Hisotry medicine through time

• Hippocrates


  Ancient Greek doctor and Philosopher
• Sickness is not given by the gods or taken away by them
• If we can find the cause we can find the cure
• Hippocratic oath – still taken by doctors today


  460-370 BCE
• Hippocrates


  • Developed theory of 4 humours
  • Treatments should include – rest, exercise and changes in diet
• Four Humours

  • Used for cure and diagnosis
  • Humours had to be in balance
  • Astrology was linked to the four humours
  • Also linked to personality traits
  • Foods and spices could help balance your humours such as a cool cucumber for when you are hot and dry or chilli/mustard for when you are cold and wet
• Galen


  • Romans did NOT allow dissections of the human body
  • Little understanding of the human anatomy
  • Rejected many Greek ideas about medicine
  • Galen relied on dissections of animals to further knowledge
  • Galen supported the theory of the 4 humours and developed the theory of opposites
  • Roman knowledge of disease did not progress
  • Galen supposedly had an awful temper
• Causes of disease


  • Balance the 4 humours – this could be done through bloodletting, opposite foods (hot could balance out a cold disease)
  • Purifying the air – spread sweet herbs to keep air free from miasma (pomanders were worn around the waist containing sweet smelling herbs)
  • Religion / superstition – pray to God or the pope to take away illness, go on a pilgrimage, touch holy relics
  • Urine charts – these could determine what types of treatments you should get
  • Blood letting – this would 'cure the mind and cure fevers', it was thought to get bad blood out however it often lead to infection or death (careless surgeons), cupping created a vacuum
• Treatments of disease


  • Balance the 4 humours – this could be done through bloodletting, opposite foods (hot could balance out a cold disease)
  • Purifying the air – spread sweet herbs to keep air free from miasma (pomanders were worn around the waist containing sweet smelling herbs)
  • Religion / superstition – pray to God or the pope to take away illness, go on a pilgrimage, touch holy relics
  • Urine charts – these could determine what types of treatments you should get
  • Blood letting – this would 'cure the mind and cure fevers', it was thought to get bad blood out however it often lead to infection or death (careless surgeons), cupping created a vacuum
  • Surgery – last resort often lead to death, surgeons did not have to go to uni but did have to pass a test
  • Herbal remedies – sold by apothecaries, over half of herbs prescribed would actually work (e.g. willow bark is the stem of aspirin)
  • Astrology – influence treatment
  • Regiment sanitatis – keep clean and look after yourself (wash, exercise, have a good diet ect.)
• Treating the sick


  • Apothecary – had some medical training, sold herbs
  • Physician / doctor – seven years at uni however they didn't understand many key principles of medicine
  • Monastery – often used as hospitals and had a herb garden to treat patients
  • Wise woman – knowledge passed through generations, often gave herbs and medicines in return for food
  • Barber surgeon – no formal teaching, you could get your hair cut and have surgery / bloodletting / pulling teeth out
  • Monks / Nuns – God sent illness, educated from (not so good) medical books
• Hospitals


  • In the Middle Ages, most people were cared for at home using treatments such as herbal remedies
  • However, there were some hospitals (in 1500 there were around 1100 hospitals)
  • 30% were run by monks and nuns
  • 70% funded by endowments
  • 47% - for the only purpose of housing the poor and elderly
  • 31% - lepper care
  • 12% - shelter for poor / pilgrims
  • 10% - cared for the sick
• Prevention


  • Making sure that 4 humours were in balance
  • Prevent miasma with sweet herbs
  • Keeping a good relationship with God
  • Regiment sanitatis
• Public health in the middle ages

  • Waste dumped in the street (including wate meat from butchers and rotten food)
  • Open sewers carrying waste to rivers – disease spread super quickly
  • Few toilets (over streams or emptied into streams)
  • Loads of sewage dumped into rivers
• Solutions for poor Public Health

  • Waste in street was solved by wearing wooden overshoes and butchers had to use a certain area for animal waste (1343)
  • Rakers removed waste from the street (Gong farmers)
  • Small sewage streams for sewage
  • Sweet smelling herbs to prevent miasma
  • General waste was put elsewhere
• Reasons for poor public health

  • Church – medical books were copied out by monks and Nuns and the church had great influence over people
  • Communication – printing press was not in England before 1470s so all books were hand written
  • Work and Harvests – 90% of people worked as farmers, little time for education
  • Food supplies and transports – animals were transported to towns to be killed, this lead to unhygienic streets and food
  • Education – up to 50% of people could read – only really read prayer books
  • King and Government – provided little money for public health
  • Attitudes – people were not encouraged to think for themselves
• Surgery


  • Women could become surgeons
  • Master surgeons needed licences and had to pass tests but very few studied surgery at university
  • Barber surgeons were the least qualified
  • A skilled surgeon could set a broken limb, remove an arrow or even remove cataracts
  • Red and white pole outside barbers used to represent how they used to advertise – a bandaged bloody arm
• Black Death 1348-50


  • Bubonic plague – carried in the bloodstream of rats, fleas who bit the rats became infected and could pass it on to humans
  • Pneumonic plague – spread through air (coughing or sneezing) much more deadly – cough up blood and your lungs would rot inside you
  • The Black death was a combination of the bubonic plague and pneumonic plague
  • Symptoms of bubonic plague – fever, headache, tiredness, painful swelling (buboes) – found on groin and armpits, small oozing red and black spots (where the name back death came from)
  • Nearly 40% of the English population died
  • Causes – God/humour imbalances/miasma/astrology/looking at an infected person /Jews/earthquakes
  • Treatment – pray to God/bloodletting/purging/fires to purify air/charms/ magic potions
  • Prevention – new cemeteries were built away from towns so you couldn't catch it from the dead / towns isolated / closed parliament / cleanliness is next to godliness / herbs / charms (such as dead toads!) / doctors wore masks with herbs inside and thick leather coats
• Black death


  1348-1350
• Printing press invention by Gutenberg in Germany

  1440
• The printing press came to England (Renaissance)

  1476
• From the Ancient ideas about medicine, not much changed at all. Most people still follow Galen's teachings of the 4 humours and many believed that supernatural, such as God, sent illness.
• Paracelsus


  Carefully measured doses of Mercury could treat syphilis
• Andreas Vesalius


  Improved the understanding of the human body
• William Harvey


  Discovered function of heart and circulation of blood
• Ambroise Pare


  Didn't use boiling oil for amputations, used silk threads to tie blood vessels
• Thomas Sydenham


  Author of medical textbook (Medical Observations)
• Jan Baptista van Helmont


  Contributed to the discovering cell theory
• Robert Hooke


  Discovered the cell
• Leeuwenhoek


  Developed the microscope
• Fracastoro


  Published new books that were different to Galen's
• Lady Grace Mildmay


  Understanding of illness and cures was extensive
• Causes of disease


  • Bloodletting was still very common
  • Purging
  • Strange treatments such as placing pigeons against the souls of feet
  • Bezor stone was supposed to be the most special sacred treatment
  • Herbal remedies – new plants were bought back from New World
  • Transference (sleep with a sheep) – disease could be transferred from one thing to another
  • Iatrochemisty – poisons to try and cancel out other poisons
• Treatment of disease


  • Bloodletting was still very common
  • Purging
  • Strange treatments such as placing pigeons against the souls of feet
  • Bezor stone was supposed to be the most special sacred treatment
  • Herbal remedies – new plants were bought back from New World
  • Transference (sleep with a sheep) – disease could be transferred from one thing to another
  • Iatrochemisty – poisons to try and cancel out other poisons
• Prevention of disease


  • Purifying the air
  • People were beginning to realise things like diet could influence disease
  • Draining boggy land to stop miasma spreading
  • Some still took part in supernatural prayer
  • Cleanliness – but people didn't bathe because they were scared of catching syphilis, so most just changed clothing more often
  • Healthy lifestyle
• Vesalius


  • Born in 1514, died in 1564
  • Had a long family history of doctors
  • Studied in medicine, became an anatomist, physician and author
  • Fabric of the human body 1543 – proved some of Galen's theories wrong; only one jaw bone, liver does not have separate parts
  • Corrected 300+ of Galen's mistakes
  • First complete book of the human anatomy
  • Tabulae Sex 1537 – showed parts of human body labelled in Latin, Greek, Hebrew and Arabic
  • He believed that dissections should be done in public places
  • Printing press spread his work fast
• William Harvey


  • Born 1578, Died 1657
  • Educated at a school in Canterbury, a college in Cambridge and studied medicine at a university in Italy
  • 1604 – joins Royal College of Physicians
  • He published a study 'An Anatomical Study of the Motion of the Heart and of the Blood in Animals' in 1628 in Frankfurt
  • Explains how the heart works, sending the blood on a continuous path with valves that only allow the blood to flow in one way
  • Corrected Galen's theory that blood was made by the liver and burned up in the body
  • 1651 – book 'On the Generation of Animals' explained sperm and egg
• Factors for change


  • Institutions – Royal Society helped discover and promote new ideas, King Charles II employed Harvey as his Royal Doctor – encouraged credibility
  • Religion – work could be published without being checked by the church, the church had much less influence over medical training and dissections
  • Individuals – Vesalius and Harvey made great contributions to the progress of medicine
  • Technology – the printing press drastically improved communication and education – books published much faster than being handwritten and adapted by church
  • Science – dissections were more common and broadened knowledge
  • Attitudes – people were beginning to think for themselves and were challenging Galen and Hippocrates' ideas
• Thomas Sydenham


  • Born in 1624, died in 1689
  • He was a well respected physician
  • Refused to rely on medical textbooks and encouraged people to observe symptoms and illness
  • He became known as the 'English Hippocrates' due to his careful observations and note taking
  • Diseases were like plants and animals so they fell into different categories
  • Treatment was different from person to person
  • Health factors included – weather, diet, individuals
  • Observationes Medicae – published in 1676 (helped by printing press)
• The Royal Society


  • Set up in 1660
  • Promoted development of theories, and promote new discoveries and ideas
  • Scientists were encouraged to record work to be put in a library – newly established journal
  • Philosophical Transactions 1665
  • News and ideas spread much faster
  • However they still relied on traditional methods such as herbs and 4 hums
• Where were the sick treated?

  • Women could practice as a surgeon but not as a doctor – they could not go to university
  • Women could no longer deliver babies as they were not allowed to use forceps
  • Country doctors were less respected than town doctors
  • Apothecaries – sold groceries and medicines (no medical training but had to have a licence to practice)
  • Number of hospitals decreased (run by charities and physicians)
  • Physicians normally came to bedside