgermsmightbemakingpatientsdieafteroperations.Hehadpreviouslyworkedatresearchinginfectionslikegangrene.CarbolicsprayhadbeenusedtotreatsewageandListerexperimentedwithsprayingcarbolicsprayduringsurgery.Heusedapumpspraythatsoakedeverythingintheroominantisepticacid.Thisstartedarevolutionincleaninginhospitals.But,carbolicspraywasn’tacceptedstraightaway.Itcrackedsurgeonshands,wasexpensiveandoftensurgeonstriedtocopyListerbutwerenotsosystematicwiththeircleaningsothepatientstillgotaninfectionandthedoctorsblameditoncarbolicspraynotworking.ListerwasalsonotascharmingasPasteurandwouldn’tdobigshowydemonstrationssopeopledidn’tfinditaseasytoaccepthisideas.But,afterKochdiscoveredthegermthatcausedbloodpoisoning,asepticsurgerywasaccepted.From1887instrumentsweresteamsterilisedandfrom1894,rubberglovesbegantobeused.Thismadethesurgeonsmoredaringandledtoanoperationtofixastabwoundtotheheartin1896.Listeralsopioneeredtheuseofsterilisedcatgutasnewligatures(before,stitcheshadnotbeencleaned).1875–KochfindsanthraxgermsRobertKochhadbeenintriguedbyPasteur’sworkonGermTheoryandsoin1871hiswifeboughthimamicroscopeforhisbirthday.Heusedthistolookatanthraxbacteriafromadeadsheep.Hefoundthebacteria,grewit,gaveanthraxtoamouseandthenprovedthatdiseasescouldreplicateindifferentmicebyrepeatingtheprocess20times.KochwasgivenapermanentjobbytheGermangovernmentandateamofassistantstohelphim.TheythenfoundthebacteriathatcausedTB,cholera,typhoidandtetanus.Kochalsodevelopedawayofstainingbacteriapurplesoyoucouldeasilyseeit.1879–PasteurandchickencholeraFranceandGermanywererivalsduringthisperiod.FrancehadlosttheFranco-Prussianwarin1871andPasteurhadaseverestroke,spurringhimtoworkharder.HegotmoneyfromtheFrenchgovernmentandateamofscientistsandvetstodealwithchickencholera,aproblemfortheFrenchfarmingindustry.Theteamwerestrugglingtomakeaweakenedformofthedisease.WhenPasteur’steamwentonholiday,somechickencholerawasleftout.CharlesChamberland,oneofPasteur’steam,accidentallyusedthisonhisreturnanddiscoveredthatexposuretotheairhadkilledthediseaseandinjectingitintothechickenhadmadeitimmune.Pasteurnamedthis‘vaccination’inJenner’smemory.Pasteurthenmovedontomakingaweakformofanthraxin1881.Hedidapublicdemonstrationtoshowthevaccineworked.In1882hemadearabiesvaccinethatworked.

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The19thcenturyundoubtedlysawmassiveimprovementsinmedicine.However,manypeoplecouldn’taffordtoseeadoctor,infantmortalitywasstillhighanddoctorsfrequentlycouldn’tcuretheirpatients.

Acartoonpublishedin1866.Thecaptionreads'Death'sdispensaryopentothepoorgratisbypermissionoftheparish'.Adispensarywasaplacewheremedicinewasgivenout.Gratis=free

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Change: Germ Theory, vaccinations, new ideas on surgery, government intervention in public health, foundations of modern medicine Continuity: Nightingale was sent by God, Chadwick believed in miasma

19th century medicine

(1800 – 1900)

Miasma causes disease at the beginning until Germ Theory in 1861

Three surgical problems (pain, bleeding, infection) dealt with

Simpson (chloroform), Lister (carbolic spray), better stitches

Vaccines invented to treat diseases

Jenner (Smallpox), Koch and Pasteur

Public health a serious problem in cities due to the Industrial Revolution

Chadwick (reports on public health), Snow (Cholera), Bazalgette (sewers)

Changes to nursing made hospitals cleaner and safer

Nightingale and Seacole at the Crimea

Great Stink made a laissez-faire government interested

Pasteur found germs, Koch proved the germs made you ill

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20thcenturymedicineWorldWarOnemadeanimportantimpactonmedicine.Althoughittook14000doctorsawayfromtheirusualjobs,theyworkedonthebattlefieldtoadaptnewtreatmentsandthenboughtthembacktoEnglandafterthewarandsetthemselvesupasspecialists.Duringthewar,doctorshadtodealwithwoundstheyhadneverseenbeforeandinventednewwaysoftreatingpeople.Surgeonsdevelopednewwaysoftreatingburnwoundsthroughplasticsurgery,brainandeyesurgerywasimprovedasshrapnelwoundscausedfacialinjuries,X-rayswereusedonthebattlefieldtofindmetalfrombulletsinthebody,bloodtransfusionsweredevelopedandsalinewasusedtocleanwounds.Afterthewar,thegovernmentpromiseda‘homefitforheroes’toaimtodealwiththepoorstandardofhealththerecruitshadsufferedfromin1914.X-rayshadbeeninventedin1895byWilhelmRontgenbutwereusedeffectivelyforthefirsttimeduringWWI.ManyofthehospitalsontheWesternFronthadthemandtheywereusedtofindbulletsandshrapnelinwoundsthatcouldhavekilledthesoldierswithouttheX-raymachines.In1901,differentbloodgroupshadbeendiscoveredandduringWWIdoctorsdevelopedawayofseparatingthebloodandpackingitinicetopreserveit,stoppingthebloodfromdryingoutandbecominguseless.Salinewasdevelopedtotreatinfectionandwounds,especiallyaswoundshappenedinthemudofthetrenchesandthebulletsandshrapneltookbacteriadeepintothebody.AfterPasteurhaddiscoveredGermTheoryin1861andKochandPasteurhaddevelopedvaccinesfordiseasessuchasanthrax,thenextstepwastofinddrugstokillthediseasesinthebody.ThefirstpersontoattemptthiswasPaulEhrlich,amemberofKoch’sresearchteam.Hedevelopedadrugin1909calledSalvarsan606,a‘magicbullet’thatsoughtoutsyphilis(anSTI)bacteriaandkilledit.Itwascalled‘606’asittook606attemptstofindacombinationthatworked.However,itwasn’talwayssuccessful,thedrugcontainedcyanidewhichoftenkilledthepatientaswellasthegerms.Thiswasdevelopedin1932byGerhardtDomagkwhoinventedProntosil,areddyethatfoundandkilledthebacteriathatcausedbloodpoisoning.Hediscoveredthisworkedafterhisdaughter,Hildegarde,wasplayingwithherguineapiginhislaboratoryandprickedherfingeronaneedle.Aftershedevelopedbloodpoisoning,heinjectedherwithProntosilandshesurvived.Thesedrugswerecalledsulphonamidesbecausethethingthatmadethemworkwasachemicalthatcamefromcoaltar(somethingthatcouldonlybeseenunderanelectronmicroscope)andweresoonusedtoattackmeningitis,scarletfever,gonorrhoeaandpneumonia.Thesedrugsmassivelyreduceddeathsofwomeninchildbirth.Thediscoveryofsulphonamidesandmagicbulletsledtothedevelopmentofpenicillin.Inthe1800s,JohnSandersonhaddiscoveredthatpenicillinmouldkilledeverythingarounditandListerhadusedpenicillinmouldonanurse’sinfectedwound.Other

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scientistspickedupanddroppedresearchintopenicillinuntil,in1928,AlexanderFlemingfromStMary’sHospital,London,startedhisresearch.HewasmademoredeterminedbywatchingthesufferingofthesoldiersinWWIwhowereaffectedbythestaphylococcusbacteriaandoftendiedinpain.Fleminggenerallyworkedinamessylaboratoryandhadleftsomeplatesofstaphylococcusgermsonthesidewhenhewentonholiday.Whenhereturned,thegermsweredead.Penicillinmould,whichwasbeinggrowninthelaboratoryabovehim,hadflownintothewindowandlandedonhispetridish,killingthegerms.Flemingmadealistofallthegermsthatpenicillinmouldwouldkillandpublishedhisfindingsin1929.Heusedthemouldasanantiseptictokillinfectioninacolleague’seyebutdidn’ttakeitanyfurtherashedidn’thavethefacilitiestocarryouttheresearch.Hedidn’tinjectitintoanimalsorpeople.Inthe1930’s,FloreyandChainreadFleming’sresearchandthreedaysafterWWIIbrokeout,askedthegovernmentformoneytodevelopFleming’sidea.However,withWWIIstarting,thegovernmentonlygavethem£25.Withthehelpofateamofpeople,theymadeenoughpenicillinfortestsonmice.Theyinjectedthemwithinfectionsandthenpenicillinandthemicelived.Theyneeded3000timesmoretotestonhumansandsoturnedtheirlabintoapenicillinfactory,growingitinmilkbottles.Inearly1941theytreatedAlbertAlexanderwhohadgotaninfectionafterbeingscratchedbyarosebush.Nootherdrugshadworkedonhimandhehadtohaveoneofhiseyesremoved.TheinfectionrespondedtopenicillinandAlexanderstartedtorecover.However,thepenicillinranoutandhedied.ThisconfirmedtoFloreyandChainthatthedrugwasworthpursuingandin1941,FloreygotfundingfromAmerica(whowerenotyetinvolvedinWWII)tomass-producepenicillin.By1944,penicillinwasbeingusedatD-Dayand15%morewoundedsoldierswouldhavediedwithoutit.Afterthewar,penicillinwasmass-producedforthepublictotreatinfectionssuchaspneumonia,tonsillitisandmeningitis.TheSecondWorldWaralsohelpedtodevelopotherwaysoftreatingpeople.DoctorsfoundwaysofstoringbloodforlongerandpeoplelikeHaroldGilliesdevelopedpioneeringskingraftsforburntairmen,whichbecamemodernplasticsurgery.Thewaralsoimprovedthehealthofthegeneralpublic.Citychildrenwereevacuatedintothecountrysidewheretheirhealth,dietandhygieneimprovedandrationingimprovedpeople’sdietbyaddingvitamins.In1940anationaldiphtheriacampaignvaccinatedallchildren.AlsoduetoWWII,theNHSwasintroduced.Peoplehadtopayforavisittoadoctorandfortheirmedicinesoin1911,thegovernmenthadintroducedNationalHealthInsurancesoworkerscouldgethelpwhentheywereill.Thiswasonlyeffectiveforthosewhowereworkinghowever,andwomenandchildrenstilldidn’tgetmedicalhelp.In1942,WilliamBeveridgewroteareportexplainingtheproblemsfacingpeoplelivinginBritain.Hesaidtherewerefive‘giants’thatneededtobeovercome:-squalor–poorhousingshouldbepulleddown,newtownsshouldbebuiltthe

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countryside-diseases–peoplewhoreallyneededmedicalhelpcouldn’taffordit,sodentists,injectionsandhealthcareshouldbefree(thiswouldbecometheNHS)-ignorance–schoolsandteachersshouldbefound,childrenshouldstayineducationuntiltheageof15sotheyaremorecapableoflookingafterthemselves-idleness–peopleneededjobssonewfactorieswouldbeopened-want–peopleweren’tabletopayforthethingstheyneeded,sofamilyallowance,freeschoolingandhealthcareweresuggestedTheLabourPartycametopowerpromisingthattheywouldimplementBeveridge’ssuggestions.In1948,theNHSstarted.Itwasinitiallyopposedbydoctorswhopreferredbeingpaidprivatelyandbytaxpayerswhothoughtitwouldbetooexpensive.Bevan,theMinisterforHealth,promisedthedoctorsasalaryandbythetimetheNHSopened,90%ofdoctorswerebehindtheplan.Publichealthcarefrom‘cradletothegrave’hadamassiveimpactonthehealthofthepeople,especiallyimprovingthehealthofwomenandchildren.

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Change: NHS, welfare state, new inventions, DNA, penicillin Continuity: Germs

20th century medicine

(1900 – 2000)

Germs caused disease Welfare state was introduced

Housing rebuilt, NHS, pensions, free school meals

Penicillin discovered by Fleming by accident and developed by Florey and Chain

Governments paid for it to treat soldiers in WWII

Modern war needed better medicine – X-rays, blood transfusions and plastic surgery

Magic bullets found the disease and killed it

DNA discovered

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FactorsandthemesCauseandCureofDiseasePrehistoricmen,Egyptians,Greeks,Romansandthemedievalperiodallbelievedinsupernaturalcausesofdisease.EvenintheRenaissance,peopleprayedandworecharmsorbelievedinunproventheoriesliketheBezoarstone,whichsupposedlycouldcureallpoisons.Thiswasespeciallytrueattimesofuncertainty,likewhenplagueshit.Allperiodswerealsoinvolvedinnaturalcures.Evenmedicinemenhadpracticalcuresforbrokenlegs,becausetheycouldseeitandsoexplaintheproblem.EgyptianscameupwiththeideaoftheBlockedChannelsthroughobservationofnature.ItwasHippocratesandtheTheoryoftheFourHumours,developedbyGalenintotheTheoryoftheOpposites,whichreallyputnaturalcausesabovesupernaturalcauses.Thisdoesnotmeanthatpeoplestoppedbelievinginsupernaturalcausesovernightthough,religioncontinuedtoplayamajorpartinmedicine.Manypeopledidnotunderstandthenewdevelopmentsorsimplydidnotlikechange.Jennerdiscoveredthiswhenhecouldnotexplainvaccination;Pasteur’sGermtheorywaschallengedbytheTheoryofSpontaneousGeneration;whilstJohnSnowfounditdifficulttoprovethatcholerawasnotcausedbymiasma.Chance

v Trialanderrorofmedicinemanv Pareandboilingoilv Jennerandcowpoxv Pasteurgoingonholidayv Simpsonsniffingchloroformv ErlichandSalverson606v Domagk,hisdaughterandProntosilv FlemingandPenicillin

Government

v Pharaohsandthefirstdoctorsv Romeandpublichealthv RomeandtheEmpirepassingnewideasv LocallawsintheMiddleAgestokeepthestreetscleanv BritishgovernmentintroducedcompulsoryvaccinationforSmallpoxv PublicHealthActs(1848optional),(1875compulsory)v BritishandUSgovernmentfundPenicillinresearchv IntroductionoftheNHS1947

War

v RomanArmyv WarintheMedievalperiodpreventedprogress

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v Parewasawarsurgeonv CrimeanWar1854-56helpednursingv FrancoPrussianWar1870-71broughtaboutrivalrybetweenKochandPasteurv WWI–Doctorsgainedexperience,improveskillsinbrainsurgery,headsurgery

andplasticsurgeryBUTstoppedresearchbecausenomoneyspentonresearchReligion

v Witchdoctorsv Priestsweredoctorsinearlycivilisationsv Evilspiritscauseddiseasev Mummificationimprovedknowledgeofanatomyv Galencouldnotdissecthumansv ChristianChurchdominatedtheMedievalperiodandranhospitalsv PlaguesentbyGodv Churchthoughtitwassinfultousechloroforminchildbirth

ScienceandTechnology

v Prehistoricflinttoolsfortrepanningv BronzetoolsformummificationandsurgeryinEgyptv EngineeringskillsofRomansforpublichealthv NewartistsanduseoftheprintingpressintheRenaissancev Inventionofthemicroscopeinthe19thcenturyv Kochdevelopshisgelandpurpledyev Developmentsintheunderstandingofbloodinthe20thcenturyv Computers,opticsandelectronicsinmodernmedicine

IndividualsPrehistoric–medicinemenEgypt–PharoahGreek–Asclepios,HippocratesRoman–GalenRenaissance–Vesalius,Pare,Harvey,DaVinci19thcentury–Jenner,Chadwick,Snow,Bazalgette,Simpson,Lister,Pasteur,Koch,Nightingale,Seacole20thcentury–Roentgen,Ehrlich,Domagk,Fleming,Florey,Chain,Beveridge,BevanWiththerevisionyou’veprepared,practiceansweringthese:'Chancebyitselfhasneverhelpedprogressinmedicine'.Explainhowfaryouagreewiththisstatement.(8)Explainhowwarhashelpedprogressinmedicine.(7)'SinceRomantimesreligionhashindered,ratherthanhelped,medicalprogress'.Explainhowfaryouagreewiththisstatement.(8)

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MedicinekeywordsWriteadefinitionnexttothesekeywords:

Anaesthetic

Antiseptic

Anatomy

Asclepion

Barbersurgeon

Cauterise

Germtheory

HippocraticOath

Inoculation

Vaccination

Ligature

LaissezFaire

Magicbullet

Miasma

Permissive

SpontaneousGeneration

Sulphonamides

Trepanning

TheoryoftheFourHumours

TheoryoftheOpposites