medicine through time 1250-present Flashcards
1
Q
what did the church teach about the cause of disease?
A
the church taught, and people believed, that God made them ill because He was either displeased with them or was testing their faith
this belief and trust in ancient medical practices, held back medical research and meant that few new ideas about the causes of disease appeared in medieval times
2
Q
how did the church control ideas?
A
- most of what ordinary people learned was taught by the church and the church was also the centre of formal learning since it set up and ran universities where physicians were trained
- unlike most people, monks and priests could read and write; most large collections of books were in monasteries which meant they had a lot of influence over what books were written and read
- the church approved of traditional explanations of disease so Galen’s ideas were promoted since they fit with Christian beliefs
- dissections were normally performed at universities but were uncommon; however if what was found contradicted Galen’s theories then it might be ignored so knowledge of anatomy didn’t advance much
- the church taught that people should follow Jesus’ example and care for the sick so many hospitals were housed in monasteries and nunneries
3
Q
what was the four humours theory?
A
The Ancient Greeks thought everyone had a mix of four humours in their body; they believed people became ill when this mix was unbalanced, so to make people better they tried to put this balance right
4
Q
what were the four humours?
A
- blood
- phlegm
- black bile
- yellow bile
5
Q
what was the theory of opposites?
A
in the 2nd century AD, Galen developed the four humours theory further
besides bleeding and purging to get rid of excess humours, treatment based on his theory of opposites aimed to balance the humours by giving the patient the ‘opposite’ of their symptoms e.g. if you had phlegm (linked to water and cold) you should eat hot peppers
6
Q
who was Galen?
A
- Claudius Galen was a Greek doctor who worked in Ancient Rome, he wrote lots of books and his ideas were the basis of medical training in the Middle Ages; he developed Hippocrates’ ideas and mainly used bloodletting, or purging, to prevent and treat illness and his own treatments based on his theory of opposites
- he drew detailed diagrams of human anatomy using knowledge he gained from operating on wounded gladiators and carrying dissections out on (mostly animals’) dead bodies
7
Q
who was Hippocrates?
A
- Hippocrates was an Ancient Greek doctor who’s ideas and books were very influential well into medieval times and beyond
- he dismissed the idea that gods caused disease, he believed there was a physical reason for illness and it needed a physical cure
- most of his treatments were based on diet, exercise and rest but he also used bleeding and purging to get rid of excess humours
- he wrote the Hippocratic oath, where doctors swore to respect life and prevent harm
- his method of clinical observation (studying symptoms, making notes, comparing with similar cases, then diagnosing and treating) is the basis of the approach used today
8
Q
what is miasma?
A
- ‘bad air’
- this related to God because bad smells indicated sin
- the theory originated in. the Ancient world but continued into the Middle Ages and well into the 19th century
9
Q
what were some rational treatments in connection with the Four Humours?
A
- bloodletting was most common; carried out by cutting a vein, leeches or cupping; different points were used for different illnesses
- purging was also used; it involved making a patient vomit or go to the toilet to remove food from the body, emetics and laxatives were mixed by apothecaries, wise women or at the patient’s home
10
Q
what were some religious and supernatural methods to prevent illness?
A
- living a christian life
- carrying lucky charms or amulets
- self-punishment
- chanting incantations
11
Q
what were some rational methods to prevent illness?
A
- trying to keep streets clean
- bathing and washing
- exercising
- not overeating
- bleeding and purging
- purifying the air
12
Q
what were some religious treatments?
A
- praying
- fasting
- going on pilgrimage
- paying for a special Mass to be said
13
Q
what were some traditional remedies?
A
the most common remedies were traditional ones made with herbs, which were drunk, sniffed or bathed in; remedies also included different foods to rebalance the humours and ointments to apply to the skin
14
Q
what were some supernatural treatments?
A
treatments included specific ideas for certain illnesses e.g. hanging a magpie’s beak around your neck to cure toothache
15
Q
who treated the sick?
A
- barber surgeons
- no training
- carried out bloodletting, pulling teeth and lancing boils
- did basic surgery like amputations
- cost less than a physician - apothecaries
- received training but no medical qualifications
- mixed medicines and ointments based on own knowledge or directions of a physician
- cost less than a physician - physicians
- medically trained at university and passed exams
- diagnosed illnesses and gave treatments , or sent patients to the apothecary or barber-surgeon
- expensive
- very few of them and almost no women - care in the home
- most ill people throughout this period were treated at home by a female family member
- the village ‘wise woman’ would also tend to people in their homes for free
16
Q
what did physicians do?
A
- usually, physicians observed a patient’s symptoms and checked their pulse, skin colour and urine
- they consulted urine charts in their vademecum
- they consulted zodiac charts to help diagnose the illness and to work out the best time to treat the patient
- they sometimes treat the patient themselves or sent them to a barber-surgeon or apothecary
17
Q
features of hospitals
A
- many hospitals were places where travellers and pilgrims stayed on their journeys
- the number increased during the Middle Ages
- many were run by the Church, so the emphasis was on God and healing souls
- usually people with infectious diseases or incurable conditions were not admitted
- patients and their surroundings were kept very clean
- hospitals were places of recuperation rather than treatment
- patients were given fresh food and plenty of rest
- some hospitals were built for specific infectious diseases
18
Q
when was the Black Death?
A
1348-49
19
Q
what was the Black Death?
A
most modern historians think it was the bubonic plague, carried by fleas living on black rats, which brought the disease to different countries on trading ships and passed to humans when an infected flea bites them and the disease enters their blood
20
Q
how did people think the Black Death was caused?
A
- religion
- God sent the plague as a punishment for people’s sins - astrology
- the position of Mars, Jupiter and Saturn was unusual at this time - miasma
- bad air or smells caused by decaying rubbish - volcanoes
- poisonous gases from European volcanoes and earthquakes carried in the air - Four Humours
- most physicians believed that disease was caused by an imbalance in the four humours - outsiders
- strangers or witches had caused the disease
21
Q
how did people try to avoid catching the Black Death?
A
- praying and fasting
- clearing up rubbish in the streets
- smelling their toilets or other bad smells (belief that this would overcome the plague)
- lighting a fire in the room, ringing bells or having birds flying around to keep air moving
- carrying herbs and spices
- not letting unknown people enter the town or village
22
Q
what were some symptoms of the Black Death?
A
- swelling of the lymph glands into large lumps filled with pus (known as buboes)
- fever and chills
- headache
- vomiting, diarrhoea and abdominal pain
23
Q
what were some treatments for the Black Death?
A
- praying and holding lucky charms
- cutting open buboes to drain the pus
- holding bread against the buboes, then burying it in the ground
- eating cool things and taking cold baths
24
Q
how did ideas on causes of disease change in the Renaissance period?
A
gradually, throughout the Renaissance period, fewer people believed in supernatural or religious causes of disease; various new rational explanations for disease were suggested, such as seeds in the air spreading disease
25
what was a major change in the Renaissance period?
the decline in the influence of the church, and with it the focus on God as a cause of illness; there was a shift to a more scientific approach to diagnosing illness
26
what are some examples in continuity of ideas into the Renaissance period?
- the theory of miasma continued to be believed by many to be the cause of disease; it was particularly popular theory during epidemics
- the theory of the four humours continued to be an accepted explanation for disease although by 1700 very few physicians still believed in it
27
how did the work of physicians and scientists change?
- as fewer popes believed that astrology caused disease, physicians stopped using astrology charts for diagnosis and timing treatment
- due to improved knowledge of digestion, physicians realised that urine was not a good indicator of disease and stopped using urine charts for diagnosis
- physicians carried out more direct observations and examinations of their patients, rather than relying the patient explaining their symptoms
28
who was Thomas Sydenham?
(the English Hippocrates)
Sydenham worked as a doctor in London during the 1660s and 70s, his book Observations Medicae (1676) outlined his theories and observations
- he didn't rely on medical books when making a diagnosis, but observed patients and recorded symptoms in detail
- he was instrumental in the 'new' idea that a disease had nothing to do with the nature of the person who had it
- he based treatment on the disease as a whole and didn't treat individual symptoms
29
when was the printing press invented?
1440
30
how did the development of the printing press change the transmission of ideas?
- it meant that many exact copies of texts could be produced in a short amount of time
- it helped reduce the church's control of ideas, as it could no longer prevent the publication of ideas it didn't approve of
- the books, and therefore the ideas and discoveries of scientists and doctors contained within those books, could be shared more effectively and much faster across a wider area
31
why was the Royal Society formed?
the Royal Society aimed to further scientific understanding by carrying out and recording the results of experiments, sharing scientific knowledge and encouraging new theories and ideas; it also sponsored scientists to enable them to carry out research
32
when did the Royal Society begin to publish their journal?
(Philosophical Transactions)
1665
33
what was good about Philosophical Transactions?
scientists could share their work and ideas which helped theories to be confirmed or dismissed and news of findings could be spread more quickly
34
what did King Charles II do for the Royal Society?
he granted a Royal Charter to the society which helped it to gain credibility
35
what happened to hospitals during the Early Modern period?
1. by 1500, hospitals were treating more sick peopled were being used less by travellers and pilgrims since most had their own apothecary to mix medicines and physicians frequently visited patients
2. in 1536, the dissolution of the monasteries in England by Henry VIII caused most hospitals to close
3. some free, charity-funded hospitals were set up but it wasn't until well into the 1700s that the number of hospitals returned to pre-dissolution levels
4.more pest houses began to appear, where people suffering suffering from a particular contagious disease could goo for care
5. when hospitals did re-appear, they were running by physicians focused on treating the sick rather than by religion
36
which treatments and preventions continued into the Early Modern period?
- traditional herbal remedies
- bleeding and purging
- healthy living
- superstitions and prayer
- cleanliness
37
what changes in prevention and treatments were there in the Early Modern period?
- more emphasis on removing miasma through draining swamps and removing sewage and rubbish
- people regularly change their clothes to keep clean rather than just bathing
- new herbal remedies from newly discovered countries appeared in England, some were effective
- the theory off transference led people to try and rub objects on themselves to transfer the disease to the object
- alchemy caused chemical cures using metals or minerals to become popular
38
why did the improved knowledge and discoveries of the Renaissance have a limited impact?
- the ideas were slow to be accepted
- they had no direct use in improving treatment or preventing disease
- their discoveries did not improve understanding of the cause of disease
39
what continuity was there during the Renaissance in the training of apothecaries and surgeons?
- they still didn't get university training
- still considered inferior to physicians
- still cheaper
40
what change was there in the training for apothecaries and surgeons?
- both were better trained through being in guild systems, where they were apprentices, then journeymen, before becoming masters
- a licence was now needed to work as an apothecary or surgeon and these were only issued after completing training
41
what continuity was there in the training of physicians?
- they were still trained at universities
- training was still based on textbooks rather than practical experience
42
what change was there in training for physicians?
- there was better access to a wider variety of medical books and detailed drawings (printing press)
- new ideas about anatomy (led by Vesalius) and causes of disease inspired some physicians to become more practical and experimental
- dissection as legalised but took time to become common
43
who was Vesalius?
Andreas Vesalius studied medicine in Paris in 1533 and became a professor of surgery is Padue (Italy); he carried out a large number of dissections on human bodies and made many discoveries about how the body worked
44
why was Vesalius important?
- he improved understanding of the human body
- he made the study of anatomy fashionable and it became central to the study of medicine
- the proved some of Galen's work wrong so others began to question Galen's theories
- he encouraged dissections and inspired further discovery
- his work was published through Europe and included detailed illustrations of the human body, which were copied into other medical textbooks
45
when was the Great Plague?
1665
46
what were people's beliefs about the causes of the Great Plague?
- miasma was by far the most commonly believed cause
- far fewer people believed it was caused by an imbalance in the Four Humours
- people knew that disease could be passed from person to person
47
what treatments were used for the Great Plague?
many were similar to those used for the Black Death, some new ones were:
- the theory of transference caused people to try to 'transfer' the disease to something else, especially birds e.g. chickens
- it was thought that people could sweat the disease out, so sufferers were wrapped up in thick blankets and put by a fire
48
what government action was taken to try and stop the plague from spreading?
- theatres were closed and large gatherings were banned
- dogs and cats were killed
- streets were regularly cleaned
- barrels of tar were burned in the streets
- every day, carts collected the dead and they were buried in mass graves
- a household was boarded into its home for 40 days or taken to the pest house if a member caught the plague
- days of fasting and public prayers were ordered
49
what did plague doctors do to prevent them catching the disease?
they wore costumes
- masks which included sweet-smelling herbs to ward off miasma
- cloak which was waxed so that nothing from the patient could be absorbed into it
- the masks was in the shape of a bird's beak as birds were believed to attract disease so the hope was that it would cause the plague to leave the patient
50
who was William Harvey?
- he studied medicine at Cambridge, then Padua and later became a lecturer of anatomy in London at the College of Physicians
- he was one of James I's doctors
- he discovered the process of blood circulation
51
what did Harvey publish his findings in?
(including detailed diagrams)
in An Anatomical Account of the Motion of the Heart and Blood in Animals in 1628
52
how did Harvey discover the circulation of blood?
- he researched Vesalius' theory that blood flowed towards the heart, which contradicted Galen's theory; he proved Vesalius was right using dissected bodies and pumps that showed blood only flowed one way
- he then proved that blood could not be produced by the liver and absorbed into the body, as Galen had thought
- he was influenced by new technology, such as mechanical water pumps, which made him think the human body worked in the same way
- he discovered that arteries and veins were part of one system and that blood was pumped around the body by the heart
53
why was Harvey important?
- he disproved some of Galen's theories, which brought his other theories into question
- he improved knowledge about how the body worked and passed this knowledge on
- by 1700 his work was being taught in medical schools
- as a royal physician, his work gained publicity and credibility (inspiring others to find out more)
- his scientific method of observation and use of dissection had brought results, and so were copied by others
- his discoveries left many unanswered questions, encouraging further experiments
54
how was there continuity in theory of causes of disease into the 18th and 19th century?
there were few new ideas about the cause of disease in the 18th century, though some scientists thought that germs were produced by decaying matter - this was called spontaneous generation; most people still thought miasma was a cause of disease, but this was becoming a less popular theory than it was in the Renaissance
55
how did microscopes develop in the 18th and 19th century?
by 1700, microscopes had developed so that cloudy images of what would become known as bacteria or germs could be seen; by 1850, microscopes had further improved so that extremely tiny images could be seen clearly, this was essential in enabling the scientific breakthroughs of the later 19th century
56
what did Louis Pasteur do?
in 1861, Louis Pasteur published his Germ Theory, which showed that spontaneous generation was incorrect; he proved that microbes in the air cause decay (which he discovered when investigating why liquids turn sour for the brewing industry) and this caused him to theorise that germs also caused disease, though he couldn't prove this
57
what did Robert Koch do?
- Robert Koch read Pasteur's work and began to study microbes himself; he proved that Pasteur's theory was right and that microbes caused disease as well as decay, he even identified the specific microbes which caused TB in 1882 and cholera in 1883
- Koch developed a new, easier way of growing bacteria on agar jelly and he discovered that chemical dyes stained bacteria (which makes them easier to see under a microscope)
58
what was the influence of Pasteur and Koch?
- Pasteur's Germ Theory had little impact on medicine in Britain to begin with since he wasn't a doctor and his work focussed more on food and drink than disease; most doctors believed in spontaneous generation, but there were some (like Joseph Lister) who mad the link between microbes and disease
- Koch's work had more of an impact in Britain than Pasteur's had and he inspired others to research other microbes... but it took time for most doctors and the British government to accept Germ Theory of disease
- even though the real cause of many diseases had been discovered, it didn't yet have an impact on their medical treatment and prevention
59
what did Florence Nightingale do?
1. nursing wasn't seen as a respectable job for women and there was little training
2. Florence Nightingale attended the first nurses' training school in Kaiserwerth hospital, Germany
3. she was asked to lead a team of nurses at the military hospital in Scutari during the Crimean War (1854-56)
4. she believed that miasma caused disease, so emphasised hygiene, fresh air, good supplies and training for nurses; her approach greatly improved conditions in the hospital
5. her work was widely reported in newspapers in Britain; she published books on nursing and hospital organisation and set up a training school for nurses/midwives
60
how did hospital care change?
- new hospitals (financed by charities and local councils) opened during the 19th century to look after the sick
- first cottage hospital (small buildings where nurses gave care and GPs prescribed to create a home treatment) opened in 1859
- middle and upper classes could afford doctors to treat them at home
- due to the work of reformers like Florence Nightingale , hospital cleanliness and organisation improved, and nurses were better trained
- Pasteur's 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
- most hospitals tried to create a home atmosphere, parents and visitors had to help nurses look after the patients
- public pressure led to infirmaries (separate from workhouses) being set up for the poorest in society
- specialist hospitals (such as asylums for the mentally ill and fever houses for infectious diseases) developed
61
what were the three main problems that made surgery so dangerous?
1. blood loss
2. pain
3. infection
62
what was used as anaesthetic before 1800?
alcohol and opium had little success in easing pain during operations
63
when was laughing gas used as anaesthetic?
laughing gas was used in 1944 in dentistry in the USA but it failed to ease all the pain and patients remained conscious
64
when was ether used as anaesthetic?
ether was used from 1846 and made patients totally unconscious and lasted a long time; however it could make patients cough during surgery and sick afterwards, whilst also being highly flammable and transported in heavy glass bottles
65
when was chloroform used as anaesthetic?
chloroform was used from 1847 and was very effective with few side effects but the dosage had to be managed carefully since it could kill someone due to the effect on the heart (an inhaler helped to regulate the dose)
66
who discovered chloroform?
James Simpson
67
when was cocaine used as anaesthetic?
cocaine was used as the first local anaesthetic in 1884; in 1905 a less addictive version (novocaine) was used as a general anaesthetic
68
why was there opposition to the use of anaesthetics?
- people worried about the long-term effects of using anaesthetics and thought that being unconscious made patients more likely to die
- the Victorians were very religious and thought that God inflicted pain for a reason, so it was wrong to interfere with His plan
- it also took a long time for doctors and surgeons to believe in the Germ Theory and therefore to accept Lister's discoveries
69
who was Joseph Lister?
Lister was a surgeon who worked at Glasgow Royal Infirmary
70
what was the timeline for the development of antiseptics?
1861- 50% of patients in surgery die from post op infections; Lister starts work as a surgeon
1864- Lister reads Germ Theory and learns that carbolic acid 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 and he publishes his ideas
1877- Lister becomes Professor of Surgery at King's College Hospital, London
71
how did aseptic surgery develop?
Lister's work inspired others to search for methods to prevent the spread of infection in hospitals; by 1900, operating theatres and wards were thoroughly cleaned using aseptic techniques, and surgeons and nurses wore sterilised clothing and used sterilised instruments
72
what was the impact of anaesthetics and antiseptics?
surgery became pain free and patients didn't struggle, so surgeons could take more time and be more careful; deeper, more complex surgery became possible and the death rate dramatically decreased as surgery was more successful, aseptic surgery was possible because antiseptics were used to clean wounds and operating theatres
73
how were vaccinations developed?
1. Pasteur carried out experiments to observe microbes and published his results in 1861 (Germ Theory)
2. Pasteur's team of scientists discovered that a weakened version of a disease-causing microbe could be used to create immunity from that disease
3. Pasteur admired Jenner and called his new discovery 'vaccination' in tribute to Jenner
4. Pasteur developed vaccines against anthrax and chicken cholera for animals, and against rabies for humans
5. Pasteur's work inspired other scientists to develop vaccines for human diseases
74
what did the Public Health Act of 1875 require city authorities to provide and do?
provide:
- clean water
- sewers
- public toilets
- street lighting
- public parks
do:
- inspect lodging houses for cleanliness
- monitor the building of new houses to prevent damp and overcrowding
- check the quality of food sold in shops
- employ a public officer of health to monitor disease
75
what were the reasons for the Public Health Act of 1875?
- previously, the government did not believe it was its role to improve living conditions and saw it as interfering in people's lives
- during the 19th century, the attitude of government began to change due to several epidemics esp. cholera and the increasing evidence that these disease were caused by poor living conditions
- the influencing number of men who could vote influenced politicians
- by 1875, people recognised that it was the government's responsibility to improve living conditions in the cities
76
who was Edward Jenner?
Edward Jenner was born in 1749 and trained in London as a surgeon and apothecary before working at St George's Hospital; he then returned to where he was born in Gloucestershire to work as a GP
77
why was Jenner important?
Jenner's work proved that scientific methods could lead to a disease being wiped out, however:
- he didn't know why it worked
- the link between cowpox and smallpox was unique so it didn't lead to other vaccinations
- other diseases were still killing people
78
how did the smallpox vaccination eventually get developed?
- since the 1720s, doctors had been inoculating against smallpox by injecting them with a mild version of the disease, this could still kill people and was very expensive
- Jenner collected evidence of the success and failure of smallpox inoculations; he regularly treated people for the mild disease, cowpox, and noticed that these people never caught smallpox
- in the 1790s, Jenner used scientific methods for carrying out experiments to test his theory and observe and record the results; he infected local people with cowpox and then tried to infect them will smallpox (none of them caught smallpox)
- in 1798, the Royal Society refused to publish Jenner's ideas, so he paid to print his findings in An Enquiry into the Causes and Effects of the Variola Vaccinae; he included detailed instructions so that others could follow them
- by 1800, around 100,000 people worldwide had been vaccinated, but it took time to gain popularity in Britain
- in 1802, the Royal Jennerian Society was set up to promote vaccination and, by 1804, over 12000 British people had been vaccinated
- in 1840, vaccinations were provided free of charge for the poor; vaccinations were made compulsory in 1853
- in 1979, WHO announced that smallpox had been wiped out
79
what opposition did Jenner face?
- people thought it was wrong to give people an animal's disease
- it interfered with God's plan
- doctors lot money when the government offered vaccination free
- some doctors didn't vaccinate people properly so it didn't work
80
when did cholera epidemics occur in Britain?
the first cholera epidemic occurred in 1831 and was followed by another in 1848-49, and another in 1854
81
what attempts were there to prevent the spread of cholera?
most people, including the government, believed cholera was caused by miasma and spontaneous generation; this meant that people tried to keep their homes as clean as possible and some local councils tried to clean the streets and clear away rubbish; the government's Public Health Act of 1848 suggested that cities should provide clean water supplies, but the Act was not compulsory so few complied
82
what do we know about cholera?
- it was known as the 'blue death' as dehydration turns the skin blue
- it mostly affected the poorest, slum areas of cities, although wealthier parts were affected too
- it causes severe diarrhoea and vomiting (leading to dehydration)
- in the early 19th century there was no treatment and most people who caught it died
83
what work did John Snow do?
- Snow was a well-respected doctor and surgeon in London; he observed the epidemic of 1848-49 and began work on his theory that cholera was spread through contaminated drinking water, not miasma
- when cholera broke out again in 1854 in Soho, where Snow lived, he mapped all the deaths and found a strong link to one water pump on Broad Street
- he removed the handle from the pump so people couldn't collect water from it and the number of deaths fell dramatically
- later it was discovered that a cesspit close by was leaking waste into the well
- in 1855, Snow presented his findings to the government
84
what was the significance of John Snow's work?
- many cholera deaths in Soho were prevented after Snow stopped people using the Board Street pump
- many did not believe Snow's theory, he had no scientific evidence to prove cholera was transmitted in water... the Germ Theory wouldn't emerge until 1861; therefore, the government didn't act on Snow's recommendation to build a new sewer system for London
- in the longer-term, Snow's work combined with other evidence (e.g. The Great Stink) and a new sewer system was completed in 1875
- also, in the longer term, Snow's work helped make the link between dirty water and disease, leading to the Public Health Act in 1875 when cities' authorities were finally forced to provide clean water
85
how did the understanding of genetics develop?
- during the 19th, Mendel showed how human characteristics could be passed between generations
- in the 20th century new technology (electron microscopes, x-rays) let scientists analyse human cells in greater detail; they found that every cell in the body contains DNA, codes controlling the genes of each person
- James Watson and Francis Crick worked together on how the genetic codes of DNA fitted together
- they analysed x-ray crystallography by Maurice Wilkins and Rosalind Franklin at King's College Hospital (London) and eventually worked out the double helix structure of DNA (1953)
- in 1990 James Watson led the Human Genome Project and started identifying and mapping every gene in human DNA
86
what new possibilities has discovering the structure of DNA and the work of the Human Genome Project led to?
- a better understanding of some genetic conditions, such as Down's syndrome
- predicting whether individuals are at higher risk of developing some cancers
- the discovery that stem cells can be grown into different cells
87
even with the new possibilities, what are scientists still struggling with?
- cure or effective treatment for most genetic conditions
- way of preventing most genetic diseases
88
what are some lifestyle factors which people have discovered can negatively affect health?
- smoking
- drinking alcohol
- diet
89
what do people now understand about smoking?
research now links smoking with many diseases, such as emphysema, high blood pressure, heart disease and many cancers
90
what do people now understand about drinking alcohol?
research now links too much alcohol to many cancers, as well as liver and kidney disease
91
what do people now understand about diet?
scientific research has confirmed that eating a balance of different foods and limiting sugar and fat reduces the chances of getting certain types of cancer or heart disease
92
what improvements in diagnosis have occurred?
although doctors today still use their own knowledge and medical books, they combine this with medical testing, using science and technology to discover what is wrong, this includes the use of:
- laboratories to test skin or blood
- x-rays, scans and endoscopes to 'see' inside the body with more clarity than ever before
- monitors to see what is going on over a period of time
93
what are some examples of technology used in 20th and 21st century medicine?
- microscopes
- incubators
- x-rays
- prosthetic limbs
- MRI, CT and ultrasound scans
- endoscopes
- pacemakers
- dialysis machines
- insulin pumps
- blood pressure and blood sugar monitors
- hypodermic needles
94
how were magic bullets developed?
- Koch discovered that different chemical dyes stained specific microbes
- Behring discovered the body manufactures antitoxins that only attack the microbe causing a disease
- Paul Ehrlich and his team of researchers searched for a 'magic bullet', a chemical compound that would attack and kill the microbe causing a specific disease
- the team, helped by German government funding, worked for many years; they tested many compounds of Salvarsan to find one to cure syphilis
- in 1909, Dr Hata joined the team and discovered they had rejected a compound that worked, the 606th
- in 1932, Gerhard Domagk developed the second magic bullet, Prontosil, which cured some types of blood poisoning
- other scientists checking Domagk's work found that the key ingredient in Prontosil, sulphonamide, also cured pneumonia, scarlet fever and meningitis
95
what do antibiotics do?
destroy bacteria or prevent its growth
96
which was the first antibiotic to be discovered?
penicillin
97
what did the discovery of penicillin cause throughout the 1940s, 50s and 60s?
it inspired other scientists to experiment with other moulds and find more antibiotics which were effective against different diseases
98
what advances occurred to result in keyhole and microsurgery?
the development of tiny cameras and surgical instruments meant surgeons could use small incisions instead of large cuts to access the body, which reduces the patients' recovery time; the small instruments also make it possible to reattach nerves and blood vessels
99
what advances resulted in robotic surgery?
some surgery can now be performed remotely, with surgeons controlling robots through computers, this has also made surgery more precise
100
since 1948, what are some examples of healthcare that taxes have funded and are provided by the NHS?
- seeing a GP
- hospital care and operations
- health visitors for pregnant women and young children
- ambulances and emergency treatment\
- healthcare for the elderly
101
how has access to care been improved?
the establishment of the NHS improved access to healthcare since all treatment was entirely free, so everyone could access the same care
102
what was one way that the access to healthcare wasn't entirely perfect?
healthcare provision was unequal across different parts of the country, both in terms of the number of doctors and hospitals and their standards, this took time to improve
103
timeline of mass vaccinations?
1942- diphtheria
1950- polio and whooping cough
1961- tetanus
1962- measles
1970- rubella
1988- MMR (measles, mumps and rubella)
2008- HPV
104
since 1948, what prevention measures has the government taken to stop illness?
- funding more testing and vaccinations
- better disposal of rubbish and sewage
- laws reducing air and water pollution
- laws banning the advertising of cigarettes and smoking in public places
- laws improving health and safety at work
- environmental health officers inspecting food outlets
105
what are lifestyle campaigns?
since 1948, the government has funded publicity to raise awareness of illnesses and dangers to health, such as smoking and binge-drinking, with some success: the 1980s 'AIDS: don't die of ignorance" campaign reduced cases of HIV infection; more recently, events and initiatives such as the Change4Life campaign, have encouraged healthy behaviour to prevent disease
106
who was Alexander Fleming?
Fleming worked on the battlefields of WW1; part of his job was to study soldiers' infected wounds and try to find treatments; many died from their infections...after the war, he worked at St Mary's Hospital in London, where he continued his work to try to find a way healing bacterial infections
107
who were Howard Florey and Ernst Chain?
Florey was an Australian pathologist who was researching ways to kill bacteria at Oxford Medical School; he assembled a group of scientists to help him, one of his first recruits was the German biochemist, Ernst Chain
(they won Nobel Prizes with Fleming in 1945)
108
what led to the discovery of penicillin?
- in 1928, Alexander Fleming noticed that bacteria in a Petri dish was being killed by a penicillin mould, he tested it on there bacteria and found that the mould produced an excellent antibiotic
- in 1929, Fleming published his findings but didn't believe that penicillin would work on living people and didn't ask for funding to continue research
- several years later, Howard Florey, Ernst Chain and their team continued Fleming's research on penicillin
- it proved effective on mice, so they tested it on humans; penicillin killed bacteria and therefore the infection
109
how did penicillin become so widespread?
- Florey asked UK drug companies and factories to help, but these were being used for the war effort
- in 1941, US drug companies agree to help fund the production of penicillin, but on a small scale
- the effectiveness of penicillin was demonstrated, after the USA joined the war, the government saw a need for more penicillin to treat casualties
- in 1942, mass production of penicillin by US drug companies financed by US government
- in 1943, mass production of penicillin by UK drug companies
110
how is lung cancer diagnosed?
- symptoms of lung cancer include a persistent cough, coughing up blood, breathlessness, tiredness, unexplained weight loss and repeated chest infections, but these can be symptoms of many other conditions, and the cancer is often very developed when symptoms show up
- if lung cancer is suspected, most patients are given a CT scan and if this shows a mass, a sample of the cells are collected and tested
111
how is lung cancer treated?
- surgery to remove the tumour or carry out a lung transplant
- radiotherapy to try to shrink the tumour or prevent its growth
- chemotherapy to try to shrink the tumour, or prevent the cancer returning
112
what methods of prevention have been tried to help limit lung cancer?
- TV advertising for cigarettes was banned in 1965, and for cigars and tobacco in 1991; all forms of advertising have since been banned
- tax on tobacco products is regularly increased make smoking more expensive and encourage people to stop
- in England in 2007, smoking was banned in public places where people worked, this ban was extended win 2015 to cars carrying under-18s
- in 2007, the legal age for buying tobacco products was raised from 16 to 18
- various campaigns have been funded to educate people about the risks of smoking, to encourage them to stop or not to start
- today, shops are not allowed to publicly display tobacco products
- cigarette packaging became standardised in May 2016, all cigarettes are sold in green packets and with graphic warnings of the dangers, whatever the brand
113
what happened at the First Battle of Ypres?
(Oct-Nov 1914)
the British managed to hold onto Ypres, which was vital in maintaining access and control of the English channel ports, but the germans gained ground
114
what happened at the Battle on Hill 60?
(Apr 1915)
the British tunnelled into and under he Holland exploded five mines from the tunnels, which enabled them to take the hill
115
what happened at the Second Battle of Ypres?
(Apr-May 1915)
the germans made very slight gains towards Ypres, the battle was notable as being the first time chlorine gas was used (first used by the Germans)
116
what happened at The Somme?
(Jul-Nov 1916)
notable for extremely high casualties on both sides, the battles on both sides of the River Somme saw two new strategies by the British - the creeping barrage and the first use of tanks - but these had little impact
117
what happened at Arras?
(Apr-May 1917)
in 1916, the British linked and expanded the underground tunnels, quarries and caves for the shelter and movement of troops; the tunnels were used to launch the battle, which was initially successful but ended with little progress and high numbers of casualties on both sides
118
what happened at Cambrai?
(Nov-Dec 1917)
notable for first large-scale use of tanks, which were successful but not backed up so the British were forced back
119
what happened at the Third Battle of Ypres?
(Jul- Nov 1917)
the British used a creeping barrage to make small gains to break out of the Ypres Salient; the awful weather left the ground waterlogged and many drowned
120
how were trenches constructed?
the first trenches were hurriedly dug by troops, they often used existing ditches or banks to make it easier; the trenches were constantly maintained and improved, for example, with drains and steps added
121
how did the terrain affect transport?
terrain varied in different places and according ti weather conditions; it could be very difficult to get around where there was deep mud and water logging, and craters and holes from explosions; the trenches themselves could be very muddy and crowded
122
what were some features of the trench system?
- all three rooms of trenches were linked by communication trenches
- artillery emplacements
- the reserve trench was where troops could be stationed for counter-attack
- dugouts were holes in the side of the trench for troops to take cover
- the support trench was where troops would retreat to from the frontline
- trenches formed a zigzag pattern
- the frontline trench was where attacks were launched
123
what was the affect of gas attacks?
they were greatly feared but were not a major cause of death; the caused (most temporary) blindness and coughing, and also burns; in July 1915, gas masks were given to all British troops (before this, they protected their faces with cotton pads soaked with urine)
124
what was the affect of head injuries?
they were unexpectedly common and were mostly caused by shrapnel; by late 1915, the soldiers' soft caps were replaced by Brodie helmets, which reduced head wounds
125
what was the affect of shell shock?
it caused a wide range of symptoms, including total mental breakdown; some sufferers were accused of cowardice, many were treated close to the Front but some were evacuated to British hospitals
126
what was the affect of trench fever?
it produced flu-like symptoms, which could last fro months and keep reoccurring; it was caused by lice so, in 1918, troops were deloused, which reduced cases
127
what was the affect of trench foot?
it was caused by standing in waterlogged trenches and could lead to gangrene, treated with amputation; to try and protect troops' feet, they were given whale oil and spare socks, pumps were used to drain trenches, and duckboards were added for soldiers to keep their feet above the water
128
what was the affect of bullets?
bullets from rifles and machine guns could penetrate organs and fracture bones
129
what was the affect of high-explosive shells and shrapnel?
they were responsible for most deaths and injuries, removing limbs and causing major internal injuries
130
how were specific injury problems dealt with?
some injuries had rarely been seen before, whilst others had never been seen on this scale; all weapons, but particularly explosions, could cause major blood loss; bullets and shrapnel had to be located and removed, extensive head wounds required brain surgery and/or facial reconstruction
131
how was wound infection dealt with?
this was a major problem as soil on the Western Front contained tetanus and gas gangrene bacteria, these would enter wounds either during attack or when victims were lying on the ground (often for some time) before being collected; from late 1914, tetanus injections were given but there was no prevention for gas gangrene
132
what is the RAMC?
the Royal Army Medical Corps
133
what is FANY?
First Aid Nursing Yeomanry
134
what were some features of the underground hospital at Arras?
- very close to the front line
- space for 700 beds
- operating theatre
- mortuary
- supplied with running water and electricity
135
what transport problems were there?
- difficult terrain meant that in some places only stretcher-bearers and horse-wagons could be used
- many roads and railway lines had been destroyed
- constant shelling and artillery fire made recovery of the injured very difficult
- initially, no motor ambulances were suntan there were not enough horses to cope; public appeal in Britain raised money for 512 motor ambulances
136
what was the chain of evacuation?
- The Regimental Aid Post
- The Field Ambulance + dressing stations
- Casualty Clearing Stations
- Base hospitals
137
what were features of Regimental Aid Posts?
- close to the front line
- the Regimental Medical Officer was helped by stretcher-bearers in administering first aid, he sent more serious injuries onto the next stage
138
what were features of the field ambulance/ dressing station?
- the Field Ambulance was a mobile medical unit of the RAMC, which set up dressing stations
- they were about a mile back from the front line in derelict buildings, dugouts or tents
- these stations were staffed by medical officers, orderlies and stretcher-bearers and, from 1915, some nurses
- they could look after men for a week, serious cases were sent straight to the CCS
139
what were some features of the Casualty Clearing Stations?
- they were larger and better equipped
- situated in buildings several miles from the front line
- staffed by doctors and nurses who prioritised treating life-threatening injuries to men who had a chance of survival
- became the most important place for efforts to reduce risk of infection until March 1918, when base hospitals regained that role
140
what were some features of base hospitals?
- situated near ports on the coast
- had many medical staff, including doctors who specialised in certain treatments
- patients could stay for some time before returning to the front or being sent home by ship for further treatment
141
how were x-rays discovered and developed into useful medical tools?
- in 1895, Wilhelm Roentagen discovered that x-rays could pass through many objects, including human flesh, but not bone
- he took the first x-ray image after putting photographic paper between the tube and his hand
- radiology departments opened the following year and were used to diagnose embedded objects and bone problems
142
what were some problems with early x-rays?
- photography was at an early stage so taking x-rays required keeping still for a long time
- high doses of radiation were released and patients were burnt and lost hair
- large machines were too heavy to be moved easily
143
how were blood transfusions developed?
- in the 17th century, doctors carried out blood transfusions from animals to humans but people rarely survived
- James Blunder performed the first human-to-human blood transfusions between 1818 and 1829, he developed useful techniques and equipment but there were problems, blood had to be transferred directly from the donor to the recipient as it couldn't be stored, and only about half the recipients survived
- in 1901, Karl Landsteiner discovered three good groups and, in 1902, his colleagues found a fourth group; they discovered that transfusions would work only between people of the same blood group
144
what led to the development of aseptic surgery?
thanks to the work of Jospeh Lister, antiseptic surgery was well established by 1900 and aseptic conditions began to be used
- operating theatres and wards were thoroughly cleaned
- surgeons and nurses wore sterilised clothing
- sterilised cloths covered surfaces and equipment
- surgeons and nurses wore masks to prevent breathing infection into a wound
- in 1878, Robert Koch developed a steam steriliser for surgical instruments; after 1887, all surgical equipment was sterilised
- in 1890, anyone touching the patient wore rubber gloves to stop germs passing from their hands to the wound or onto instruments they were using
145
what new techniques for infections were there?
- antiseptic and aseptic surgery were not possible in Dressing Stations and Casualty Clearing Stations, and many wounds were already infected by the time the patient was operated on
- surgeons went back to using chemicals to kill bacteria but this didn't work against gas gangrene
- by 1917, the Carrel-Dakin method, in which sterilised salt solution was moved through the wound using tubes, was found to be more effective
- this didn't work when infections were very deep in the body, so surgery was developed to remove the damaged an infected tissue as well as removing all traces of the bullet or shrapnel
- if this didn't work, the only remaining way to save the patient was to amputate the limb
146
what advances in blood transfusions were made?
- blood loss could lead to shock which often caused death; blood transfusions were used from 1915 but were limited as blood couldn't be stored
- in 1915, Richard Lewisohn found that adding sodium citrate to blood stopped it clotting, so it could be stored a short time, Richard Weil used refrigerators to store it for much longer
- in 1916, Francis Rous and James Turner added citrate glucose, which meant blood could be stored even longer
- in preparation for the Battle of Cambrai in 1917, Oswald Hope Robertson stored 22 units of blood in what he called the first 'blood depot', he used it to treat Canadian soldiers suffering from shock and demonstrated its potential
147
what is the Thomas Splint?
from December 1915, the Thomas Splint was widely used and reduced the death rate from broken limbs to fewer than 20%, this was because the splint kept the leg rigid which reduced blood loss; previously, 80% of soldiers with broken legs died
148
what advances occurred in surgery?
the number of brain injuries during the war led to the development of new surgical techniques and improved the success rate, the large number of facial injuries led to huge improvements in plastic surgery, led by Harold Gillies who worked at the Queen's Hospital in Kent
149
where were mobile x-ray units used?
x-rays were essential in locating bullets and shrapnel before operating; static machines were used in base hospitals from 1914 and in some Casualty Clearing Stations; mobile units were used closer to the front and their numbers increased as the war went on, their images were not as clear as those from the static machines but still prevented many deaths
