Health

• Hippocrates and Galen


  Very influential, their ideas were taught for centuries, but some were wrong
• The Church


  Influential, stopped anyone disagreeing with Galen and outlawed dissection
• Supernatural causes of disease


  • Punishment from God
  • Witches, demons and evil spirits
  • Astrology — the movement of the planets and the stars
• Natural causes of disease


  • The Four Humours Theory
  • The miasma theory
• Medieval healers


  • Physicians
  • Apothecaries
  • Wise women
  • Barber-surgeons
• There were few public hospitals in the Middle Ages and most were run by the Church. Their main purpose was to care for people, not treat disease.
• Islamic medicine was more advanced than British medicine in the Middle Ages. Islamic doctors made new discoveries and questioned the ideas of Ancient Greek doctors like Galen.
• Poor living conditions in medieval towns


  • No clean water
  • Pollution
  • Overcrowding
  • No waste disposal
  • No sewerage systems
• Monasteries were healthier in the Middle Ages - they had cleaner water as well as better waste and sewerage systems.
• The Black Death came to Britain in 1348 and a huge number of people died.
• No-one understood what caused the Black Death. Some believed it was a judgement from God, while others blamed humour imbalances or miasma.
• Attempts at prevention of the Black Death were mostly ineffective.
• The Great Plague hit London in 1665.
• As with the Black Death, most treatments for the Great Plague were based on magic, religion and superstition.
• Local councils did more to try to combat the Great Plague than the Black Death - but they failed because they didn't know the cause of the disease.
• Vesalius


  • Performed dissections and wrote books with accurate diagrams, showed the importance of dissection for understanding the human body, pointed out some of Galen's mistakes which encouraged others to question Galen
• Harvey


  • Discovered that blood circulates round the body, which contradicted Galen. This was a major breakthrough.
• Paré


  • A French barber-surgeon who improved surgical techniques, published his ideas and British surgeons used his methods
• Doctors resisted Paré's ideas at first. It was only with the support of the King of France that his ideas started to be accepted.
• Changes in hospitals


  • The dissolution of the monasteries in the 1530s led to the closure of monastic hospitals
  • Charity hospitals opened from the 18th century
  • In the 19th century, some university hospitals were founded, used for training and research
  • From the 1850s, Florence Nightingale improved hospital hygiene and raised nursing standards
• In the 18th and 19th centuries, hospitals focused more on treatment and training doctors, rather than just caring for patients.
• Anaesthetics


  • Helped to solve the problem of pain, e.g. James Simpson showed the effects of chloroform in 1847, let surgeons do longer, more complex operations
• The rise in deaths from infection due to anaesthetics was because surgeons didn't know that their unhygienic methods spread disease.
• Antiseptics


  • Helped to kill germs and prevent infection, Joseph Lister started using carbolic acid in the operating theatre in the early 1860s, from the late 1800s surgeons used asepsis, keeping theatres clean and germ-free
• Key public health developments in the 1800s


  • 1832 - First cholera epidemic in Britain
  • 1842 - Edwin Chadwick publishes his report on poverty and health
  • 1848 - The government passes a Public Health Act
  • 1854 - John Snow links cholera to contaminated water
  • 1858 - The Great Stink in London
  • 1865 - London's new sewer system opens
  • 1875 - A more effective Public Health Act is passed
• The industrial revolution led to poor living conditions in towns, and the government slowly abandoned its laissez-faire attitude and started to take action to improve public health.
• Government intervention since 1900


  • Liberal social reforms (1906-11) - Driven by Booth's and Rowntree's reports on poverty, and the Boer War
  • Housing Measures (1920s-1960s) - The World Wars created pressure for social change, encouraged the government to build new, better-quality housing
  • The Welfare State (1946) and the NHS (1948) - Introduced after the Beveridge Report (1942)
• Today, the NHS faces many challenges: increased life expectancy, lifestyle choices (e.g. smoking) and high expenses. It has to make difficult choices about which treatments it can afford to provide.
• Developments in doctors and surgery


  • From 1518, many doctors trained at the College of Physicians and studied medical developments
  • Explorations abroad brought new treatments, e.g. quinine to treat malaria
  • Dissections became a key part of medical training for doctors in the 1700s
  • Surgeons became more important from the 1700s, the London College of Surgeons was created in 1800 and set training standards for surgeons
  • John Hunter (1728-93) made important discoveries and encouraged better approaches to surgery
• Pasteur


  • Published his Germ Theory in 1861, developed vaccines for anthrax and rabies
• Koch


  • Built on Pasteur's work by finding the bacteria that cause specific diseases
• Ehrlich


  • In 1909, discovered the first magic bullet (Salvarsan 606) - a way of attacking specific germs
• Germ Theory


  The theory that many diseases are caused by microorganisms
• Vaccination


  The only way to prevent smallpox in the 1700s was inoculation, Edward Jenner's discovery of the smallpox vaccine in 1796 was a big development in preventative medicine
• The vaccine faced opposition, but got the approval of Parliament in 1802. It was made compulsory in 1853 and led to a big fall in the number of smallpox cases.
• Advancements in surgery during World War One


  • Plastic surgery
  • Blood transfusions
  • X-rays
• Surgery vastly improved in the 20th century and became far less risky. War and scientific developments were key factors.
• Penicillin


  The first antibiotic, discovered by Alexander Fleming in 1928. Between 1938-40, Howard Florey and Ernst Chain found a way to purify penicillin. During World War Two (1939-45), penicillin began to be mass-produced, first in the USA and then in Britain.
• The success of mass-produced drugs in the 1940s, such as penicillin, helped the pharmaceutical industry take off.
• Pharmaceutical companies have developed new treatments, e.g. for cancer, AIDS and SARS. The industry faces problems too, e.g. antibiotic resistance.