British Medicine Through Time: Overviews - PDF

@mrthorntonteach British Medicine Through Time: Overviews Medieval Renaissance Industrial Modern...

@mrthorntonteach British Medicine Through Time: Overviews Medieval Renaissance Industrial Modern Dates Dates Dates Dates 1250-1500 1500-1700 1700-1900 1900-Now Thirteenth to fifteenth century (13-15th) Sixteenth to Seventeenth Century century (16-17th) Eighteenth to Nineteenth century (18-19th) Twentieth to Twentieth First Century (20th-21st) Life Expectancy: 35 Life Expectancy: 40 Life Expectancy: 60 Life Expectancy: 87 Key Events Key Events Key Events Key Events 400BC Hippocrates Printing Press, 1440 1798, First vaccinations Penicillin discovered, 1928 160BC Galen Dissolution of Monasteries, 1536-40 1864, Chloroform, anaesthetic Mass Vaccinations from 1942 (Diphtheria) St Bartholomew, first hospital 1123 Vesalius Fabric of the Human Body, 1861, Pasteur releases the Germ Theory NHS set up 1948 Black Death, 1348 The Great Plague, 1665 1865, Carbolic acid, first antiseptics DNA Discovered, 1953 How much progress? How much progress? Progress? Progress? Medicine ‘Stood still’ in this period, Medicine made some progress on knowledge, but Medicine made some serious breakthroughs Medicine made some serious breakthroughs there was minimal progress. large amounts of continuity Ideas on cause: Significant progress, end of Ideas on cause: Science/Tech can pinpoint Ideas on cause: No progress Ideas on cause: Minimal progress with Sydenham traditional ideas and Germ Theory finally found case specific illness (DNA, Biopsy, X Ray, CT Scan) Treatment/Surgery: Some herbal challenging 4 humours/ Plague seen as contagious but of bacterial diseases, but slow change and SG popular which means treatment more successful remedies worked, and surgeons more mainly continuity on before e.g. Miasma Treatment/Surgery: Surgical progress with Treatment/Surgery: Huge improvements due to experiences Treatment/Surgery: Some new herbal remedies antiseptics which led to aseptic surgery, development science and technology, which now means Prevention/Public Health: Little worked e.g. quinine but mostly continuity of anaesthetics. Solved Pain/Infection but still not surgery and treatment is best, whilst antibiotics progress (Regimin Sanitatis) , Prevention/Public Health: Little progress but, bloodless yet. Complex surgery e.g. heart 1896 like penicillin have had huge impact on infections government reactive not proactive government did make more effort to react to Great Prevention/Public Health: Vaccinations key but slow but still issues on genetics/superbugs Hospitals/Care: Growth of hospitals Plague to start, whilst government finally passed Public Prevention/Public Health: Government made 500 by 1400) but Hospitals/Care: Decline of hospitals, most cared for at Health Acts, first step by government ever huge steps; lifestyle campaigns, national Knowledge: No progress, controlled by home still, Sydenham promoted direct observation Hospitals/Care: Decline of hospitals, most cared for vaccinations, laws like Clean Air Act and NHS Church and respect for traditions Knowledge: Considerable progress due to Vesalius at home still, Sydenham promoted direct observation Hospitals/Care: NHS the most significant impact, (Anatomy) Harvey (Circulation) and Royal Society but Knowledge: Progress due to Germ Theory, improved free healthcare for all. Nurses and Doctors/GPs little impact on medicine itself, laying foundations training of doctors and nurses (Nightingale) highly trained Factors for/against progress Factors for/against progress Factors for/against progress Factors for/against progress Church: Church controlled everything Church: Decline of church power in reformation, Government: Government finally began to spend on Science/Tech: Hugely important, led to rapid and people afraid of God, limited allowed new ideas/dissection, improved knowledge health (Vaccinations/Public Health Act) which was changes in diagnosis, prevention and treatment change. They controlled education and but many people still highly religious and resistant, first time in history, big breakthrough but they took e.g. DNA, Penicillin, CT Scans, Robotic Surgery ideas on disease, which support whilst closing of churches did impact hospital care time as vaccinations and 1948 Public Health Act not Government: NHS and Vaccinations huge in put Hippocrates/Galen’s ideas so no one Tech: Printing press allowed spread of ideas to compulsory at first, only since Germ Theory into improving public health, the government has dared or wanted to challenge ideas as if challenge church, took printing out of church hands Individuals: Medieval & scientific Improvements done more than ever to improve public health. you challenged Church, you were God! and Royal Society allowed to print Vesalius books. pushed by Jenner, Lister, Pasteur, Koch and Simpson Whilst US government supported development Tradition: Many simply respected Microscope and water pump influenced Harvey all made significant impact, whilst Nightingale pushed of penicillin, which meant it was mass produced tradition, e.g. Hippocrates/Galen and Government: Charles II supported scientific revolution hospital and nursing care to significantly improve, Individuals: Watson, Crick, Fleming, Florey and saw ideas as rational and respected. and Royal Society, govt. action in Great Plague but still John Snows work on Cholera led to Public Health Acts Chain all pushed huge discoveries in medicine Galen wrote 300 books, so why bother only reacted to problems. Science/Tech: Development of microscopes led to and without their drive no penicillin and DNA looking for change? Hard to challenge Individuals: Sydenham, Vesalius, Harvey and Royal Germ Theory, laboratories for discoveries, War: WW2 was a factor in development of Government: King and government Society all played key roles in improving knowledge vaccinations and syringes. Scientific methods used by penicillin spent nothing, only during Black Death Respect for tradition: Majority of population still Jenner, Snow and Pasteur to prove findings and were reactive to issues respected tradition, especially during Great Plague Significant impact Science/Technology: non existent BUT, little short term change as old ideas continued Church: No impact on medicine any more @mrthorntonteach The Big Picture of ‘Ideas on the Cause of Disease’ Over Time Medieval Renaissance Industrial Modern God Traditional ideas Miasma Genetics/DNA The Church taught God caused disease Traditional ideas remained popular with people at a Miasma theory remained popular until the late 1800s, DNA identified by Crick/Watson in 1953, and to test faith or as a punishment e.g. the time, espcially during the Great Plague. when they even with Florence Nightingale. Some link linked to then Human Genome Project allowed doctors to 1348 Great Plague were no closer to the real cause Spontaneous Generation. Great Stink of 1858 made identify genetics (hereditary) diseases like God: Although less people believed in God, during the people still think caused disease. Declined after Germ Parkinson's and Alzheimer's. plague, it was blamed on Gods punishment Theory Mapping DNA allows to look for future illness, Miasma Astrology: the alignment of Jupiter and Saturn blamed like spotting genes that may cause breast cancer, Bad air called Miasma causes disease, Spontaneous Generation better prediction! caused by dirt/waste for the 1665 Plague In early 1700s, doctors using microscopes came up People believed the Great Plague was Four Humours: Less people believed it, Sydenham the theory of Spontaneous Generation. Idea that However, no treatment available for genetic caused by miasma that came from the challenged but used with Charles II bacteria was caused by decay and spread. illness yet but can test/prevent Downs Syndrome movement of planets of volcanic in embryo eruptions This was popular up to the 1870s, with doctors like Four Humours Direct Observation Henry Bastion still believing it, despite the Germ Germ Theory Idea by Hippocrates that body Thomas Sydenham encouraged direct observation of Theory proving it wrong. Continued use, but now improved science contained 4 humours (blood, black bile, the sick (in his book observationes medicae), alongside Eventually not believed by 1900 allowed to specific germ using technology yellow bile, phlegm). When humours making notes on symptoms rather than using imbalanced, it made you ill, for example textbooks to diagnose patients. Lifestyle Traditional Ideas Doctors and scientists have now linked impact of nosebleed = too much blood. By 1700, God the four humours, and supernatural are lifestyle on health e.g. STD/Drugs He believed that disease were ’species’ e.g. measles no longer believed Smoking: Link to Lung Cancer found, alongside To medieval people, it made sense and must be categorised to help treatment. (rational) and as it was over 1000 years high blood pressure and asthma old, this traditional idea was respected. Diet: High sugar causing Type 2 diabetes Urine Charts The Germ Theory Idea also supported by the church, who Discoveries into the digestive system meant that In 1861, Louis Pasteur came up with the Germ Theory Diagnosis taught it to physicians at university, so physicians no longer believed urine charts and proved that bacteria in the air caused decay Biggest change in the 20th century was that never challenged. (rotting), this proved Spontaneous Generation wrong. treatment was now based on medical testing, Miasma Contact Also created pasteruisation after his work in the using science/technology e.g. electron Physicians also used Urine Charts, The most common The use of ‘Bills of brewery, used with swan neck flask microscopes from 1931, 10m zoom linked to humours to diagnose illness idea in the period. Mortality’ during the However, Pasteur cant prove it causes disease. Idea more than one cause of disease plague alllowed people to At first Germ Theory not believed and many like This means that diagnosis is incredibly accurate, Summer heat, waste identify that the Plague Henry Bastion rejected the theory, preferring and means treatment can be improve. and dunghills caused could spread between Spontaneous Generation until the 1870s Blood Tests From the 1930s, used to test for ‘vapours’ blamed for people, and their efforts to Supernatural conditions anaemia or deficiencies the Great Plague, quarantine and ban In the 1880s, the Germ Theory was developed by Astrologists blamed stars & planets for 1665. meetings suggest they Biopsy's: A sample of human tissue can be used Robert Koch, who’s experiments (growing and dying illness, for example the movement of understood it was to identify disease e.g. cancer bacteria) proved that specific bacteria caused Mars/Jupiter caused Black Death in Even Thomas contagious, but could not Ultrasound: Using sound waves to look at disease, for example he discovered TB (1882) and 1348. People also superstitious, e.g. Sydenham believed it, yet explain it. children in women or kidney stones Cholera (1883). This was a huge breakthrough, and witches calling it became the basis for identifying bacterial disease we X Ray: From 1890s to spot broken bones ‘atmospheres’ use today. MRI Scans: Magnets & radio wave CT Scans: Advanced X-Rays which can be used to Germ Theory took over 30 years to be accepted, and diagnose tumours and cancer was at the end of the Industrial period, but a major breakthrough and huge impact @mrthorntonteach The Big Picture of ‘Key Individuals’ Over Time Medieval Renaissance Industrial Modern Hippocrates and Galen Thomas Sydenham: the ’English Hippocrates’. James Simpson Paul Ehrlich The ideas of Galen English doctor working in London during 1660s Developed Chloroform in 1847, tested various chemicals on himself and Ehrlich set up a private laboratory and a and Hippocrates (the Book called Observationes Medicae – which was friends until found chloroform useful team of scientists and by 1914 they had Four Humours were used for by doctors for over 200 years. Simpson promoted it and even Queen Victoria gave it her blessing after the Salvarsan 606, the first ‘magic bullet' – A well respected as they Direct Observation: Doctors shouldn’t use books (like birth of her son in 1853. Knighted for his work = chloroform respected chemical mixtures that would target and were over 1000 years Galens) but should observe the sick and make kill specific bacteria, e.g. syphilis old and logical. detailed notes on symptoms to make diagnosis. Edward Jenner Galen had written Argued that the the Four Humours was completely Created first vaccine in 1798 to prevent Smallpox using experimentation using cowpox to inoculate 23 diff people. Alexander Fleming over 300 medical wrong and that diseases were like ’species’ with Took over 50 years to be accepted, government finally supported due to Accidentally discovered Penicillin in books, they were different treatment, but did still believe in Miasma Smallpox outbreak and Germ Theory 1928, the first organic antibiotic after detailed and Pioneered use of Quinine for malaria leaving petri-dishes with bacteria on and illustrated, so doctors then noticed the mould that grew killed believed everything Andreas Vesalius Florence Nightingale: Italian doctor, taught surgery at Padua university Trained as nurse, helped in Crimean war, death rate dropped 40% to 2% the bacteria, he tested a diluted version to be correct. outside of the body and it worked. Carried out dissection, “graverobber” Promoted hospital design changes; sanitation, ventilation, set up wards, To medieval doctors, He wrote a paper on it, but little Huge impact on improved understanding of anatomy tiled floors for cleaning. Used in Birmingham the Four Humours attention paid as Fleming abandoned and proved Galen wrong 300 times e.g. The human Wrote books & opened Nightingale School of Nursing (1860) to train theory worked and work on it from 1931 jaw. Book translated in 4 languages nurses/midwives, made it a respected you could see Fabric of the Human Body (1543) detailed drawings evidence. Joseph Lister Florey and Chain of human body, used in medical training When someone was Developed first antiseptic in 1865 after reading about the Germ Theory and In 1938, two oxford scientists Florey and He encouraged others to challenge Galen/do sneezing, they had believed it, so used scientific methods to create and test it in 11 different Chain developed penicillin and dissections, first UK in 1565, inspired Harvey too much Phlegm. cases, using carbolic acid soaked bandages. Reduced death rate by by 30% in managed to create a pure penicillin The sneezing was the William Harvey surgery, published results but faced criticism, he even stopped using in 1890 which could kill bacteria inside the body body rebalancing its James I’s doctor, Interested in anatomy & blood like septicemia. humours – this made Wrote leading book on blood circulation John Snow They tested it on mice and a man, but sense to them, so Proved Galen was wrong in saying blood ‘burnt up’ Proved that Cholera spread through contaminated water in Soho, used struggled to ‘grow’ enough penicillin, they continued to in the body, it was circulated and reused scientific investigation but could’t prove why (pre Germ Theory) but luckily in 1941 American companies follow it. Proved heart pumped bloody around the body Helped change attitudes to Public Health in Britain and reduce Cholera agreed to mass produce it and the US All medieval training through veins and arteries in one connected system, government provided funding. Edward Chadwick (from the church) used human dissection and experiments Led to the development of penicillin we Government official who completed 1842 report on the living conditions in focused on the work Ideas took 50 years to be accepted and made no use now cities, finding unhealthy conditions, poor diet and overcrowding causing of Hippocrates and impact on medicine at the time disease. Suggested cleaning streets etc. However, still believed in Miasma Galen Eventually work taught in university, long term Crick and Watson Hoped to encourage government to better public health, it did eventually They were taught impact on surgery and blood transfusions In 1953, two scientists Francis Crick and that all they wrote Did public dissections, encouraged others Louis Pasteur James Watson discovered the structure was correct and not French Scientist who created the Germ Theory in 1861, of DNA. They also proved DNA was in to challenge it, The Royal Society Worked with brewery and dairies to develop pasteurization every human cell and was passed down instead to prove how Set up in 1660 and given Royal Charter by Charles II, Used experiments (swan neck flask) to prove spontaneous gen wrong from parents to children through their Galen was right. This encouraged science & printed scientific journal Limited short term impact but inspired Lister and Koch, who proved right! genes, and with Rosalind Franklin they meant these ideas ‘Philosophical transactions’. Contained manages to photograph DNA. were NEVER breakthroughs like e.g. Van Leeuwenhoek seeing of Robert Koch Huge breakthrough that led to challenged. bacteria and Lowers first experimental blood German scientist who proved germs cause disease, Anthrax in 1876 understanding of genetics (mapping of transfusion. Known as ‘father of “bacteriology”: invented growing & staining bacteria genomes) and genetic cause of disease Translated and printed foreign books e.g. Vesalius Helped develop vaccines for TB, Cholera (proved John Snow right) @mrthorntonteach The Big Picture of ‘Treatment and Surgery’ Over Time Medieval Renaissance Industrial Modern Religious: Herbal Remedies New Medicines Antibiotics Many felt only god could cure Exploration of the New World brought new New ‘alternative’ cures began to include electrical Paul Ehrlich develops first Magic Bullet (Salvarsan 606) Prayers, fasting and pilgrimage to herbs/spices like quinine which Sydenham, used to shocks, injection with animal hormones, and a range in 1914 to attack infections in body, used to treat shrines and tombs to touch holy successful cure malaria. However, herbs like of harmful substances including cocaine, mercury, Syphilis. It was a chemical cure made from arsenic, so relics and pray tobacco did nothing but used for all illnesses and creosote. it actually poisoned patients, but he didn’t know! Books used to spread ideas on herbal remedies, Quack remedies remained popular for example ‘Lily Prontosil, the 2 nd Magic Bullet developed in 1932, it Four Humours many such as Mary Doggett's scurvy cure worked as the Pink's medicinal compound’ was tested on mice and humans to cure blood Galen’s ‘Theory of Opposites’ used it contained orange and horseradish. ‘Cure all’ medicines, made in pill form were popular poisoning. Helped post-natal (after giving birth) to treat humour with opposite, Herbal remedies remained inconsistent. but they did nothing to cure illness infection drop from 20% to 5%. Unpopular phlegm= have hot/spicy food Penicillin: First organic antibiotic, wonder drug! Leeching, Cupping (warm glass Alchemy Surgery In 1928, Fleming accidentally discovers penicillin cups on cuts) and bleeding to Alchemy (atrochemistry ) was became a new In 1700s surgery remained similar, the problems of (mouldy petri dishes) and that it kills bacteria but only remove bad blood treatment. The College of Physicians suggested over infection, pain or blood loss remained. Most surgery on the outside of the body Purging with herbs/animal fat to 122 chemicals to treat 2140 illness. was completed in dirty conditions, with the tools and In 1938, Florey and Chain create pure penicillin. make you sick or empty your Antimony and Mercury used to purge illness by clothing never being cleaned. This spread infection America funded production during WW2 and use on bowls to ‘cleanse’ yourself encouraging sweating and sickness, however they Attempts made to use alcohol or opium as an the army (2.3 million doses!) Cold baths used for Black Death did not understand it was poisonous! anaesthetic had been unsuccessful NHS then made it free for all to treat most bacteria Herbal Remedies Transference infections like pneumonia – huge impact on post natal Wise women gave homemade Idea that an illness could be transferred to Considerable progress from mid 1800s infection. Led to new antibiotics remedies that did work e.g. honey something else if you rubbed an object on it e.g.: Anaesthetics But, growth of penicillin resistant bugs e.g. MRSA for infection, mint for stomach Rubbing an onion on warts to transfer the wart Ether trailed but risky and highly flammable Deaths from infectious diseases drop from 25% to 1% In 1847 that James Simpson discovered However, drinking vinegar, eating Four Humours Chloroform. It could make patients unconscious in Drug Treatment crushed minerals, arsenic, This technique remained popular to rid the the Four surgery, even Queen Victoria used it in labour New mass produced medicines such as Aspirin which mercury or even ten-year-old Humours, even King Charles II was bled and purged. Chloroform now allowed doctors to perform deeper was now used as a painkiller and fevers treacle was used for the Black Rhubarb was used to purge the bowels during the and more complex surgery (e.g. First heart surgery Pills that dissolve in stomach, insulin pumps and Death Great Plague but it just weakened patients. 1896) and solved the issues of pain. injections of medicine. New custom drugs However, Chloroform had risks, overdoses were Supernatural Religious Modern Treatment common, 1850-1870 called the ‘Surgery Black Rubbing onions, herbs or a People still believed God cured disease, 92,000 Science & technology huge improved treatment Period’ as many patients died e.g. Hannah Greener chopped up snake on the boils or touched Charles II hand to cure scrofula. Blood Transfusions from 1900, using in WW1 Antiseptics rubbing a chickens bottom on the Many still prayed in Great Plague Machines: Dialysis for kidneys, pacemakers In 1865 Joseph Lister, an English surgeon who buboes for the Black Death. X Rays: Radiotherapy to target cancer tumours Barber surgeons trepanned skulls Supernatural studied the Germ Theory developed Carbolic Acid Robotics: 3D printed prosthetic limbs to remove ‘demons’ The New London Dispensary suggested magic to spray as an antiseptic. A huge breakthrough cure malaria ‘cut off hair, feed to birds in an egg and In trials, antiseptics helped reduce deaths in Surgery put inside a tree’. During the Great Plague, magical amputations by 15% Anaesthetics: From the 1930s, injected into the blood Surgery charms continued to be used However, Carbolic Acid damaged hands of doctors stream with precise dose & safer surgery. Barber surgeons used trepanning and others didn’t believe GT so didn't use Keyhole Surgery: Tiny cameras and minute to remove demons from skulls, Surgery instruments to operate = quicker healing and less Led to Aseptic Surgery: clean equipment and basic antiseptic like honey, Little change, surgery remained dangerous with impact on the human body. operating theatres. From 1887 all instruments were experienced in times but high high rates and no way to stop infection, pain or steam cleaned and sterilised Microsurgery: Allows tiny nerve endings and blood chance of death due to dirty tools, blood loss. Only improvement was in anatomical vessels can now be reattached after surgery. Led to high risk of infection and no knowledge, but little impact on key issues. Surgeons first kidney transplant was in 1956, and heart began to train themselve and get more experience Blood loss remained the key issue by 1900 anatomical knowledge transplant in 1967. @mrthorntonteach The Big Picture of ‘Prevention and Public Health’ Over Time Medieval Renaissance Industrial Modern Supernatural ‘Regimin Sanitis’ and Moderation Vaccinations NHS To prevent diseases some wore amulets charms) This idea continued, and combined with new In the 18th century smallpox was a serious epidemic The NHS encouraged healthy living, administers and bought incantations ( to provide protection he idea of moderation spread, avoiding As a result, doctors like Thomas Dimsdale began to inoculate people vaccinations and uses checkups and modern from spirits. exhaustion, fatty foods, drinking too much or who wpuld pay (making inoculators rich!) This risky method technology to hep prevent or catch diseases like cancer People also based their treatments on the zodiac being too lazy. involved rubbing put from a smallpox scab into an open cut. Results early. NHS provides free health check over 40 and they charts were mixed, some died communicate risks like Ebola in 2014 The work of Edward Jenner Religious Avoidance Jenner, a doctor in Gloucester, noticed that milkmaids who caught DNA Many people thought ONLY God could cure To many, avoiding disease like the Great cowpox did not get smallpox, so trailed infecting James Phipps with Doctors can now screen for genetic diseases and or diseases so they aimed to prevent it first. Plague remained a popular opinion and many cowpox, he did not get smallpox! He tried it a futher20 times, each those with hereditary traits such as breast cancer. Flagellants whipped began to identify that the Plague was time his vaccination worked. They can then be offered a masectomy to remove themselves to beg God for forgiveness during contagious (but could not explain why!) In 1798 he wrote up his findings but he did now know how to the tissue to prevent cancer the Black Death People can to avoid bath houses as they linked explain it, but little support, so he set up Royal Jennerian Society to Simply, parents can be offered an abortion for People fasted, made offerings to God and lit it with the spread of syphilis do himself embryos which highlight early signs of Downs candles to show they were sorry for their sins Short Term Impact Syndrome. Many people simply followed Preventing Miasma Smallpox vaccine saved many, 100,000 people by 1800 a Christian lifestyle; praying, going to church and As this was the most common idea on the Slow use at first due to opposition from inoculators, church and Vaccinations following the commandments. The King ordered cause, more was done to prevent it: slow government support, not compulsory in 1840s Government support for vaccinations grew in 100s with religious service during the Black Death Removing sewage, draining bogs and Long Term new vaccines, led to first national vaccination campaign cleaning up rubbish from the streets. Jenner inspired Pasteur and Koch to search for more vaccines but for Diphtheria 1942 and Polio eradicated by 1984 due ‘Regimin Sanitis’ During the Great Plague Tar and herbs were Rich could pay physicians health regime to no new vaccines until 1900s to compulsory vaccinations. burnt in the streets Led to eventual government enforcement of vaccinations from Key vaccinations have been introduced ever since, such prevent disease During the Great Plague smoking tobacco 1871 after a smallpox epidemic in 1860s and smallpox was wiped as: This included; avoiding stress, exercising, eating a was encouraged to ward off miasma and out smallpox by the 1970s! Tenatus, 1961 healthy diet and bathing regularly Carrying a pomander (a ball of stuffed Measles, 1968 perfumed items) to ward away the miasma Cholera, 1854 Rubella , 1970 (targets unborn children) Cholera epidemics common in 1830s-50s : blamed on The government has also introduce vaccines Preventing Miasma Superstition Miasma/Spontaneous Gen but John Snow identified it was like HPV, which protects women against an People attempted to solve miasma by removing Your birth was blamed for later issues contaminated water through testing around Brad Sdtreet pump STI than can cause cervical cancer the bad air. The idea of avoiding areas with disease and Impact Helped reduce deaths in Soho but little immediate impact as Concern in 2000 over anti vaccine movements People carried sweet smelling herbs and lit fires checking the weather to do this before the Germ Theory, so not believed but long term changes: to overpower the bad air sewage system built by John Bazalegtte in late 1850s, and helped Public Health Lifestyle Campaigns Others rang bells to keep the air moving away lead to 2nd Public Health Act Government remained reactive not proactive Understanding of causes led to specific campaigns, from them. to public health but did more during the Great Advertising campaigns which warned against the Public Health The rich could visit bath houses and hung sweet Plague Public Health in the 1700s dangers or smoking, binge drinking, drug use and herbs in their houses Public meetings, fairs and large funerals were Government was Laissez Faire, felt not their concern to improve unprotected sex. banned whilst theatres were closed public health, so towns and cities were filthy sand overcrowded, ’Stoptober’ to encourage people to not smoke for a Public Health month Government was reactive not proactive to public Barrels of tar or sweet smelling herbs were causing epidemics like Smallpox and Cholera to spread burnt on newly cleaned streets to drive away In 1842, official Edwin Chadwick completes a report that states the ‘Sugar Smart’ and ‘5 a day’ aims to encourage health, the king/government only spent during eating well and moving more. the Black Death. the miasma living conditions in British cities is causing sickness The government introduced ‘quarantine’ to stop Over 40,000 dogs and 20,000 cats were 1948 Public Health Act Government Acts people moving around so much, whilst victims slaughtered as they were blamed for spreading The aim was to improve sanitary condition within towns however More laws to improve public health were stopped from leaving their houses. The the disease as it was not compulsory an pre germ theory, many local councils Clean Air Act of 1956 and 1968 This was passed due hospitals would not accept sufferers either did nothing and public health did not improve. to bad smog (heavy fog pollution) In London caused The mayor appointed searchers and wardens 1875, 2nd Public Health Act King Edward ordered the cleaning of the streets, looking for those with the disease. Households by burning coal. Reducing pollution to remove Miasma and by 1370 there were 12 Work of John Snow, Germ Theory, Cholera outbreaks and Great The law aimed to reduce air pollution with it were marked with a red cross and ‘Lord Stink of 1858 helped government end Laissez Faire view rakers on the streets of London have mercy upon us’ written on it. They were Smoking ban inside all public buildings, 2007, Tax on Some cities like London made few Local government had to improve public health; sewers (1,3000 Tobacco, no advertisement on cigarettes quarantined for 28 days, and the dead were miles built in London), clean water, public toilers, public health improvements, but overall cities were filthy and collected daily Limiting car emissions (taxing cars that cause more helped spread disease. officers. Biggest government act ever pollution) @mrthorntonteach British Medicine Through Time: Care and Hospitals Medieval Renaissance Industrial Modern Hospitals Hospitals Hospitals Care & Hospitals First hospital called St Bartholomews Early Renaissance Early 1700s The 1911, National Insurance Act did in 1123 and over 500 hospitals by A patient could expect: Still few hospitals, but they did provide treatment provide help for workers who fell ill but it 1400 1. A good diet of healthy foods Hospitals were poor designed and remained unhygienic as was a long way from including all the Almost all ran by the church, 2. A visit from a physician who would they still did not understand germs cause disease population such as the elderly, families or connecting to monasteries and ran observe and suggest treatment Work of Florence Nightingale unemployed by monks/nuns but had no training, 3. Medication, rom the hospital apothecary Nurse who trialled methods in Crimean war and made 1942 Beveridge Report that said treatment relied on God Dissolution of the Monasteries impact on deaths (-31% in the hospital) and brought back should be available to the rich and the poor. Treatment: offered ‘care not cure’ Henry VIII closed monasteries from 1536- ideas to England, wrote ‘Notes on Hospitals’ The NHS set up 1948 huge change, as thought thought God would cure 40, with it taking away almost alll Nightingale feltt hospital conditions needed improving, and essentially free health care for all people your instead they prayed for you hospitals made the following suggestions regardless of background, paid for by taxes Hospitals were clean, provided good By 1700 only 5 hospitals left in England, Ventilation: Fresh clean air in wards, as she still believed in At first, lack of money, hospitals and GP food and you had to share a bed with including St Bartholomew's miasma quality and waiting times but improvements a fellow patient Changes Sanitation: Clean water, sewage systems and toilets GP’s Charter 1966 to improve GPs and Only accepted old, poor and Specialist hospitals grew that focused on Supplies: Fresh food & clean clothing encourage research, Quality Care travellers and turned away those one disease such as the plague and smalpox She promoted pavilion plan hospitals with large Commission to monitor hospitals and more with diseases. e.g. Pest and Pox houses rooms, more windows, tiled floors for easy cleaning hospitals built, even specialists like Alder and isolation wards for infectious patients, the first was a Hey for children. NHS played huge part in Care Care hospital in Birmingham life expectancy growing to 83 due to free Majority of people care for at home Most sick people continued to be cared for Development of Hospitals care and medical developments by women at home or in the local community as New hospitals opened by charities, small Cottage hospitals The NHS is now responsible for over 2500 physicians remained too expensive with nurses & doctors from 1859. hospitals and GPs surgeries in the UK hospitals cleaner (Aseptic) due to Germ Theory. Old, Sick or Issues today: Rising costs, waiting times, Carers & Doctors Carers & Doctors Poor still had to visit workhouses but eventually infirmaries increasing lifestyle problems Physicians: trained by church at Women continued to play an important role opened for the poor. Specialist hospitals for mentally sick university, no anatomical knowledge in the care of the sick (Asylums) as dissection was banned. Took Apothecaries and Surgeons: still not given Rich could pay doctors to visit at home. observation and diagnosed any university training and considered Care Apothecaries: Chemists who made inferior to physicians. They remained a Care NHS now provides free healthcare to all herbal remedies, experienced but no cheaper alternative to doctors. Rich continued pay doctors to visit at home whilst poor still regardless of background, paid for by taxes training Physicians: Continued to be trained at struggled to get free healthcare Wise Woman: Local woman with university's but new subjects such as Carers & Doctors medical skills such as midwifery & anatomy due to discoveries by Vesalius, Training – Nurses have developed specialist Carers & Doctors skills in the care of patients, some can now making remedies Harvery and Sydenham. Slowly dissections Florence Nightingale: Wrote ‘Notes on Nursing’ and opened Hospitals: First in 1123, ran by the allowed from late 1500s in England, which prescribe medicine. Royal College of Nursing to train nurses/midwives. This was Doctors: the GPs Charter, 1966 – This gave church. Offered ‘care not cure’ , led to improvements. significant as previously nurses were untrained working class thought God would do it. Turned Surgeons: Remained filthy, untrained but incentives to GP’s who kept up with medical women, whereas it became a respected profession research and encouraged GP’s to work in away those with diseases. skilled. Apothecaries were now known as Pharmacies, the most Barber Surgeons: practices together famous being Boots opening in 1849, whilst quack doctors selling ‘cure all’ pill continued Surgeons: Huge improvement due to antiseptics, anaesthetics and aseptic surgery. @mrthorntonteach The Big Picture of ‘Western Front Medicine’ WW1 & Conditions Injuries Care Treatments Key Battles Trench Foot Royal Army Medical Core (RAMC) Mobile X Ray Units Ypres, Hill 60, 1914: First use of Major problem caused by standing in water logged Responsible for medical care, it organised 6 Mobile vans were used throughout the British sector of the mines dug under German positions trenches with no change of boots/socks. Feet would and provided medical treatment. In 1914, Western Front to identify bullets/shrapnel to blow them up swell, go numb, quickly led to gangrene and there were 9000 men, by 1918 113,000 There were a number of weaknesses such as timing, poor quality, Second Battle of Ypres, 1915 amputation In winter of 1914-15, the 27th Division of who were doctors, stretcher bearers etc. overheating, could only be used 3 times an hour First use of Chlorine Gas by the British army experienced 12,000 cases Germans. British unprepared, Solution: Soldiers ordered to carry 3 pairs of socks Blood Transfusions First Aid Nursing Yeomanry (FANY) 1915, first blood transfusions at base hospital, human to human cotton pads until gas masks and change them twice a day and rub whale oil into Women's voluntary organisation to go 1915, Lewisohn added Sodium Citrate so blood could be stored Battle of the Somme, 1916 their feet. Efforts made to pump out trenches front. First 6 women went in 1914, Keynes created a portable blood transfusion kit that could store Largest British battle in WW1, eventually 500. FANY help by driving blood and be used on the front line, helped reduce shock 400,000 causalities for British Gas ambulances, delivering supplies to the By 1917 blood transfusion stations at CCS, massively helped First tanks & creeping barrage Gas caused great panic, but only killed 6000 soldiers frontline and setting up a mobile bath 1917, first blood bank at Cambrai, 22 units of blood saved 11 lives Battle of Arras, 1917 Chlorine: Ypres 1915 Caused death by suffocation. units (Bathed 40 men an hour) – blood transfusions began to have a huge impact. British build tunnels for bases and Before gas masks, so soldiers soak cotton pads in also Arras Underground Hospital, urine and put to their faces. Led to introduction of The Chain of Evacuation Thomas Splint with 700 beds. gas masks Regimental Aid Post :Within 300m of In 1914 men with thigh wound, small chance of survival (20%)., the Battle of Cambrai, 1918 Phosgene 1915 Used at Ypres. Faster acting than front line, gave immediate first aid but existing splint made things worse, due to terrain and type First tank battle, 450 used chlorine, killed exposed person in 2 days. basic Aim to send men back to front line, In 1915 Thomas split invented, kept the leg straight so the bone Conditions Mustard Gas 1917 Odourless gas. Caused internal or onto the ADS healed in the correct position, survival rates increased 20-80%. The constant bombing and shelling and external blisters/burns through clothes Advanced Dressing Station: Within 400m ruined landscape. Evacuation tough. of RAP, in a tent or shelter, could deal Stretcher Bearers 4 man stretcher Shell Shock with 150 men. Medical officers but no Brain Surgery bearers Carried the wounded during Symptoms included tiredness, nightmares, loss of surgery, overwhelmed at Ypres Injuries to the brain were almost always fatal in WW1 due to a lack day and night, often under enemy speech, uncontrollable shaking and complete Causality Clearing Station 7 miles from of experience/infection. Harvey Cushing pioneer new ideas fire in poor conditions mental breakdown. It is estimated 80,000 British the front on railway line, contained Development of magnets to withdraw metal fragments Horse Ambulance: Often made troops experienced shellshock. Condition not doctors and operating theatres, x ray Local Anaesthetic to avoid brain swelling in surgery patients worse due to shaky journey, understood, some accused of cowardice, others machines and could deal with 1000 men Chain of Evacuation sent on head injuries to CCS quickly often killed treated in Britain Treated critical injuries and assess Specialist base hospitals such as Mendingham for brain injury Ambulance Cars Shortage at the wounded; send back to front or to base Trench Fever Plastic Surgery start of war. Red Cross raised money hospital Flu-like symptoms with high temperature, headache Harold Giles pioneered plastic surgery in WW1 for 512. Hard to drive on destroyed Base Hospitals Near ports in and aching muscles. It affected 500,000 men on Set up specialist Queens Hospital in Kent, 1917 roads. France/Belgium, large hospitals with all Western Front. Only by 1918 had its cause been Using skin grafts (taking skin from to graft to another area) Trains/Canals: Used transport equipment and some specialist ones for tracked down to lice (a parasitic insect). After this Using jaw splints, wiring and metal replacement cheeks wounded to base hospitals gas/head injuries Could treaty 2500 delousing stations were set up and cases declined. By 1915, 7 specialist hospitals in France 12,000 operations done Arras: Underground hospital built 1916 Trenches New Injuries 700 beds, operating theatre, water Gas Gangrene Not all trenches same across front Artillery shells and shrapnel caused 58% of wounds supply. Dressing station close to fighting Infections caused by gas gangrene & no aseptic surgery on front Frontline: Where attacks were made with 60% of these injuries were to arms and legs Amputation: If antibiotics/excisions failed to stop the spread of Progress up to 1914 from, most dangerous area Bullets were responsible for 39% of wounds. infection, amputation only way. By 1918 over 240,000 men Wound X-rays: Discovered by Wilhelm Roentgen Support: 80m behind, to retreat Gas Gangrene from bacteria in soil, could not be excision or debridement :This was cutting away the dead, in 1901, but not portable yet and slow. Reserve: 100m back, counterattacks cured, spread rapidly and led to amputations. damaged and infected tissue from around the wound to reduce Blood Transfusions: Blood groups Communications: Linked trenches Tetanus vaccines infection. discovered in 1901, couldn't store blood Duckboard: to prevent trench foot Brodie Helmet (1915) = 80% reduction in deaths by The Carrel-Dakin method: Sterilised salt solution pumped into Aseptic Surgery: Germs Theory led to Parapet: low protective wall head injury. 20% of injuries to head and face. wound through a tube. Only lasted 6 hours, not enough of it and more hygienic surgery, hard on frontline Dugout: Hole in trench for cover had to be ready made, by 1917 was the most effective method.