1500 - 1799: the beginnings of change

• Andreas Vesalius (1514 - 1564)

  *considered the father of modern human anatomy

  *respected Galen's work but believed that it was vital to ask questions and challenge traditional ideas by carrying out dissections

  *stole the dead body of criminal to dissect - a local judge then gave him the bodies of executed criminals so that he could study anatomy

  *encouraged doctors to carry out their own dissections, however many doctors stuck to traditional views and didn't dare to challenge Galen

  *faced lot of criticism and was forced to leave Padua University
• The Fabric of the Human Body

  *book written by Vesalius and published in 1543

  *proved Galen had made some mistakes: the human jaw bone is made of one bone (not two), the breastbone has three parts (not seven) and blood does not flow into the heart through invisible holes in the septum as such holes do not exist

  *the book was full of illustrations showing the body in far more detail and ore accurately jam had ever done before

  *by the 1560s, it was being used in England to train doctors and correct mistakes in order medical books
• Vesalius' short term impact

  *his book quickly improved knowledge about anatomy around Europe

  *helped change attitudes as some doctors realised there was more to be learned

  *helped change training with some doctors carrying out human dissections instead of animal ones to learn more

  *triggered other research into anatomy - using the approach outlines by Vesalius, one of his students (Falloppio) published a book showing the structure of the human skull and ear
• Vesalius' long term impact

  *gradually, other doctors followed his example and started to challenge traditional ideas in other areas of medicine (e.g. Pare and Harvey)

  *by the late 1600s, most students were encouraged to find things out themselves and gain hand-on dissection experience
• Vesalius' limitations


  *no one was healthier as a result of his work

  *did not affect the understanding of disease - for most of the Renaissance period, doctors still based their treatments on Galenic teachings
• how knowledge of anatomy improved

  *printing press: the quicker and cheaper way to produce books

  *enquiry: challenging old ideas and making new discoveries
• the printing press


  *15th century invention which revolutionized the ability to print information which in turn affected the speed of the spread of information itself

  *human error with books being copied by hand was less likely to happen as each copy with the printing press would be identical

  *thousands copies of Vesalius' book were sold all over Europe and as a result, doctors in Britain improved their knowledge of anatomy
• enquiry


  *an act of asking for information

  *with the printing press, nearly 600 printed editions of Galen's books were produced and sold, which helped to encourage people to think and challenge his ideas

  *Galen himself loved enquiry, which encouraged others to do so

  *the spirit of enquiry changed the way that doctors were trained and helped lead to a scientific revolution
• William Harvey (1578 - 1657)

  *developed new ideas about physiology through dissection, detailed observation and scientific experiment

  *showed that the heart pumps blood around the body by working out that the amount of blood going into the arteries each hour was three times the weight of a man

  *showed that the body has a one-way system for the blood by trying to pump liquid pasted the valves in the veins and being unable to do so, meaning that valves in the veins always directed blood towards the heart

  *his theories explained how poisons spread so rapidly in the body
• An Anatomical Account of the Motion of the Heart and Blood

  *book published by Harvey in 1628
• Harvey's short term impact


  *his discovery was only gradually accepted as some doctors ignored his theory and other said that he was wrong as he was challenging Galen
• Harvey's long term impact

  *nearly 50 years later his ideas were accepted and taught instead of Galen's

  *many areas of medicine today (e.g. surgery or injections) depend on understanding of the circulatory system

  *other doctors followed Harvey's scientific methods to build on his work: Professor Marcello Malphgi used one of the first effective microscopes to discover capillaries, which move blood from the arteries to the veins

  *Vesalius and Harvey's wok led to a scientific revolution in the late seventeenth and eighteenth century, with the Royal Society being established in 1660 and its members meeting weekly to discuss ideas and carry out experiments
• Ambroise Pare (1510 - 1590)

  *spent 20 years as an army surgeon and used his experiences on the battlefield to make important breakthroughs in surgery

  *designed and arranged the making of more than 50 kinds of false limbs for soldiers and included drawings of hem in his books to spread the idea

  *boiling oil was used to stop the poisoning of gunshot wounds at the time, however one time he had run out of oil and created an ointment from egg yolks, rose oil and turpentine to treat his patients: he was afraid of his patients ending up poisoned or dead from this, however he found they were in less pain and their wounds were not inflamed or infected, as opposed to soldiers who had oil used on them

  *knowing that cauterisation was extremely painful and did not always stop bleeding, he experimented with tying ligatures around individual blood vessels to stop bleeding, however they were incredibly slow to carry out and dangerous as the thread could carry infection
• Pare's impact

  *his books were widely read and his techniques were adopted by surgeons across Europe

  *encouraged surgeons to think for themselves and try out new techniques, showing that improvements were possible

  *helped raise the status of barber surgeons, making it a respected profession
• Pare's limitations


  *surgeons still dud not have access to effective anaesthetics

  *they had no effective antiseptics to stop infection

  *they did not understand blood groups or have fast ways of stopping major bleeding
• traditional Renaissance methods of treating illness

  *bleeding and purging: still one of the most common treatments as many physicians continued to believe illnesses were caused when the humours were out of balance

  *herbal remedies: handed down through generations from mother to daughter and they used everyday ingredients (e.g. honey) - the printing revolution meant that more people learned how to read and could buy books describing the properties of herbs and how they help different parts of the body
• new treatments from abroad

  *European explorers brought back new treatments though trade

  *rhubarb from Asia was widely used to purge the bowels

  *bark of the cinchona tree from South America was used to treat fevers

  *opium from Turkey was used as an anaesthetic - it worked, though it was highly addictive and it was easy to overdose on it

  *tobacco from America was greeted as a 'cure-all' as it was recommended from toothache, poisoned wounds, joint pains and as protection from plague
• Quackery


  *began in the Middle Ages and rose during the Renaissance period

  *quacks were travelling salesmen with no medical qualifications, travelling town to town selling medicines and pills that they claimed could cure anything

  *Joshua Ward made a lot of money selling pills that supposedly could cure every illness - all they did was make people sweat a lot

  *James Morrison made a lot of money by selling "Vegetable Pills", encouraging people to take as many as possible to stay healthy - they contained mainly purgatives and caused numerous deaths due to excessive bowel movements
• the Great Plague of 1665

  *epidemic with some improvements on how to prevent its spread compared to 14th Century (plague in 1348) but many treatments still the same

  *after the Black Death of 1348, plague never completely disappeared
• believed causes of the Plague

  *similar beliefs to 14th century ones

  *sent by God

  *planetary movements

  *miasma
• methods of treatment for the Plague

  *similar beliefs to 14th century ones - hygiene is now better in comparison

  *bleeding and purging

  *prayers for the sick or religious charms to wear

  *cutting of buboes to let the pus out

  *herbal remedies, some were a mixture of herbs and superstition (e.g. wrap in wooden clothes, make the sick person sweat, which if he do, keep warm until the sores begin to rise, then apple to the sores live pigeons cut in half or else a plaster made of yolk of an egg, honey, herb of grace and wheat flour)
• methods of prevention of the Plague

  *hanging of song smelling herbs in doorways and windows and carrying a bundle of herbs while walking through the street

  *those with the disease to be quarantined

  *bedding had to be hung in the smoke of fires before it was used again

  *fires were lit in the streets to cleanse the air of poisons

  *order to sweep the streets outside homes

  *killing of stray dogs and cats

  *Lord Mayor's rule: no public gatherings and the shutting of infected households with watchmen on guard
• limitations to methods of prevention of the Plague

  *parliament refused to turn the orders into laws because MPs refused to be shut in their houses

  *the King and his council left London, prioritising his safety

  *six of the nine men put in charge of dealing with the plague in London left as soon as they could

  *plague symptoms were not reported and over 20 watchmen were murdered by people escaping from houses that had been shut up

  *not enough men could be found to work as watchmen and some of them took the chance to steal from sick people
• consequences of the Plague

  *quarter of London's population died

  *combination of cold weather and then the Great Fire of London in 1666 to put an end to it

  *following the Great Fire, central London was completely rebuilt: narrow streets and wooden buildings were replaced by stone and brick buildings and wider,better-paved streets

  *for some time, London became healthier, but with overpopulation during the Industrial Revolution, the benefits of the rebuilding disappeared
• Renaissance hospitals

  *less hospitals after dissolution of monasteries by Henry VIII (1536)

  *charities and some local councils helped keep hospitals open, with St Bartholomew's Hospital having 12 wards, up to 300 patients, 3 physicians, 3 surgeons, 15 nursing sisters and a larger number of nursing helpers by the 1660s

  *by 1800, more hospitals were beginning to be established (as well as specialist hospitals, such as maternity hospitals), with London's hospitals treating more than 20000 patients a year
• Renaissance hospitals limitations


  *only treated minor complaints (e.g. bronchitis or leg ulcers)

  *infectious diseases were still not treated

  *most just provided food, warmth and prayer

  *anyone with any money preferred to pay for a doctor/nurse to look after them at home

  *by 1700, London's population had risen to over half a million people, yet it only had two large medical hospitals
• Renaissance medical training


  *theory of the four humours was still widely accepted

  *training was concentrated on the writings of Greek and Arab doctors

  *in a few hospitals, part of a physicians training took place on the wards

  *training emphasised the importance of scientific approach, observing symptoms and trying out treatments

  *most doctors carried out dissections

  *technological advances with improved medical equipment (e.g. better microscopes and the first thermometers) helped training
• Renaissance health practitioners


  *physicians were highly regarded and better trained, however most people could not afford them

  *many people continued to prefer cheaper and more familiar remedies from surgeons and apothecaries

  *women or local wise women were still relied on

  *travelling quacks growing in popularity
• the Royal Society


  *an honorary English society (formalized in 1660 and given a Royal Charter by Charles II in 1662) through which the British government has supported science

  *met weekly to discuss new ideas in physics, botany, astronomy, medicine and other sciences

  *built its own laboratory and bought equipment, such as microscopes, and demonstrated experiments

  *this experimental approach to science changed the ways that doctors thought - they were more prepared to challenge old ideas and search for new discoveries

  *by the late 1600s, support for Galenic ideas had begun to fade
• John Hunter (1728 - 1793)

  *surgeon to King Georgie III and Surgeon General to the British army, giving him great influence

  *set up his own anatomy school and surgical practice and his books covered a wide range of topics

  *successfully treated a tumour on a patient's knee by tying off arteries to restrict blood flow to the aneurysm, encouraging new blood vessels to develop and bypass the damaged area - the usual treatment would have involved amputation

  *also cut a 4kg tumour from a patient's neck

  *stated that the area around gunshot wounds should be cut out to remove "poison" and it should be treated like any other wound, allowing the body to heal itself
• Hunter's impact


  *encouraged scientific approach and experimentation

  *his books were widely read and helped improve surgical knowledge

  *many surgeons that Hunter trained became great medical practitioners themselves

  *his large display of preserved animals, plants, fossils, diseased organs, embryos and other body parts was en for public viewing and helped improve attitudes to dissection of the human body

  *his fame reflects how surgery and anatomy was beginning to be seen as am important part of medicine
• smallpox prevention before Jenner

  *inoculation: involved spreading pus from a smallpox spot into a cut in the skin of a healthy person - if the person was lucky, they only got a mild dose of smallpox and did not catch it again as their body had developed a resistance to smallpox

  *this method was dangerous, as a severe dose could be induced and death could occur, the smallpox could be passed on to someone else and most people could not adore inoculation, with it being charged for up to £20 (£1500 in today's money)
• Edward Jenner (1749 - 1823)

  *a student of John Hunter

  *developed a vaccination for smallpox in 1796

  *by knowing that milkmaids that caught cowpox never got smallpox, he decided to carry out experiments to see if he could use cowpox to prevent smallpox

  *he injected the cowpox pus from a sore of a milkmaid into a healthy 8 year old boy and then inoculated him with smallpox matter

  *with careful observation, he saw that no disease followed, even after inoculating the boy again several months later

  *he did 23 similar experiments and then in 798, he felt sure enough of his method to publish his findings
• Jenner's short term impact

  *the government gave Jenner £30000 to develop his work - vaccinations became widely used and were free

  *vaccinations were not made compulsory until 1852, partly due to opposition, and even then it was not strictly enforced

  *attitudes eventually changed as people realised vaccination was more effective than inoculation

  *from 1872 to 1887, vaccination was strictly enforced and after 1887 parents were allowed to refuse vaccination of their children
• reasons for opposition to vaccination

  *some people did not like the idea of a treatment being linked to animals

  *some believed disease was punishment for sin so the only protection was living a godly life

  *some people did not believe Jenner because he was from the countryside and was no a famous London doctor

  *Jenner could not explain how his vaccination worked

  *inoculators were worried about losing income to free vaccinations
• Jenner's long term impact

  *deaths from smallpox plummeted and in 1980, world health organisation declared smallpox eradicated

  *by 1800s, doctors were using his technique in America and Europe

  *his work laid the foundation for vaccinations for other serious diseases