history

• Hippocrates

  • Greek physician

  Theorised that disease was caused by an imbalance of the Four Humours
• Galen


  He developed a new approach to treatment, based on the Four Humours. He suggested that the balance of humours could be restored through bleeding, purging or the Theory of Opposites. 
• Religious causes of disease

  • Gods punishment
  • Testing faith
• Preventions for religious causes of disease

  • Pilgrimage
  • Prayer
  • Fasting
  • Flagellation – whipping to repent sins
• Religious treatments

  • Prayer
  • Provde offerings to the church
  • Fasting
• Supernatural causes of disease

  • Astrology
  • Witchcraft to explain epidemics
• Supernatural preventions of disease

  • Carrying 'lucky charms'
• Supernatural treatments of disease

  • Astrology- treatments were particularly effective at certain times depending on star signs
  • Folk remedies- eating a fried mouse to cure a cough
• Rational causes of disease

  • An imbalance of the Four Humours
  • Miasma- 'bad smells'
• Rational preventions of diseases

  • Good diet, exercise and sleep
  • Bleeding/purging to balance the humours
  • Quarantine – not allowing people in or out of villages
  • Cleaning the streets
  • Carrying herbs and burning tar
• Rational treatments of disease

  • Theory of Opposites- a hot fever was caused by too much yellow bile, would be balanced by eating cooling cucumber
  • Herbal Remedies
  • No treatments based on miasma
• Physicians

  • Medical degree
  • Diagnosis by studying urine.
  • Consulted star charts.
  • For richer people only.
• Apothecary

  • Mixed remedies using herbs and spices
• House wife

  • Local wise woman or lady of the manor.
  • Cheap.
  • Mixed herbal remedies.
  • Helped with childbirth and broken bones.
• Barber surgeon

  • Hairdresser who would perform basic “operations”: amputation.
  • Removed rotten teeth.
  • Also would perform bleeding
• Hospitals

  • Run by the church.
  • Monks and nuns cared for patients.
  • Good diet, prayer and rest.
  • People with infectious diseases were taken to ‘leper houses’
• Role of religion

  • Controlled the publishing of books, and teaching in Universities – emphasis on Galen’s writings
  • Ran hospitals where monks and nuns would provide care so they did not interfere with God’s plan
• Attitudes to society

  • Most people were religious so supported the idea of disease being a punishment from God
  • There was little emphasis on trying to understand or find a cure – “Galen had proved everything”
  • Few people could read or write to challenge or spread ideas
• Key individuals

  • Galen had written many books on medicine and anatomy, his ideas fitted with Christian ideas of the soul, so he had support of the church
  • Church banned dissection so no-one could disprove Galen’s wrong ideas
• jenner= preventions

  • lady montagu saw innoculation as a way of protecting patients against smallpox- was not safe as patients contracted small pox and died
  • jenner discovered people who had cowpox were immune to smallpox. he began to give people cowpox, calling it a vaccination
• jenner- positives

  • jenner does experiments for proof and self publishes research
  • vaccination was made compulsory in 1872
  • smallpox was eradicated by 1979
• jenner- negatives

  • great deal of opposition- seen as unnatural
  • doctors opposed as money fron innoculation was taken away
  • jenner could not explain how his ideas worked
• snow- preventions

  • snow observed the cholera outbreak of 1848-9, concluded it was from drinking dirty water
  • 1854- cholera broke out in soho, where snow lived. prompted him to investigate 93 deaths and prove it wasnt caused by miasma
• snow- postives

  • had an immediate ompact in residents in soho
  • 1875 health act was passed due to snow
  • presented his work to the government
  • first scientific evidence miasma wasnt real
• snow- negatives

  • many rejected snows work- some argued that cases still occured among people who lived further away from the pump
  • clung onto ideas of miasma
  • steps to provide clean water was expenisve
• nightingale methods

  • 1854 crimean war- nightingale and 38 nurses made changes to the care of wounded soldiers
  • demanded 300 scrubbing brushes to get rid of dirt near patients
  • clean bedding and good meals were provided
  • methods had a positive effect- within 6 months, death rate from infection fell from 42% to 2%
  • her ideas were based on miasma
• nightingale- nursing

  • Wrote Notes on Nursing in 1859 – setting out the role of a nurse and the importance of thorough training
  • 1860 – set up Nightingale School for Nurses at St Thomas’ Hospital in London – nurses were trained on sanitary matters
  • Made nursing seem like a respectable occupation and a skilled job
• nightingale- hospitals

  • Hospitals were built out of materials which could be easily cleaned
  • ‘Pavilion style’ hospitals – separate wards to keep infectious patients separate
  • Improved ventilation, more windows, larger rooms to stop spread of disease
• pasteur- causes

  • 1860 Pasteur entered a government competition to prove or disprove the theory of Spontaneous Generation
  • Pasteur conducted experiments to prove that bacteria was in the air and this led to decay (and infection.)
  • The Germ Theory 1861 proved that Spontaneous Generation was wrong since germs were in the air and not created by decaying matte
• pasteur- positives

  • Led to focus on hygiene & improvements in prevention
  • Pasteur developed a way to isolate and weaken the bacteria causing chicken cholera. This was a new vaccine
  • Scientists did start to look for links between microbes and disease, i.e. Robert Koch and Joseph Lister
• pasteur- negatives

  • To begin with his work had no impact because it focused on decay and spoiled food, not disease
  • Spontaneous Generation continued to be important until 1870s
  • Limited impact because attitudes among doctors meant people refused to recognise the link between germs an disease
• koch

  • Pasteur had been the first scientist to identify microbes and their role in decay. Other scientists were then inspired to look for a link between germs and disease.
  • Koch invented chemical dyes and a solid medium for growing microbes to investigate microbes causing human disease
  • In 1882 he discovered the bacteria causing tuberculosis. He published his ideas on the methods that could be used to identify disease.
• koch- positives

  • Koch continued to look for the microbes causing different disease, In 1883 he discovered cholera and proved it was spread in water supplies
  • Inspired other scientists, over the next 2 decades they discovered the microbes responsible for other diseases, such as, diphtheria, meningitis, tetanus
• koch- negatives

  • British government did not listen to Koch’s discoveries in the short term as they clung onto the idea of miasma
  • Progress was slow as each individual microbe had to be isolated
• lister- surgery

  • Lister was interested in Pasteur’s ideas about microbes and decay/infection. In 1865 he experimented using carbolic acid to clean tools and soak bandages.
  • His methods were successful as no patient suffered infection following their operation. As a result, Lister developed carbolic spray to kill infection in the wound. Also invented catgut stitches which could be disinfected.
• lister- positives

  • Problem of infection was overcome
  • Lister published the results for 11 different cases where carbolic acid had been successful in
  • His work paved the way for antiseptic and aseptic surgery
  • Other surgeons began looking for different methods to prevent infection
  • By 1900, instruments were steam cleaned, operating theatres were scrubbed, rubber gloves and surgical gowns were introduced and surgeons used face masks.
• lister- negatives

  • Carbolic acid made surgeon’s hands painful and the tools slippery so his methods were often criticised
  • News of Lister’s success spread more quickly than the Germ Theory meaning the science behind the new technique was not fully understood (this meant some surgeons did not believe the air was full of germs so did not use his theory)
  • Lister focused on encouraging his colleagues to use the spray instead of scientifically proving his theory
• simposon- surgery

  • There had been many investigations to find anaesthetics to tackle the problem of pain.  E.g. In 1846 Robert Liston used ether to anaesthetise a patient before an amputation. However this made patients cough, vomit and kept them asleep for hours or days
  • Simpson experimented to find a better solution – he found chloroform and this began to be used in operations.
• simpson- positives

  • Anaesthetics meant surgeons could take longer and do more complex operations
  • John Snow solved the problem of regulating the dosage of chloroform by developing an inhaler to control the dosage
• simpson- negatives

  • Longer more complex surgery meant more risk of infection and death from blood loss – led to the ‘Black Period’ of surgery
  • There were problems with the dosage of chloroform as it was difficult to regulate, this caused a number of healthy people to die during operations