This article will go into detail the whole of B1, Medicine Through Time which includes (you are more than welcome to skip to the parts most relevant to you) Hippocrates and the four humours, Galen, why people still believed in Galen by 1348 and the fall of Rome, why people were reading Galen in 1350, the plague (Black Death), cause of the plague, what people thought caused the plague, how effective people were in dealing with the plague, doctors of medical renaissance including Ambroise Pare, William Harvey and Andreas Vesalius and how they came up with their medical theories, did medicine get better after the dark ages, hospitals and training of doctors in 1350-1750, Edward Jenner and Vaccination, inoculation and smallpox, why life expectancy decreased in 19th century London, John Snow and cholera, Louis Pasteur’s germ theory and Robert Koch, magic bullets, Florence Nightingale vs Elizabeth Garrett, discovery of DNA, how science effected medicine in early 1900s, discovery and development of penicillin and the government role in medical care or the NHS. Phew, that was a lot and it is a lot. However, you are more than welcome to skip to the parts most relevant to you and I hope article that took 3 days to write will prove helpful to you.
To start things off, just like I done for Surgery, here’s a timeline of the eras we will go into on medicine:
- 1100 BC – 323 BC – Greeks
- 323 BC – 500 AD – Romans
- 500 AD – 1350 – Middle/Dark ages
- 1350 – 1750 – Medical Renaissance
- 1750 – 1900 – Industrial Revolution
- 1900 – onwards – Present day
It’s one thing showing a timeline of medicine and it’s another showing the progression of medicine during these time periods. Therefore, I’ve created a graph to show the progress of medicine over time:
As you can see, the Greeks did have progress with medicine but then it crashed back down to no progress at all (we will see later why). Since then, the only progress has been the last few years or ‘present day’ where we have progressed in medicine at an incredible rate.
During the Greek period, a doctor, Hippocrates, had a new medical theory which as we find out would stick around for a very long time…
He had a new medical theory that disease is caused by natural things called the four humours (liquid in the body)which are:
- Blood (made in the heart)
- Black Bile (made in the spleen)
- Yellow Bile (made in the liver)
- Phlegm (made from the brain)
His theory also stated that the four humours have to be balanced: if one is more than the other, you will get ill causing disease.
His theory was put into practice to cure disease was to get rid of the what ever humour you have most. To get rid of phlegm, you would make them sick which would get rid of excess phlegm. They would force people to purge and to get rid of blood, they would cut and bleed people which we know won’t cure the patient from disease.
Hippocrates was able to develop his theory for a number of reasons. He is rich and therefore had the money to perform experiments and buy equipment. He had time to think in his sitting room and observed patients a lot, writing their symptoms down and deciding whether they are ill or not.
After Hippocrates came Galen (born in Greece), a doctor in the Roman period of 129 AD. He believed in Hippocrates’ theory but thought his ways of curing disease was wrong.
Galen had a very medical based up bringing and career. At 16, he began to study medicine. He had 12 years of travelling to improve his knowledge and visited medical school at Alexandra in Egypt where to gained practical experience as a surgeon at gladiators.
Galen did believe in Hippocrates or the theory of there being ‘four humours’ but he didn’t believe removing a humour if there’s too much of it. He believed in his theory of opposites where if you have too much phlegm, which is cold and wet, you need peppers to cure you which are hot and fiery.
Therefore he believed in the theory of four humours and theory of opposites.
Galen was involved also in dissection, where he started dissecting humans in Alexandra, then went to Rome and dissected animals. He learnt and proved the brain controlled speech and that veins and arteries carried the blood.
Galen had views on the design of the body. He showed all the parts of the body fitted together into a well designed whole. This linked in particular with Christianity in the belief that God created and was the only one to have the power to create human beings.
What doctor would you prefer to be treated by? Galen or Hippocrates? Why?
Why were People still Believing in Galen and the 4 Humours by 1348? The Fall of Rome
490 BC was the Greeks, 162 AD was the Romans and 500 AD was the fall of the Roman Empire which led to the Middle/Dark ages of 1348 AD.
The Roman empire was truly amazing. Here are some of the features the Roman Empire had:
- A powerful Government.
- Easy communication and spread of ideas.
- Lots of leisure time.
- Lots of money and trade.
- Centre of learning – libraries etc..
Now, it will seem a bit obvious why some people got jealous of the Roman Empire. Everything was clean, rich and beautiful and almost perfect. This is why a group of people decided to attack the Roman Empire which lead to the fall of it. These group of people were called Barbarians: Goths, Visigoths and Ostrogoths. They attacked everything except the Church. Everything destroyed but the Church. Therefore, what was Rome like after 500 AD?
- The Church was powerful as they had not been attacked. This caused everyone to fear the Church.
- The Government turned weak.
- Trade turned difficult.
- Communication turned poor.
- All Libraries were destroyed so all education and medical developments destroyed too.
Why were People Reading Galen in 1350?
People were reading Galen for mainly two reasons: due to the chaos in Europe and the church becoming powerful.
Chaos in Europe
War and Destruction
- The Barbarians destroyed lots of good medical ideas such as the Roman Public Health system. Many good doctors were killed and their ideas lost forever. (But how do we know these ideas were breakthrough to medical knowledge?)
- When the Goths, Visigoths and Ostrogoths caused the Roman Empire to fall in 500 AD, they destroyed all the libraries. Most medical books were destroyed.
- Europe was at war between 500 AD and 1300 AD. Countries were torn apart and many millions were murdered.
- Despite Arab countries having many good medical ideas, the Church preferred to go to war with them rather than talk to them.
Lack of Communication
- Travel became dangerous due to the fear of Barbarians and war. This prevented doctors communicating with each other and sharing new ideas.
- The Arab countries had many good medical ideas at this time. However, it was difficult for new ideas to reach Europe due to lack of communication.
- Because the governments were weak, they needed to spend money on armies to defend themselves. This meant they had no money to put into improving medicine.
- Governments started to collapse. They were more worried about fighting the barbarians than improving public health.
Church Becomes Powerful
Church Kept Galen’s Books
- The Church kept Galen’s books in its monastery libraries. While all other medical books were destroyed, these were the only ones that survived.
Church Believed only in Galen
- The Church said that anyone who challenged Galen was going against god. If you said that Galen was wrong, then the Church would burn you alive!
- The Church thought Galen was right and all other doctors were wrong,. The Church liked Galen’s idea of God ‘designing’ the human body.
- The Church had the power to educate villagers as to what to believe now that government was weak. The priest told people that Galen was the only correct doctor.
Church Educated Others
- When the wars started to get better universities were opened. The Church controlled what was taught there. They told people that Galen was the only correct doctor.
- Monasteries were in control of education. Only priests and monks could read and write. They only taught other people about Galen’s ideas.
- The Church encouraged people to believe in old ideas and not to challenge them. They were told not to listen to any new medical ideas.
Why are people still reading Galen still then? Why?
The Plague (The Black Death)
The Black death was an infection caused by the Yersina Pestis bacteria which was carried by fleas. Due to lack of medical knowledge and poor hygiene, people with the plague died the vast majority of times.
There are two types of plague: bubonic and pneumonic
- Day 1 – Buboes would appear (black swelling the size of apples). Infected would have a high temperature and a fever.
- Day 2 – Infected would start vomiting frequently and have bleeding under skin looking like black rings.
- Day 3 – Attacking of the nervous system causing great amounts of pain.
- Day 4 – Increased attack on nervous system causing even greater amounts of pain.
- Day 5 – Dead…in just 5 days.
Pneumonic plague was by far the worst out of the two types of plague. The symptoms of pneumonic plague are as follows:
- High temperature.
- Vomiting frequently.
- Violent chest infection.
- Sneezing and coughing up blood.
- Attacking of nervous system causing great pain.
- Dead…in just 1-2 days.
Bubonic plague infects the skin more with buboes appearing and popping increasing the chances of infection. The pneumonic plague affects the lungs and respiratory system more meaning it will be more easier to spread the disease as people with pneumonic plague will cough and sneeze a lot more than someone who has bubonic plague
A Story of The Black Death (Bubonic)
On day 1 of the disease you would develop a painful swelling called buboes. These were in the neck, armpit and groin. On day 2 of the disease you would vomit and develop a very high temperature which would eventually turn into a fever. On day 3 you would begin to bleed under the skin. This would cause dark patches all over your body. On day 3-4 the disease will attack your nervous system. This will cause spasms and terrible pain. On day 5 the buboes might burst and squirt out black smelly liquid. If this happens it is good if not then you will die.
What actually caused the Black Death?
The Black death follows a viscous cycle which caused the death of many people in 1348.
- A person is infected with the Black Death
- Yersina Pestis: the bacteria that causes the Black Death
- The flea carries the bacteria (there are fleas because of poor hygiene).
- The flea gets a ride and goes on a black rat from Asia.
- The black rate goes on a trading ship.
- The black rat goes off ship and heads for dirty streets and houses in English towns.
- Poor personal hygiene of people in towns attract rats, flea from black rat jumps onto human.
- We then go back to point 1. A person is infected with the black death.
What People in 1348 thought caused the Black Death
Here we have 6 different theories in which people thought caused the Black Death. The names of the people who came up with the discovery isn’t important so I’ll make the names up.
Doctor: Im Religious
Cause of the Black Death: God angry with behaviour of people (greed, corruption and the growing pride of men). Sent the plague to punish.
Treatment: Seek God’s forgiveness by praying or whip yourself as a way to say sorry.
This did not work. The plague had nothing to do with religion or God being angry and the treatment of praying and whipping would have not cured you.
How Effective did people deal with the Plague?
- In 1350, some people thought that miasma came from rotting matter and privies.They tried to clean up the streets. This could have helped reduce the rat population. They wouldn’t have known this though.
- In 1665, all householders were to sweep clean their streets outside their houses every day and all filth was to be removed daily.
- In 1665, no animals were to be kept in the city and no rotting food was to be sold.
- In 1665, anyone who was suspected of the plague was shut up in their houses and the door was marked with a red cross and the words ‘Lord have mercy upon us’. Watchmen ensured no-one went in or out. This may have stopped the spread of pneumonic plague.
- In 1665, no beggars were to be allowed in the street and no plays, bear baiting or public entertainment were to be held.
- In 1350, they thought that God caused the plague and so they prayed to him to say sorry for being sinful.
- In 1350, they thought that the Jews had poisoned the wells and so they killed them to try and stop the Black Death.
- In 1350, they thought that God caused the plague and so groups such as the flagellants whipped themselves to show how sorry they were to God.
- It was hard for people to deal with the bacteria that caused the plague because they did not know it existed. Germs were not discovered until 1861!
- Many people ignored the Lord Mayor’s orders in 1665. More than 20 watchmen were murdered by people escaping from their houses that had been shut up.
- In 1350, people thought that the plague was caused by the misalignments of the planets. They believed that this would put your humours out of balance. They would purge and bleed themselves.
- The Lord Major of London had many strategies to stop the spread of plague. However, Parliament refused to make these into laws because it would mean that the members of Parliament would be also shut into their houses.
- In 1350, they thought that miasma (poisonous smells) caused the Black Death so they carried herbs and spices in posies.
- While they may have had some methods to prevent the plague, if someone got the plague they did not have antibiotics to kill the plague bacteria Yersina Pestis.
- In 1665, nine men were put in charge of dealing with the plague. Six of them left the city as soon as possible!
- In 1665, there was no direction as to how to deal with the plague. The King and his council left London. They only discussed how to deal with it 3 times in 7 months and 3 of those times were only concerned about the safety of the King.
With our Knowledge of what caused the plague, what do you think would have stopped the plague most? Why?
Doctors of the Medical Renaissance
We are now in the period between 1500-1700. During the medical Renaissance there was a renewed interest in medical theories for the first time since the fall of the Roman Empire in 500 AD. There was a ‘rebirth’ or ‘renaissance’ of new medical theories. Three men helped to come up with new medical theories or ideas. They were Andreas Vesalius, William Harvey and Ambroise Pare.
Early life and career: Born in France in 1510, he was a barber surgeon then became a surgeon in Paris. In 1536, he became an army surgeon and spent twenty years on campaign treating sword and gun shots. He wrote a book ‘works on surgery’ in 1575 and died in 1590.
What were Pare’s new surgical ideas?
Tie silk thread round each of the blood vessels to close them up. The silk thread was called ligatures. They provided a very effective way of stopping bleeding. He would then put on a mixture on the wound. This mixture was made from eggyolks, oil of roses, and temperature to heal the wounds.
How did he develop his methods?
Experimentation and Chance. It was only by fluke he was treating a wound and was using cauterisation (pour boiling oil onto wound to burn the wound) but had run out of oil. He looked around and saw some silk so tied the exposed blood vessels with the silk thread.
Did people believe his methods?
People thought it was risky (as some people had died from infected ligatures because there were no antiseptics yet) so it wasn’t that popular and people respected the tradition of cauterisation. When he became famous, people began to believe in him.
Early life and career: Born in Kent in 1578, he studied medicine at Cambridge and Padua. He worked as a doctor in London and then lectured in anatomy. Published his own book in 1628 and died in 1657.
Theories on how the body worked before Harvey
Galen’s theory that new blood was constantly being made in the liver to replace blood that was burnt in the body. The theory had been challenged but no-one had proved how the blood moved around the body.
What were Harvey’s new theories about the body?
- He showed blood flows around the body and is carries away from the heart by arteries and returns to the heart by veins. Capillaries link veins and arteries.
- He proved the heart acts as pump and blood does not burn up so no organ is needed to make new blood.
- Harvey knew there were capillaries but couldn’t prove it.
- Proved Galen wrong.
How did he develop his theories?
- Dissected live, cold-blooded animals with slow beating hearts so he can see movements of muscle in the heart.
- Dissected human bodies to build knowledge of heart.
- Tried pushing blood wrong way up a vein and didn’t work: proved it’s a one-way system.
- Measured the amount of blood moved with each beat, worked out how much blood is in the body from that.
- Gave proof to other doctors if they thought he was wrong, like Galen’s theory.
Did people believe his theories – could he prove them?
- He had proof and detailed conclusions when he disagreed with Galen.
- Explained carefully why other doctors were wrong. People still believed Galen’s theory about how the liver makes blood.
- Couldn’t prove there were capillaries as he couldn’t see them (had no microscope).
Early life and career: Born in Brussels (Belgium) in 1514 and studied medicine in Paris and Italy where he met artists who were studying skeletons and dissecting bodies to make their paintings more realistic.
Anatomy before Vesalius
Doctors believed books of Galen and other ancient doctors were completely accurate and contained all the knowledge they needed therefore there was no need to learn more about anatomy by dissecting human bodies.
What were Vesalius’ new ideas about anatomy?
Vesalius showed that galen was wrong in some important details of the anatomy. He believed that this was because Galen had to rely on dissecting animals. He said it was vital that doctors dissected human bodies to find out about the human structure and exactly how it works. He said doctors needed to test Galen’s ideas instead of accepting them uncritically. An example to test Galen’s ideas instead of accepting them uncrtically would be the jaw bone. Galen said the jaw was made of two bones. He got this from dissecting a pig. However, Vesalius dissected a human body finding the jaw was one bone.
How did he discover his ideas?
He dissected criminal bodies after hanging. He would snatch the bodies after a hanging and took them back to his house for dissection.
Did people believe his methods?
He had proof from his drawings but he was using criminal methods to gain the proof. He was trying to prove Galen’s established methods were wrong which was hard to do.
How Harvey, Pare and Vesalius came up with their Medical Theories
Harvey and his theory on circulation
- Renewed interest in Galen – wanting to prove Galen wrong
- Experiments – such as the experiment where to tried pushing blood wrong way up vein
- Wealth – had money to do experiments
- Education – from Cambridge and Padua
- Printing – published his own book
- A challenging attitude
- New machinery i.e. the water pump
Pare and the invention of ligatures
- Experiments – was willing to try out silk to tie the blood vessels to stop blood loss.
- A challenging attitude
- War – the injuries from the war helped him develop the ligature
- Luck – it was lucky how he ran out of oil and silk to the side of him so he used that
Vesalius and his new theory on anatomy
- Renewed interest in Galen – showed Galen was wrong (jaw has only one bone, not two like Galen said)
- Experiments – dissecting bodies to discover more on anatomy
- Wealth – had the money to dissect bodies but had to steal bodies after hangings
- Education – Studied in Paris and Italy
- Printing – to share the pictures drawn by artists of the human body
- A challenging attitude
- Art – the ability to draw the human body for others to see and learn from
Did Medicine get any Better after the Medical Renaissance?
We will find the answer through seeing the ways people treated the king’s evil/scrofula during and after the dark ages.
The king’s evil or scrofula is a skin disease or tuberculosis infection which causes inflammation of lymph nodes causing growths.
How was this treated in the dark ages?
- Person with scrofula.
- Goes to see a priest.
- Priest says it is caused by God.
- Goes to see king (appointed by God)
- Dies – family suggests God killed him.
Gets better – thanks the king for making him better.
How was this treated after the medical renaissance?
- Person with scrofula.
- Sees a doctor.
- Doctor prescribes herbal remedies.
- Die or recovers.
Hospitals in the Medical Renaissance 1350-1750
Hospitals in 1350 were no very helpful at all:
- Hospitals were Churches which had beds for somewhere to sleep.
- Treatments were mainly herbal remedies and general tender loving care.
- A warden decided if you could go into the hospital or not: no contagious people, lunatics, pregnant women, sucking infants and intolerable people.
- Doctors would only be for the rich, everyone also were treated by nuns from the Church.
So as you can see, you would only ever get good treatment if you were rich. The hospitals in the medical period were basic and provided the bare minimum. But, how did hospitals in the medical renaissance compare to hospitals in 1750?
What was the Hospital?
Hospital in 1350
- Building similar to Church.
- Often part of monasteries.
- Crucifixes and chapels in buildings.
- Crowded but comfortable.
Hospital in 1750
- Run by council and charity.
- Paid for by local or donations.
- 57 new hospitals funded in 1700s.
Who were the patients?
Hospital in 1350
- The poor: rich people got doctors at home.
- 1200 hospitals in England and Wales, only 10% actually cared for the sick.Rejected patients with leprosy, contagious diseases, madness, pregnant women and devious character.
Hospitals in 1750
- Nearly all hospitals in 1750 looked after poor.
- Didn’t let people in with contagious illnesses or long term medical problems.
- Rich people got doctors at home.
Who treated the sick?
Hospital in 1350
- Monks and Nuns.
- Volunteer helpers making beds and making patients comfortable.
- Monks, Nuns and helpers had no medical training.
Hospitals in 1750
- Nurses, Physicians (doctors) and surgeons.
- Doctors been trained at university and practised treatment on poor.
- Nursing sisters treat patients.
- Nursing helpers stick to manual work.
How were they treated?
Hospitals in 1350
- Heal people spiritually.
- Pray for soul and speedy recovery.
- Provide beds, food, drink and rest.
- Had excellent herbal remedies.
Hospitals in 1750
- Kept warm, clean and well fed.
- Given herbal remedies or bled.
- Simple surgery carried out such as fractured limbs and amputation.
How did the Training of Doctors change from 1350-1750?
Where? – University
Who controlled their training? – Church
What did they study? – Galen, Hippocrates, bleeding, four humours, purging, herbal remedies, the Zodiac man, leeches and the urine chart.
Who could be trained? – Men and women (as a apprentice surgeon or midwife).
However, we find out women can’t be apprentice surgeons as they are not allowed to go to university and can’t be a midwife either due to the invention of the obstetric forceps which enables men, women, anyone to help successfully deliver a baby.
1750: Medical Licencing
In the 1700s there are two types of people with medical licencing: those with licences and those without.
Physician – Fully qualified and trained at university.
Apothecary – Sold and mixed medicines prescribed for physicians.
Surgeon – Trained by watching and copying other surgeons.
Midwife – Licence to supervise the last week of pregnancy and deliver babies.
Wife or Mother – Treated family members but had no training.
Wise Women – Large knowledge of herbal remedies past down through generations.
Housewife Physician – Learnt how to treat illnesses or common injuries.
Travelling Quack – Travelled around country. Took patients money and ran.
Edward Jenner and Vaccination – Story of Curing Smallpox
Smallpox is a deadly virus which kills 20-30% of its victims. Large puss filled pustules develop all over the body including mouth, throat and even eyes making victim blind. If the victim survives, s/he will have huge scarring which meant in the 18th-19th century social isolation and the fear that your job/trade would suffer.
In the 1720s, inoculation was discovered. Inoculation was the method by which a small amount of a disease is introduced into the body to gain immunity against that disease. Smallpox would have been introduced into the body through sniffing smallpox pus/scabs or by exposing a cut to smallpox puss/scabs.
WARNING – If you give too much smallpox the person might get the disease. There is also the problem of other infections entering the body too.
How Smallpox Inoculation got into Britain
- Chinese doctor discovers cure (inoculation).
- trade too it to the rest of Asia.
- Lady Mary Wortley Montague discovered it in Turkey (she had just overcome smallpox and didn’t want her children to suffer the same thing).
- She took it back to England and used her influence to convince doctors that it worked.
- Inoculation was properly introduced in Britain.
How Edward Jenner made his Breakthrough – Vaccination
- Edward Jenner was a doctor in Gloucestershire. When he tried to offer inoculation to his patients, he found that many people refused.
- The reason people refused to be inoculated in Gloucestershire was because the local farmers believed that they would not catch smallpox if they already had a milder form on the disease called ‘cowpox’. Therefore they did not need to be inoculated.
- Jenner looked into the theory and discovered that diary maids, who often caught cowpox did seem less likely to catch smallpox.
- Jenner wondered whether he could use cowpox as a method of preventing smallpox. He took a healthy boy and inserted matter from a cowpox sore into a cut made on the boy’s skin. The boy became a little weak but remained well. Jenner then gave the boy a dose of smallpox. No disease followed.
- Jenner repeated his experiment with 23 different cases. Only then did he conclude that ‘the cowpox protects the human constitution from the infection of the smallpox’.
- Jenner wrote up his findings and submitted them to the Royal Society for publication in 1798. However there was some opposition to the theory and the Society refused to publish his work.
- Jenner then decided to publish his findings himself. He called the technique vaccination from the Latin work for cow vacca. His book was widely read and distributed.
- After reading Jenner’s findings, parliament thought Jenner’s work was very significant and he was given a grant of £30,000 to open a vaccination clinic in London.
- By 1803 doctors were using the technique in America. Thomas Jefferson President of the US championed it.
- In 1852 more than 50 years after Jenner’s discovery, the British government made vaccination compulsory
What factors helped/hindered the development of vaccination?
- + Travel – communication spread Jenner’s ideas (US, Turkey, France).
- + Printing Press -publish books and spread ideas.
- + Government – £30,000 grant and made vaccinations compulsory.
- + Individuals – Jenner.
- + Experiments – Jenner performed 23 successful vaccinations.
- – Attitudes – such as the Royal Society refusing to publish Jenner’s work.
- – Lack of scientific knowledge as he has no microscope. No technology/equipment leads to no proof.
- Innoculators – losing money.
- Public opinion – disliking vaccinations being compulsory.
|This famous picture shows reaction of public to Jenner’s vaccination. People though they would start turning into cows
making them reluctant and scared to be vaccinated. They are afraid to get cowpox.
Life Expectancy decrease in 19th Century in London
During the industrial revolution hygiene and therefore life expectancy decreased due to a number of reasons.
What were conditions like on the streets?
- Buildings were close together.
- Share one toilet for the whole street.
- Heaps of refuse, offal and sickening filth in streets.
- Ragged women and children in streets.
- 20 people live in each of the little houses of 2 rooms, an attic and a cellar.
- Excrement/faeces, poo in streets.
- One privy (toilet) is shared between about 120 people.
- No sewers.
- Throwing rubbish in streets.
- Migration from country side to the towns/cities.
- Generally dirty streets.
- Overcrowding spreads disease.
- Government ignores the working class in the towns because they live in the countryside and people don’t have a say (can’t vote).
Because of this factors of London, it made disease extremely easy to spread.
How was Cholera Spread?
Cholera is an infectious and often fatal bacterial disease of the small intestine, caused by the bacterium Vibrio cholerae and typically contracted from infected water supplies and causing severe vomiting and diarrhoea.
- Cholera victim.
- Cholera victim’s waste (vomit and diarrhoea) will go into a privy (toilet).
- The privy leads to the River Thames which is London’s drinking water.
- Public drink the water infected with cholera.
- Back to step 1. Cholera victim.
John Snow and Cholera
John Snow was worried about cholera and made a map of all the people that have died from cholera. He interviewed a man who said his neighbour died from cholera and she drank from Broad street pump. He then knows Broad street pump is causing the epidemic of cholera so shuts down Broad street pump.
Pasteur’s Germ Theory and Robert Koch
In 1600, Leeuwenhoek invents the first ever microscope. Later in 1800, Pouchet creates a theory of spontaneous generation where bacteria (they called animalcules) creates rotting matter which creates flies and maggots. 1830, Joseph Lister invents a new and improved microscope. Louis Pasteur in 1861 then comes up with the germ theory that rotting matter attracts flies and bacteria. 1875, Robert Koch links the anthrax bacteria to the disease anthrax and after that, the causes of diseases such as tuberculosis, cholera and the plague were identified.
How Louis Pasteur came up with the Germ Theory
Place of Birth: Germany
First research topic: Linking Anthrax bacteria to human disease
Experimental method: Took organs from sheep that had died of anthrax. In organs he found the bacteria which everyone thought caused anthrax. He extracted it, grew it, studied it, then injected it into a mouse. The mouse died after time with developed anthrax. He took the blood from the mouse, isolated the anthrax and put it in another mouse. It died of anthrax too and repeated with 20 generations of mice. Had same bacteria he had at start and therefore said it was anthrax.
How his research methods were useful: Provided a method everyone could follow which lead to other diseases being identified such as typhoid, tuberculosis, cholera, tetanus and the plague.
What better way of growing bacteria did he develop?: Made a solid medium, when competitors used liquid, stained them so they could be observed more easily (used agar jelly).
How did he observe bacteria more easily?: Stained the bacteria that caused blood poisoning purple so he could see them.
What factors influenced Koch’s success?
- German government for funding.
- Individuals such as Louis Pasteur Robert Koch himself.
- Experimentation on the 20 generations of mice.
- Technology such as Joseph Lister’s improved microscope.
Pasteur’s new vaccination: for chicken cholera
As we know, Edward Jenner discovered a vaccination which is a weak form of the disease (cowpox/smallpox) protecting you from the strong form. The problem is that not every disease has a weak form.
Therefore, Pasteur came up with a new vaccination that can apply for all diseases:
Chicken Cholera Vaccine
- Man 1 injects chicken with cholera, doesn’t die….hmm….
- Man 1 tells Man 2 chicken hasn’t died. Man 2 tells Man 1 that the cholera he injected the chicken with had been exposed to the air for a long time.
- Man 2 tells Man 1 to inject same chicken with fresh germs, chicken stays alive still.
- Man 2 thinks fresh germs are faulty so tries them out on another chicken. Chicken dies so they know there’s nothing wrong with the fresh germs.
- ‘The old germs must have protected the first group of chickens just like Jenner’s vaccines’.
Developed another vaccine.
Magic bullet was the name given to the first chemical drugs that were used to pinpoint bacteria within the body and kill them. The chemical in them was sulphonamide. This was inspired by Koch and his staining of bacteria. Scientists thought that if it was possible to pinpoint bacteria to stain them with a dye, you could also use a chemical to kill them.
1909 Paul Ehrlich: Salvarsan 606
Who did Ehrlich work for?: Robert Koch
Why did they find antibodies interesting?: They can kill bacteria without killing any other cell
What disease were they trying to find a magic bullet for?: Syphilis
What poison did they base the chemical compound on?: Arsenic
Why did they name it Salvarsan 606?: It was the 606th compound of Arsenic they used
What was the downside of Salvarsan 606?: It could kill you
1930 Gerhard Domagk developed Prontosil
Why had no-one looked into chemicals to kill bacteria in the 1910s?: Distracted by World War One
What was Prontosil?: A red dye
What did he try Prontosil out on first?: Mice
What bacteria was he trying to kill?: Septicaemia (bacteria that causes blood poisoning)
How did he come to test it on humans sooner than expected?: Daughter pricked her finger on an infected needle and go blood poisoning. She was dying so Gerhard Domagk last hope was to try Prontosil on her and it worked.
Where did the chemical sulphonamide come from?: Coal tar
What factors helped in the development of magic bullets?: Chance, individuals, experimentation, previous scientists and technology.
Who was more important in increasing the role of women in medicine – Florence Nightingale or Elizabeth Garrett?
Helped to change people’s minds about women being effective doctors, nurses and surgeons
- Changed stereotype of nurses.
- Showed women could work.
- Only nurses.
Helped women to gain official qualifications in the medical profession
- Nightingale didn’t help women gain qualifications, she only trained nurses to treat the sick and restore hospitals.
Helped to communicate effective practice for how to improve nursing and hospitals
- Wrote a book that was used all over the world.
Helped to change people’s minds about women being effective doctors, nurses and surgeons
- Garrett found the medical profession to accept her as a doctor and proved women are just as capable as men at being doctors helped persuade women to go into the medical profession.
Helped women to gain qualifications in the medical profession
- Because she got the first women qualifications in medicine and opened up a school hospital just for women where they could get medical qualifications, she helped a lot.
Helped to get the government to open all medical professions to women in 1876
- Eventually led the government to allow women to become doctors.
- Temporarily hinders women
- Other helped too.
Helped to communicate effective practice for how to improve nursing and hospitals
- Opened hospitals for women and children.
From my perspective I think that Elizabeth Garrett made the most effective contribution to increase women’s role in medicine because Florence Nightingale only helped nurses while Garrett opened the door for a women to be any kind of doctor. Nightingale helped clean hospitals but I think hospitals would generally get cleaner over years anyway, Nightingale only sped this up. Garrett broke out of the stereotypical view that women couldn’t be doctors.
Who do you think was more important to increasing the role of women in medicine?
Discovery of DNA
The discovery of the DNA (deoxyribonucleic acid) did not happen immediately but was part of a series of discoveries.
Before we go into detail, here is a few diseases/illnesses that are either caused by bacteria or are inherited (environmental).
Caused by Bacteria:
Caused by Inheritance (environmental):
- Downs Syndrome
- Heart disease
- Cystic fibrosis
Let’s move onto the discovery of DNA
What came first was the…
Researching and Photographing (taking pictures) of DNA in 1951:
Maurice Wilkins and earlier research
- Worked at King’s college in London.
- Expert in X-ray photography.
- Began to look at DNA strands.
- Later joined Rosalind Franklin but DNA was not discovered immediately. This was only part of the long series of DNA discoveries.
Rosalind Franklin and photography of DNA 1951
- Joined Maurice Wilkins in 1951.
- Developed technique to photograph DNA.
- 1st person to ever take a X-ray photograph of DNA.
- Wasn’t able to describe DNA.
- Fell out with Wilkins.
Discovery of the Structure of DNA:1953
- Cambridge scientist in 1953.
- Joined with Mr Watson to find structure of DNA.
- Used the work of Franklin.
- Was able to discover DNA was made from a double helix and was joined together by two bases.
- Worked with Mr Crick.
- He figured out DNA was present in every cell however still didn’t know what each gene did.
The Human Genome Project:1990
The Human Genome Project 1990
- Was able to identify role of each of the 100,000 genes in the human DNA.
- Created a complete human gene map.
- 18 different countries helped to do this including scientists from Britain, USA, Japan, France and Canada.
Funding and Technology
- Head of a large drug company along with government.
- Donated many computers and much findings to the human genome project.
- Human DNA if written would take up 80,000 books or 5 CD roms.
- Key individuals – Crick trained as a physicist at London University but changed to biology and genetics. Watson, on America born in 1928, went to Chicago University aged only 15 and started his research into DNA. They were both experts in their own area but were prepared to get outside of their fields to get answers.
- Earlier research and discoveries – For hundreds of years, scientists knew that some illnesses could be inherited. Mendel showed characteristics could be passed from one generation to the next. Using microscopes proved cells in the body were made. Crick and Watson were able to build on this work.
- Teamwork – Crick and Watson had complimentary skills; Watson knew about genetics while Crick knew more about biophysics. If one was heading off in the wrong direction, the other was not afraid to tell him.
What was a bigger discovery? Pasteur’s germ theory or DNA?
Impact of Science on Medicine in Early 20th Century
There were two major breakthroughs in science in the 20th century being X-rays and radiotherapy.
How did doctors try to detect tumours before X-rays?: Thudding on suspected area and listening for an indication of denser tissue. Then cut open and inspect.
What materials do X-rays pass through easily?: Flesh, tissue, rubber, paper and wood.
What materials can’t X-rays pass through?: To a certain extent denser tissue, metal and bone.
Who developed the X-rays?: Wilhelm Rontgen
Why did he call them X-rays?: They rays were unknown.
Why were X-rays important in the history of medicine?: Because it prevents risk when trying to identify broken bones or tumours.
Apart from seeing bones and tumours inside the bodies, what else can X-rays be used for?: To kill cancerous growths and tumours (radiotherapy).
How did Marie Curie improve X-ray machines for use in the 1st World War?: She created mobile X-ray machines.
How did Marie Curie and her husband discover radium’s radioactive properties?: When Marie’s skin was being burnt when she held radium.
What does radium give off that can be used to see bones. tumours or foreign bodies inside the body?: Gamma rays.
How is radium used in radiotherapy?: To remove cancerous growths and tumours.
How was Curie rewarded for her efforts?: She got two Nobel prizes for her work.
What happened to Curie in the end?: She died of Leukaemia from handling radioactive materials.
Why were so few women involved in scientific research in 19th and 20th centuries?: Women were seen as weak and weren’t allowed into institutions or universities.
Radiotherapy – When radiation (X-rays or gamma rays) are used to kill cells in the body i.e. tumours.
Radiography – The method by which we can see objects inside the body without cutting someone open.
Discovery and Development of Penicillin
Penicillin is a bacteria which can be easily grown in a petry dish. It comes from the mould Penicillium and is an anti-biotic (kills bacteria)
Like with the discovery of DNA, the discovery of penicillin happened in parts ranging from the 1880s to 1941. I will lay it out in chronological order:
Jon Sanderson – Discovered the mould in 19th century and saw that nothing grew on it. That is all Jon Sanderson did.
Joseph Lister – He saw what Jon Sanderson saw. He then tested it on infected wounds and it successfully treated the wounds. But then, he mysteriously stopped using the mould…
Alexander Fleming: 1928
- He worked as a scientist at St Mary’s hospital in London.
- He was looking at the Staphylococci bacteria in petry dishes (bacteria which causes infection in wounds).
- He left some bacteria in a petry dish in his laboratory when he was away.
- Overnight, some mould had blown from an open window of the department upstairs and happened to land on the dish full of bacteria. This mould was Penicillium.
- Fleming noticed that the mould was killing the bacteria in the petry dish.
- He then writes a paper explaining how Penicillin could be used to treat wounds.
- However, he did not have the money or facilities to carry on. His ideas were lost until…
Howard Florey and Ernst Chain: 1930s
- They were interested in Fleming’s discovery of Penicillin.
- They then asked the government to fund its development.
- After the outbreak of WWI in 1939, the government agreed.
Stage 1: Growing Penicillin
They used milk bottles, dog baths and bed pans to grow the mould on. They then freeze dried the mould to extract pure penicillin. Unfortunately, they were only able to extract a very small amount for testing.
Stage 2: Testing Penicillin on Mice
They had just enough penicillin to test on mice. Therefore, they gave 8 mice a dangerous infection and then four mice were given penicillin and four weren’t. The mice with penicillin survived while the other mice died from infection.
Stage 3: Testing Penicillin on Humans
Chain and Florey tested penicillin on a man with a serious infection. The man starts to recover. Unfortunately, they ran out of penicillin and had to extract it from his urine to recycle the penicillin. Gradually, the penicillin ran out completely and the man died. Despite this, they proved that penicillin was medically effective.
Stage 4: Mass Production of Penicillin
Chain and Florey knew they needed to mass produce penicillin to produce enough to save lives. However, Britain was slow due to war conditions and when USA entered the war in 1941, Florey travelled to USA to persuade big drug companies to invest in this.
- 1939, government agreed to fund Florey and Chain development of penicillin.
- In 1942, the US government gave $80 million to four drug companies to find a way to mass produce penicillin.
- By 1944 there was enough penicillin to treat all casualties suffered on D-Day.
Because of the discovery of penicillin, Fleming, Chain and Florey each got 1/3 of the Nobel prize. Do you think it was right for each to get 1/3 or did one of them deserve more than others?
Government Role in Medical Care – NHS
By 1942, the government felt like it had to play a bigger role in improving medical care 1900-1942 for these reasons:
- People had to pay for doctors or medicines. Instead, people are using patent or home remedies. This is bad because as some of these remedies are dangerous or didn’t cure you at all.
- Have hospitals for sick and aslym to care for the poor. However, this is dependant on the charities to fund them. Charities can’t make enough money to treat everyone so they only offer basic care for the sick.
- Doctors chose what patients they wanted to accept and treat and could charge as much as they liked.
- From 1899-1902, Britain was fighting the Boer War. Men volunteered to fight but were shocked 1/3 of men were turned away because they were unfit (ill with disease). They needed to do something to have a strong army.
- 1911, government introduced national health insurance act. If you had a job, pay contributions to pay for medicines and doctors. If you didn’t have a job, had no money or was unemployed, sick, wives, children and old people you couldn’t be covered by the insurance.
- The Minister of Health in 1919 felt the government needed to start taking control of health care. They need an overview of health care and needed to take responsibility. In 1919, the ministry was set up to take responsibility of health care.
- It was a shock to find out that 3,000 children died from diphtheria in 1938. Government decided to have a vaccination program offering free vaccinations to children. Here you can see government start to take more responsibility.
- William Beveridge in 1942 wrote a report in the middle of second world war. He said how he was getting bombed alot and had many casualties. Medical surgeons couldn’t cope with this. He also said how people being evacuated to the countryside showed people had poor medical care as there are not as many doctors in the countryside. The government needed to improve medical care after the war.
The Creation of the NHS 1948
This is what it said in William Beveridge’s report:
I propose that all citizens should pay a weekly contribution of 4 shillings 3 pence for men and 3 shillings 6 pence for women. Their employers should also add to this contribution. This will ensure that we have a free national health service. This will give free medical benefits from ‘cradle to grave’ for everyone from duke to dustman This would include free dental, eyesight and hospital treatment; an allowance for children; maternity benefits etc.
However, to this proposal of the NHS came opposition:
- The British medical association ran a survey in 1946. 54% of members said they wouldn’t co-operate with the NHS. Repeated survey in 1948 and this number rose to 90%.
- ‘I am a doctor. At the moment we can charge patients what ever we like for our services. If we are forced to work for the government we will lose money.’
- ‘I am head of a private hospital. The NHS will mean that over 3,000 private hospitals will be controlled by the government. We want to stay in control and don’t want the government to interfere.
- ‘I am a doctor. At the moment we can accept whoever we like as patients work where and when we want. We don’t want the government to interfere with this.’
- (opinion) The NHS will be far too expensive. There will be enormous costs involved and they will need to be paid for by someone.
How did Bevan overcome the opposition?
- Bevan has a charismatic personality. He took the leaders of the British Medical Association out to dinner in expensive restaurants and persuaded them the NHS was a good idea.
- Bevan in 1948 introduced the NHS and managed to introduce 90% of doctors to join.
- Some doctors were worried that they would lose their income. Bevan said that they would lose out on income if they didn’t join the NHS as they would have no patients left.
- He won over consultants by promising them a salary and allowing them to treat some private patients in NHS hospitals. He stuffed their mouths with gold until they couldn’t refuse.
- There were some people who thought the NHS would be too expensive. Bevan argued that it was important and that the nation had to afford it.