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Medicine Through Time, Classical thinking in the Middle Ages - Coggle…

- - - - Supernatural and religious explanations of the causes of disease
        
        The Theory of the Four Humours
        The theory that the body contained 4 elements-or humours- and that they must all be balanced.
        It was created by Hippocrates, but was further developed by Galen, by for example including the theory of opposites.
        The theory was popular because it was easy to use to diagnose all diseases.
        
        Phlegm
        Linked to the Winter, and water. It was cold and wet, and so was treated with things that were hot and dry.
        
        Black Bile
        Linked to the Autumn, and earth. It was cold and dry, and so was treated with things that were hot and wet.
        
        Choler
        Linked to the Summer, and Fire. It was hot and dry, and so was treated with things that were cold and wet.
        
        Blood
        Linked to the Spring, and fire. It was hot and wet, and so was treated with things that were cold and dry.
        
        Astrology
        The alignment of the stars and planets were seen as very important. Physicians would look at star charts to identify what was wrong.
      - Other ideas about the cause of disease
        
        Miasma
        Bad air that was suspected to be filled with harmful fumes capable of transmitting disease.
        
        Urine Charts
        Urine was thoroughly examined for a diagnosis. Aspects such as thickness, colour, smell and taste were evaluated.
      - Influences on ideas about the cause of disease
        
        Individuals and the Church
        The Church was in control of books distributed and therefore medical learning.
        Hippocrates and Galen were popular with the Church, meaning their works were promoted.
        
        Science and Technology
        Printing Press 1440: Allowed for fast and easy sharing of medical texts.
        
        Attitudes in Society
        People didn't want to criticise the Church in case they went to hell. They thought that since medicine had always been done this way there was no need to change.
    - - Religious and supernatural treatments
        
        Religious:
        -Healing Prayers and incantations
        -Paying for a special mass
        -Fasting
        
        Supernatural:
        Astrology
        -Star Charts
        -Horoscopes
        -Planet Alignments
      - Humoural Treatments
        
        Blood-letting (phlebotomy)
        Was used in order to rid the body of excess of a humour.
        
        Purging
        It was believed that humours were created by the foods eaten, so a common treatment was purging the digestive system of any leftover food. Ways of doing this included emetics, laxatives or enemas.
      - Remedies
        Herbal infusions to drink, sniff or bathe in.
        
        Bathing
        Warm baths were often prescribed to steam out impurities and ease aching joints.
        Herbal remedies could be given this way. Various plants and herbs were added to the water.
      - Preventing Disease
        
        The Church
        Most people believed that the best way of preventing disease was to live a life free of sin.
        
        Hygiene
        Guidance on maintaning this was stored in Regimen Sanitatis.
        Regimen Sanitatis was a loose set of instructions which became very common by 1250. It listed advice such as:
        -Take moderate exercise
        -Do not overeat
        -Avoid stress
        
        Diet
        Since the humours were thought to be produced by what you ate, the diet was viewed as very important. It was important to avoid too rich of a diet.
        
        Purifying the air
        People tried to rid the air of miasma through spreading sweet herbs such as lavendar
      - Medieval 'medics'
        
        Physicians
        The main role of a physician was to diagnose illness and recommend a course of treatment. He would use:
        -Urine
        -Astrology
        -Humoural Tendencies
        
        Apothecaries
        Mixers of herbal remedies.
        
        Surgeons
        Generally Barber Surgeons, who were inexperienced, and dealt with minor surgeries.
        Some Surgeons were highly trained. They could remove an arrow, set a broken limb, or even remove cataracts.
    - - Hospitals
        By 1500, there were an estimated 1,100 hospitals. However, many did not offer treatment, but instead hospitality.
        Most were funded by the Church, yet some were funded by endowment, which was when an individual left money in their will for the funding of a Church,
      - The home
        The vast majority of the sick were cared for at home.
        Women were expected to be responsible for care of relatives, so they would provide herbal remedies and food. They could have possibly also carried out minor surgeries.
    - - The Black Death
        An outbreak of the Bubonic Plague. It was carried by fleas on rats who came to England on merchant ships.
        People who caught the disease were unlikely to survive.
      - Causes of the Black Death
        
        Religious and supernatural
        Many thought the Black Plague was God deserting humanity.
        In 1345 there was an unusual positioning of Mars, Jupiter and Saturn, which was interpreted as a sign something wonderful or terrible was bound to happen
        
        Natural causes
        Miasma from an earthquake or volcano was blamed.
        
        Common beliefs
        In Europe, many blamed the Jews, but the Jews had been expelled from England in the 13th century so this was not the case in England.
      - Treatments of the Black Death
        
        Supernatural
        The main recommendation to treat the Black Death was to confess your sins and ask God for forgiveness through prayer.
        
        Natural
        Firstly, physicians tried bleeding and purging, yet they did not work.
        In addition, they recommended things to drive away the miasma, such as aloe, along with boiling vinegar or prescribing theriaca.
      - Preventing the Black Death
        
        Supernatural Means
        Main advice given included:
        -Pray to God and fast
        -Go on a pilgrimage and make offerings to God
        -Self-flagellation (whipping self)
        
        Natural Means
        People were advised to flee to prevent catching the plague.
        If this movement was impossible, people held a posy of flowers to avoid miasma.
        
        Common Beliefs
        Physicians and commoners alike did not know how to avoid the plague. However, it was commonly believed that plagued people should be avoided.
        
        Government action
        New quarantine laws were implemented, and new people had to stay away from eveyone else for 40 days.
        However, the government were not awfully powerful at the time, so they often could not enforce these laws.
- - - - New ideas and discoveries in the period c1500-c1700
        
        In 1628, it was suggested that blood circulated around the body instead of being made in the liver as suggested by Galen.
        Influential Individual: William Harvey
        
        A better understanding of the digestive system developed, so people stopped believing disease was caused by eating the wrong things.
        Influential Individual: Jan Baptiste van Helmont
        
        New microscopes were being developed, which allowed for much clearer magnification.
        Influential Individual: Robert Hooke
        
        In 1676, it was theorised that disease was cause by external factors rather than the Four Humours.
        Influential Individual: Thomas Syndenham
        
        By 1683, more powerful microscopes had been developed to allow for observation of 'animalcules' or bacteria.
        Influential Individual: Antony van Leeuwenhoek
        
        The Theory of the Four Humours began to be rejected
        Disease was viewed as seperate from the body and needing to be attacked, leading to chemical treatments being produced.
        Influential Individual: Paracelsus
        
        In 1546 it was thorised that disease was caused by tiny seeds in the air
        Influential individual: Girolamo Fracastoro
      - Changing Ideas
        
        Ideas that changed a lot
        -The Theory of the Four Humours
        -The human body
        -Diagnosis using urine
        
        Ideas that changed a little
        -The use of medical books
        -The influence of the Church
        -Supernatural
        
        Ideas that stayed the same
        -Miasmata
      - A scientific approach to diagnosis
        
        Humanism
        It represented:
        -A love of learning
        -Breaking away from medieval traditions
        
        Thomas Sydenham (The English Hippocrates)
        Sydenham did not rely on medical books, but instead made careful observations for a treatment.
      - Improved communications
        
        The printing press
        c1440, Gutenberg created the first printing press, which allowed information to be spread accurately and quickly.
        
        The work of the Royal Society
        The Royal Society met for the first time in 1660, with their aim being to promote and carry out experiments to further the understanding of science.
        It made it possible for physicians and scientists to access and study eachother's research.
    - - Treatment: change and continuity
        
        Change
        -Tranference: The theory that an ailment could be transferred to something else
        
        Continuity
        -Bleeding, purging and sweating: to remove excess humours.
        -Herbal remedies: ingredients now selected for shape or colour.
        -Chemical Cures: included using salts, metals and minerals.
      - Prevention: change and continuity
        
        Change
        -Practicing moderation
        -Birth condition
        -Frequent clothing changes
        -Suspicion of the weather
        -Efforts to remove miasma
        
        Continuity
        -Superstitions & prayer
        -Cleanliness
        -Regimen Sanitatis
        -Miasma
      - Medical care: change and continuity
        
        Change
        Andreas Versalius: Found 300 mistakes in Galen's works, including:
        -The lower jaw was in one part, not two.
        -The vena cava did not lead to the liver.
        
        Continuity
        Apothecaries: Continued to mix remedies.
        Surgeons: Continued to carry out simple operations.
      - Caring for the sick: change and continuity
        
        Hospitals
        Changes began to occur with the introduction of hosiptals providing:
        -A good diet
        -A visit from a physician
        -Medication
        
        Pest houses
        These were new types of hospitals that specialised in a particular disease.
        
        Community care
        Most sick continued to be cared for at home.
        Communities were close-knit so people provided remedies and advice to eachother.
        Women continued to play an important role in caring for the sick.
    - - Harvey's research
        
        Discovering the circulation of the blood
        Harvey famously proved that the arteries and veins were linked together.
        In addition, he discovered that blood only flowed one way through the veins.
        
        Factors enabling Harvey's discoveries
        
        Science and technology
        New technology like the firehose pump inspired Harvey to review the heart.
        
        Attitudes in society
        There was more interest in science, and people began to search for rational explanations for things.
        
        Individuals and institutions
        Harvey gained credibility once hired by Charles I as his personal physician.
        The decline of the Church's power meant Harvey could be critical of Galen.
      - The impact of Harvey
        
        Immediate impact
        Encouraged other scientists to experiment on actual bodies
        
        Less impactful aspects
        The understanding of the circulation of the blood had little practical use, which meant Harvey's discoveries on treatment during the 17th century were quite limited.
    - - Ideas about the causes of the Great Plague
        
        Astrology
        Things such as unusual planet alignments and comets led to people believing something terrible was bound to happen.
        
        Punishment from God
        People believed God had sent the Plague to rid the world of sin.
        
        Miasma
        People thought the stench from 17th century life poured out of the ground when the weather warmed up, causing Plague.
        
        Other people
        By 1665, many people believed that disease could be spread from person to person.
      - Approaches to treatment of the Great Plague
        
        Herbal Remedies
        Herbal remedies continued to be extremely popular.
        
        Quack Doctors (Unqualified 'doctors')
        Quack doctors sought to take advantage of the panic, and sold supposedly miraculous treatments for easy money.
        
        Sweating
        It was advised to wrap up in woolen cloth next to a fire to sweat out the disease.
        
        Tranference
        People tried things like strapping animals to themselves in order to try and transfer the disease.
      - Approaches to preventing the Great Plague
        
        Advice from physicians
        -Prayer and repentance
        -Quarantine
        -Pomanders (perfumed ball)
        -Diets
        -Plague Doctors: The bird shape was thought to attract the plague away from others
        
        Advice from other healers
        -Plague water
        -Catching syphilis (inoculation)
        
        Government action
        -Public gatherings were banned.
        -Streets were regularly cleaned.
        -Sweet-smelling fires burned on corners.
        -Cats, dogs and pigeons were killed on sight.
        -Wardens were appointed to search for carriers of the disease so they could be quarantined
        -Carts would travel through the city to collect the bodies of the dead.
- - - - Continuity and change
        
        Change
        The Theory of the Four Humous had been discarded.
        The theory of spontaneous generation emerged. Scientists thought that microbes were a product of decay, rather than the cause
        
        Continuity
        People still believed in miasma, but this theory was becoming less popular.
      - Medical breakthrough: Germ Theory
        
        Louis Pasteur and the development of Germ Theory
        
        Due to improved microscopes, Pasteur was able to observe microbes in wine and vinegar which turned both liquids bad. He published these findings in 1861, calling them Germ Theory.
        As these microbes were causing decay, he theorised that they could also be causing disease within the human body, but he did not publish his germ theory of infection until 1878.
        
        The four basic principles of Germ Theory
        
        The air contains living microorganisms
        
        Microbes are not evenly distributed in the air
        
        Microbes can be killed by heating them
        
        Microbes in the air cause decay
        
        Pasteur's influence in Britain
        
        The theory of spontaneous generation continued to be important until the 1870s. It was heavily promoted by Henry Bastian, a higly influential doctor.
        
        Joseph Lister began to look for a link between the microbes and disease. However, his ideas were doubted as he could not prove his theory.
        
        John Tyndall promoted the link between microbes and disease. He had observed small organic particles in the air.
        
        Robert Koch's work on microbes
        Koch was the first to identify different germs caused different disease.
        
        Koch published ideas on the methods that could be used to identify disease-causing microbes.
        -The microbe is present in every case of the disease
        -Once taken from the body the microbe can be reproduced into a pure culture
        -The disease can be reproduced in test animals using that culture
        -The microbe can be taken out of the test animals and used to start a fresh culture
        
        Koch's influence in Britain
        
        The identification of microbes that caused specific diseases was an enormous breakthrough in the diagnosis of disease, and now doctors sought to study the disease instead of the symptoms.
      - Factors affecting the understanding of the causes of illness and disease
        
        Individuals
        Namely Robert and Koch: key for developing Germ Theory.
        
        Institutions: the British government
        The government did not help to improve understanding of disease. Germ Theory offered no practical solutions, so it was not promoted.
        
        Science
        There were strong desires to find answers to the big questions of science.
        Improved communications allowed ideas to be easily shared.
        
        Technology
        The microscope meant that microbes were able to be observed, making it crucial in the development of Germ Theory.
        
        Attitudes in society
        People were more interested in rational explanations to disease, however, people were reluctant to change their minds, which hindered Germ Theory.
    - - Extent of change in care and treatment
        
        Change
        -The way sick people were treated
        -Most people accepted that germs caused disease
        -Prevention being the most important aspect was widespread
        -People began to realise that infection was everywhere
        -The government and population were more willing to take steps to stop disease from spreading
        
        Continuity
        -Herbal remedies were still popular due to lack of understanding.
      - Improvements in hospitals and the influence of Florence Nightingale
        
        Hospitals in the 18th century
        Hospitals increasingly began places to be treated instead of accomodated.
        More people started to attend, so they became less sanitary. Disease spread quickly.
        
        Florence Nightingale
        Nightingale was a nurse with big impacts on hospitals.
        In the Crimean War, she made changes to the care of the wounded by:
        -Using scrubbing brushes to eliminate dirt
        -Organisation
        -Clean bedding and good meal provision
        She became a national hero.
        
        The impact of Florence Nightingale in British hospitals
        Nightingale implemented pavilion plans within hospitals. This meant:
        -Improved ventilation
        -More windows
        -Larger rooms
        -Isolation wards
        
        Hospitals by 1900
        Cleanliness was of utmost important, with use of antiseptics and isolation wards becoming prominent.
        
        Improvements in surgical treatment
        Problems faced in surgery were as follows:
        -Bleeding
        -Pain
        -Infection
        
        Tackling pain: the development of the anaesthetic
        
        Laughing gas
        Laughing gas had been successful for smaller operations.
        
        James Simpson and chloroform
        Simpson was convinced there were better anaesthetics than laughing gas. He experimented with sniffing various chemicals until he tried chloroform and passed out.
        Although the dose had to be carefully controlled, it began to be used as a solution to pain. It became extremely popular after assisting Queen Victoria during childbirth.
        
        Tackling infection: the development of antiseptic surgery
        
        Joseph Lister and carbolic acid
        Lister was an English surgeon. He began to look for a chemical which would clear bacteria from wounds.
        He knew of carbolic acid being used in sewer treatments, so in 1865 he used a bandage soaked in carbolic acid on a patient. The wound healed cleanly.
        Surgeons finally understood that performing safe surgery was their duty.
        
        Opposition to change
        -Anaesthetics lead to deeper surgeries, which led to higher death rates. People did not trust anaesthetics.
        -People believed that pain relief interfered with God's plan.
        -Some doctors believed that unconscious patients were more likely to die if they were unconscious.
        -It took a long time to accept germs caused infection
      - Jenner and the development of the vaccination
        
        Smallpox in 18th century Britain
        It was a terrible threat to Britain.
        People were still unaware of the cause of the disease.
        Some people treid to inoculate themselves against smallpox by catching a mild dose of the disease.
        
        Jenner discovers the vaccination for smallpox
        Jenner was a doctor.
        He noticed people who had cowpox did not get smallpox.
        He injected James Phipps with cowpox, and later smallpox. He was not infected.
        
        Reactions to the new vaccination
        People were suspicious.
        The government promoted them, as they were cheaper than inoculation.
        
        The impact of the smallpox vaccine
        
        Short-term
        The vaccine saved many lives.
        The inoculation was slow to become popular in Britain due to anti-Jenner propaganda.
        
        Long-term
        By the end of the 19th century vaccination became normal.
      - New approaches to prevention: the development and use of vacinations
        
        Pasteur's involvement
        Pasteur knew that the specific disease must be identified in order to treat it.
        He tried to make one for chicken cholera and discovered that a weakened strain worked.
      - The Public Health Act, 1848
        The government took more responsibility for the public's health.
        -In London 1,300 miles of sewers were built.
        -In Birmingham, slums were demolished.
        -In Leeds, a court order was obtained to prevent sewage being drained into local water.
        
        The Second Public Health Act, 1875
        Some responsibilities listed include:
        -Clean water provison
        -Sewage disposal
        -Building public toilets
    - - Attempts to prevent the spread of cholera
        Cleaning of streets was common so that miasma could be avoided.
      - John Snow
        A surgeon who observed cholera. He concluded cholera was spread by dirty water.
        
        The 1854 epidemic
        Snow created a spot map of deaths surrounding Broad Street. He found they were centered around the water pump.
        
        The impact and significance of John Snow and the Broad Street pump
        Snow presented his findings to the government, who promptly invested in a new sewage system.
        Although Snow had plenty of evidence to show cholera was waterborne, he had no scientific proof.
        Snow's impact was only partially influential on his local area.