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history- medicine in britain - Coggle Diagram
history- medicine in britain
c1900-present:modern Britain's
genetics and life styles
understanding genetics
19th century= mendel-human characteristics can be passed between generations
20th century- new technology-electron microscopes, x-rays let scientists analyse human cells in greater detail. the body contains DNA-codes controlling the genes of each person
james watson and Francis crick-genetic coding of dna
analysed xray crystallography by maurice wilkins and Rosalind franklin-worked out double helix structure of dna
1990-james watson led human genome project and started to identify and map every gene in human dna.
new possibilities- dna and gemone project led to better understanding of some genetic conditions-downssyndrome-
predicting high risk genetic cancers
stem cells can be differentiated
however not yet a cure or effective treatment for most genetic conditions or a way of prevention for genetic disease
lifestyle factors- smoking-high blood pressure, heart disease and cancers
drinking-liver and kidney disease
diet- cancer or heart disease is reduced by balance of different foods and limiting sugar or fat
improvements in diagnosis
improvements-laboratories to test skin and blood
xray scans and endoscopes in the body
monitors-over time
medical technological advances- microscopes, incubators, x-rays, prosthetic limbs, mri, ct and ultrasounds, endoscopes, pacemakers, dialysis machines, insulin pumps, blood pressure and blood sugar monitors, hypodermic needles
change in care and treatment
magic bullets- koch-chemical dye stained specific microbes
behring- body manufactures antitoxins that attack the microbe that causing the disease
paul ehrlich and team- magic bullet- would attack and kill microbe causing specific disease
german government helped for many years- tested salvarsan for syphilis
1909-dr hala joined- found 606th compound worked
1932-gerhard domagk-2nd bullet-prontosil-blood poisoning, pneumonia, scarlet fever and meningitis
antibiotics- destroy bacteria or prevent growth. first-penicillin
more antibiotics-40s, 50s, 60s
chemical structure made antibiotics easier
saved lives but caused super-bacteria
advances
keyhole and microsurgery- small incisions, reduced recovery time
robotic surgery-more precise
preventing disease
NHS- 1948- tax funded healthcare
GP hospital care, operations, health visitors, emergencies
it improved healthcare, was free. but was unequal across country because of towns, doctors etc
improved access to healthcare-everyone could access the same care, but the provision was unequal across the country in terms of standards and this took time to improve.
compulsory vaccinations- 19th-20th century, too expensive, 1938-diptheria epidemic-government funded vaccinations
prevention measures- 1948-government has taken more action
testing and vaccination funding more
rubbish and sewage disposal
air and water pollution laws
cigarettes and smoking laws
work health and safety laws
food outlet inspections
lifestyle campaigns- 1948-smoking, 1980-aids, change 4 life
the development of penicilin
discovery- 1928-fleming-bacteria growing in a petri dish was killed by penicillin mould. he tested and produced antibiotics
1929- fleming published his findings but didnt think it worked for living people and had no funding for research
several years later- howard florey, ernst chain and team continued the research-worked on mice so tested on humans. a miracle drug
alexander fleming- worked on battlefields in ww1-studied infected wounds and find treatment. after war- worked at st mary's hospital to find a healing for bacterial infections
howard florey and ernst chain- florey-australian pathologist-researching bacteria killing at oxford medical school. group to help him and included ernst chain a german biochemist. they won first nobel prize for physiology or medicine in 1945
mass production- huge amounts for one person and growing mould took time, space and money
florey asked uk drug companies but they were being used for war, 1941-us drug companies agreed but on small scale, effectiveness of penicillin was shown, usa joined ww2, government saw the need and funded 21 companies for mass production. us drug companies began mass production of penicillin in 1942 and british companies started 1943
timeline-
1928-fleming sees mould kills bacteria
1929-publishes findings
1939-florey and chain continue research
1941- US companies help, its effective, december USA join ww2
1942- mass production from US funded by US government
1943- mass production by UK companies
1945- crowfoot hodgkin-penicillins chemical structure
1951- chemical copy of penicillin made
lung cancer
diagnosis- symptomes=cough, cough up blood, breathlessness, tiredness, weight loss, chest infections. it is a mass of cells in the lungs- ct scan shows
treatment- surgery, radiotherapy and chemotherapy
prevention- reduce smoking-advertising banned
tax increased, banned smoking in public and cars
legal age to buy from 16 to 18
campaigns of risks of smoking
not publically display tobacco in shops
cigarette packaging standardised-warnings of dangers,
c1500-c1700: the renaissance
change in ideas: not religious ideas anymore.
continuity in ideas of causes...
miasma
four humours-by 1700 few people believed in it
physicians and scientists
new scientific approach adopted, the diagnosis of disease, fewer people believed in astrology and they stopped using charts and timing, improved knowledge of digestion made physicians realise urine wasn't a good indicator, physicians were more direct and examinatory.
Thomas Sydenham
worked as a doctor during 1660s and 70s. wrote a book called observationes medicae in 1676 showing theories and observations. he didn't rely on medical books for diagnosis but recorded the symptoms. he investigated the idea disease had nothing to do with the nature of the person who had it.
he based treatment on disease as a whole and not individual symptoms. name=english hippocrates
church
fewer people believed supernatural or religious causes of disease, ideas of air spreading and this changed the church influence
new religious ideas challenged the authority of catholic church, people were still very religious but began to look for new ideas of causes other than god
Printing press
1440-gutenberg. hundreds in 1500 across europe. texts could be produced quickly and spread the ideas and theories of the scientists and doctors, reduced the church's control of ideas.
Royal Society
sponsered research into experiments, scientific knowledge, new theories and ideas, and for people to challenge, study and build on each others research they wrote a journal in 1665 called philosophical transactions. its a medical community
continuity in prevention, treatment and care.
hospitals
1500- treating more sick and less travellers. own physicians and apothecaries to mix medicines.
1536-dissolution of monasteries by henry VIII caused most hospitals to close.
charity funded hospitals set up but not until 1700s the amount of hospitals was equal
pest houses for particular diseases
hospitals run by physicians, treating the sick not religion
community care
care for at home by female. physician too expensive. women gave advice and remedies, some were paid
healthy living, herbal remedies, bleeding and purging, superstitions and prayer, cleanliness
prevention and treatment
emphasis on removing miasma, draining swamps, removing sewage and rubbish
changing clothes
herbal remedies
theory of transference led people to try and rub objects to transfer the disease
alchemy caused chemical cures using metals or minerals.
lack of change
ideas were slow to be accepted, no direct use for improving treatment or prevention, discoveries didn't improve understanding of cause of disease.
training
apothecaries and surgeons
continuity
not university changed, inferior to physicians because they were cheaper
change
better trained through guild systems, apprentices, journeymen, masters
a licence to work as an apothecary or surgeon after training
physicians
continuity
trained at university for many years
training based on textbooks not practical
change
better access to books and drawings because of the printing press.
new ideas about anatomy and causes of disease caused practical and experimental physicians
dissection was legalised but not common
vesalius
andreas vesalius studied medicine in 1533, became professor of surgery. did dissections on human bodies and discovered how the body works more.
he improved understanding of the human body
study of anatomy became central to study of medicine
proved galen wrong
encouraged dissections
widely published detailed illustrations.
the great plague
causes
same beliefs as black death. miasma, less believed it was four humours, disease could be passed from person to person
the black death and the great plague
they were the same disease, it shows what has changed and what has stayed the same over 300 years.
government action
1665-1348, there was a greater reaction by local councils, the king ordered them to stop the plague from spreading. theatres and large gatherings were banned, dogs and cats were killed, streets cleaned, barrels of tar were burned, carts collected the dead and buried in deep mass graves, a household was boarded into its home for 28days or taken to the pest house if they had the plague, days of fasting and public prayers were ordered.
treatments
similar to black death- herbal remedies, quack doctors, theory of transference to transfer the disease to something else, people could sweat the disease out so they were wrapped up in thick blankets.
plague doctors wore costumes to prevent them catching the disease. the masks had sweet-smelling herbs to rid miasma and the cloak was waxed so nothing could be absorbed. birds were believed to attract disease so the mask was a birds beak in hope that it would cause the plague to leave the patient
william harvey
studied medicine at cambridge, became lecturer of anatomy , was one of james I's doctors, carried out public dissections, showed recording symptoms and observing rather than textbooks, discovered the process of blood circulation.
circulation of blood- harvey reasearched vesalius theory that blood flowed towards the heart which contradicted galen. he disected bodies and pumps that showed blood only flowed one way and proved vesalius right.
he then proved blood couldnt be produced by the liver and absorbed into the body as galen thought
he had new technology like mechanical water pumps which made thoughts of the body working the same way
he discovered arteries and veins were part of one system and the blood was pumped around the body by the heart
importance of harvey- he proved some of galen's theories wrong.
he improved knowledge about the body. by 1700 his work was being taught in schools.
harveys work gained publicity and credibility which inspired others
his methods of observation and dissection brought results therefore inspired others.
his discoveries asked more questions and encouraged further experiements
c1700-c1900: 18th and 19th century- industrial revolution
germ theory
theory of cause of disease- 18th century- some thought germs were produced in decaying matter-called spontaneous generation. most people still believed miasma was the cause but was less popular.
microscopes- 1700- microscopes developed cloudy images of what would become known as bacteria or germs. 1850- microscopes had extremely tiny images could be seen clearly.
change in theory- 1861- louis pasteur published germ theory- showed spontaneous generation was incorrect. proved microbes in the air cause decay-he discovered this when investigating why liquids turn sour for the brewing industry- he theorised that germs also caused disease but couldn't prove this
robert koch- read Pasteur's work and studied microbes, he proved pasteur's theory that microbes caused disease as well as decay. he identified specific microbes that caused TB in 1883.
koch developed a new easier way of growing bacteria on agar jelly and also discovered that chemical dyes stained bacteria, which made easier to see under a microscope. other scientists used these methods to identify microbes that caused other disease
eventually these discoveries were to have direct impact on the prevention and cure of many diseases
pasteur and koch- Pasteur's germ theory had little impact on the medicine in britain to begin with as he wasn't a doctor and his work focused on food and drink not disease. most doctors still believed in the spontaneous generation theory but some, joseph lister, made te link between microbes and disease.
Koch's work had more of an impact in britain than Pasteur's had as he inspired others to research microbes. it took time for doctors and government to accept the germ theory of disease. the real cause of disease had been discovered however hadn't made an impact yet.
improvements in hospital care
florence nightingale
she was a significant influencer in improving hospital care. the changes she made to hospital conditions are the high death rates in military hospitals changed public opinion.
nursing wasnt a respectable job for women with little training
she attended the first nurses training school in germany
she was asked to lead a team of nurses at a military hospital
she believed miasma caused disease so had hygiene, fresh air, good supplies and training for nurses which improved conditions in hospitals
the got spread in newspapers and published books on nursing and hospital organisation and set up training schools
changes in hospital care
new hospitals, financed by charities and local councils opened during the 19th century to look after the sick.
first cottage hospital, nurses gave care, GPs prescribed treatment, in 1859
middle and upper classes could afford doctors to treat them at home
hospital cleanliness and organisation and training was improved. pasteurs germ theory led to improved hygiene
nurses were given a more central role caring for patients and assisting doctors
the elderly, sick or disabled poor were forced to enter workhouses
hospitals had a home atmosphere, parents and visitors helped patients
public pressure led to infirmaries set up for the poor.
specialist hospitals for mentally ill and fever houses were developed
anaesthetics and antiseptics
development- 1861-half the patients in surgery die from postoperative infections. lister starts to work as a surgeon
1864- lister reads Pasteur's germ theory and learns that carbolic acids kills parasites in sewage
1865- lister soaks bandages in carbolic acid to avoid wounds getting infected.
1866- lister uses carbolic acid to clean wounds and equipment and invents a spray to kill germs in the air
1867- lister states that his wards have been free from infection(sepsis) for 9 months. he publishes hisideas
1877- lister becomes professor of surgery
aseptic surgery- lister inspired others and by 1900 operating theatres and wards were thoroughly cleaned using aseptic techniques, the clothing and instruments were sterilised
impacts- surgery became pain free and there was no struggle so surgeons could take more time and be more careful. deeper surgery became possible and death rate dramatically decreased as success rate of surgery rose. aseptic surgery was possible because antiseptics were used to clean wounds and operating theatres
opposition- worries about long-term effects of anaethetics that could make you die victorians were very religious and thought god inflicted pain for a reason so it was wrong to interfere. took a long time to believe germ theory and accept listers discoveries
search for anaesthetic
before 1800- alcohol and opium didn't help ease pain.
laughing gas- 1844 but failed to ease all pain and patients remained conscious
ether 1846- made patients totally unconscious but lasted long. but could make patients cough during operations and sick afterwards, it was very flammable and transported in heavy glass bottles
chloroform-1847- very effective, but could kill if dosage was wrong. it was discovered when james simpson was looking for pain solutions and he gave lectures and wrote articles to promote it. he was knighted for his services to medicine
cocaine 1884- local anaesthetic
190s- novocaine- less addictive and general anaesthetic
prevention of disease
vaccinations- pasteur carried out experiments to observe microbes and published in 1861, called germ theory
pasteurs team discovered a weakened version of a disease-causing microbe could be used to create immunity from that disease
pasteur admired jenner and called the discovery vaccination as a tribute
pasteur developed vaccines against anthrax and chicken cholera for animals, and against rabies for humans
Pasteur's work inspired other scientists to develop vaccines for human diseases.
1875 public health act
government didn't believe it had a right to interfere with lives and in 19th century they changed. 1875- city authorities must provide
clean water, sewers, public toilets, street lights, public parks as well as inspect houses for cleanliness, monitor building houses to prevent damp and overcrowding, check quality of food sold, employ a public officer of health to monitor disease
jenner and vaccination
smallpox- 18th century- smallpox killed children and thousands of adults. survivors were often left with terrible scars, the disease was very contagious
jenner
important- scientific methods could lead to disease being wiped out, but he didnt know why it worked, the link between cowpox and smallpox was so unique it didn't lead to other vaccinations, other diseases were still killing people
opposition- people thought it was wrong to give people animals disease,interfered with gods plan, doctors lost money when the government offered vaccination free, some doctors didn't vaccinate properly so didn't work
edward jenner- born in 1749, trained surgeon and apothecary. worked as GP and made discovery
vaccination and smallpox -1720- doctors inoculating people against smallpox by infecting them with a milder version of the disease, this could still kill and only rich could afford it.
jenner collected evidence of success and failures, he regularly treated people for the mild disease cowpox and noticed no one got smallpox
1790s- he used scientific methods for experiments to test this theory. he infected locals with cowpox and none of them got smallpox after trying to get it.
1798- royal society refused to publish jenners ideas so he paid to print his findings elsewhere and included detailed instructions so others could follow it.
1800 100,00 people wordlwide had been vaccinated ut took time in brtain
1802- royal jennerian society promoted the vaccine and by 1804 12000 british people were vaccinated
1840- vaccinations were provided free to poor. vaccinations made compulsory in 1853
in 1979 smallpox had been wiped out
Cholera 1854
prevention for spread of cholera- miasma and spontaneous generation. keep homes clean, clean streets, clear away rubbish and the government's public health act of 1848 suggested clean water supplies but was compulsory so few complied.
cholera- blue death, turns skin blue form dehydration
mostly affected poorest slums.
caused severe diarrhoea and comiting leading to dehydration
19th century there was no treatment and most died
john snow
the work- snow was a respected doctor and surgeon. he observed the epidemic of 1848-49 and began work on his theory that cholera was spread through contaminated drinking water not miasma.
1854- soho where snow lived broke out with cholera, he mapped all the deaths and found a strong link to a water pump on broad street.
he removed the handle and the number of deaths fell dramatically
later they found a cesspit had been leaking into the well
1855 snow presented his findings to the government
significance of john snow- many lives saved after the pump was found.
many didn't believe the theory as there was no scientific evidence that it was transmitted by water. germ theory didn't emerge till 1861 so government didn't act on a new sewer.
long-term snows work combined with other evidence and a new london sewer was completed 1875
helped make ink between dirty water and disease, leading to public health act in 1875, authorities forced to provide clean water
c1250-c1500:middle ages
The church
astrology
the planets and stars showed the disease and to diagnose the patient, increased after black death.
god was the cause of disease
god made them ill- he was testing them or displeased. people didnt investigate any further which held back medical research.
the church's control
the teaching was by the church, they discouraged dissection, disapproved of challenge to authority, the monks could read and write and the books were in the monasteries, they promoted Galen and theories because it was based on god, the church taught to care for the sick therefore many hospitals were in monasteries and nunneries.
the four humours
theory of opposites
galen
greek doctor- wrote books and ideas based on medical training in the middle ages. he developed hippocrates ideas and used bloodletting, purging. theory of opposites and human anatomy from operating on wounded gladiators or dissections.
hippocrates
ancient Greek doctor- influenced into medieval times and beyond. dismissed the idea of god and believed there was a physical reason which needed a physical cure. treatments= diet, exercise and rest, also bleeding and purging. he wrote a Hippocratic oath- doctors swore to respect life and prevent harm. he studied symptoms, made notes, compared, diagnosed and treated, basis of today.
miasma
cause of disease was transmitted by bad air- related to god because bad smells indicated sin. continued into 19th century
theory of opposites was when Galen developed four humours futher, besides bleeding and purging to get rid of excess humours, there was an aim to balance the humours by giving the patient opposite of their symptoms. e.g phlegm(water and cold)=hot peppers
treatments
who treated the sick?
barber surgeons- no training, bloodletting, pulling teeth, lancing boils, cut hair, amputated limbs with a very low success rate, cheap.
home care- females, wise women
apothecaries- training but no qualifications, mixed medicines and ointments, cost more
physicians- trained and qualified, diagnosed illnesses and gave treatments, sent patients to apothecary or barber-surgeon, expensive, rare to have women.
bloodletting- cutting a vein using leaches or cupping. performed by barber-surgeons or non-medical people.
purging- make patient vomit or go to the toilet to remove food. emetics and laxatives were mixed up.
preventions
religious and supernatural methods- christian life, incantations, lucky charms, self-punishment
rational methods- purify the air, keep streets clean, washing, bleeding and purging, not overeating, exercising.
herbal remedies, praying, fasting, pilgrimage, paying for a special mass.
supernatural=hanging magpies beak around neck to cure toothache
physicians
observed patients symptoms, checked pulse, skin colour and urine for colour and taste. urine charts, zodiac charts, sent patients to barber-surgeon or apothecary.
hospitals
travellers and pilgrims stayed, number increased in the middle ages, run by the church so emphasis on god, some built for specific disease, patients given food and rest, places of recuperation not treatment, clean surroundings, people with disease or infections not allowed.
the four humours- blood, phlegm, yellow bile and black bile. when unbalanced you were ill, so to get well you would have to balance them.
The Black Death
causes
religion-punishment from god, astrology- position of planets, miasma- bad smell from rubbish, volcanoes - poisonous gases carried in the air, four humours - unbalanced, outsiders- strangers or witches caused it.
avoidance
praying, fasting because they thought god had sent the disease
cleaning up rubbish on streets, smelling other bad smells to overcome plague, lighting a fire, ringing bells, having birds flying to keep air moving, carrying herbs and spices to avoid breathing bad air, no unknown villagers.
symptoms
swelling of the lymph glands into large lumps filled with pus known as buboes, fever and chills, headache, vomiting, diarrhoea, abdominal pain.
treatments
lucky charms, cutting open buboes to drain pus, holding bread against buboes then burying in the ground, eating cold things and taking cold baths
they think its the bubonic plague, carried by fleas living on the black rats from other countries. passed to humans by flea bites and gets into blood.