Treatment and the Prevention of Disease

1350-2000

How Far Did Approaches to Treatment and the Prevention of Illness Change from 1350-1750?

The Ancients: 1. Hippocrates- stressed the importance of focusing on the nature of

diseases to find out how to treat them.

Taught the need to restore the balance of the humours- eg make patients vomit, purge their bowels and bleed them.

Patients could visit the Asclepion to ask the god Asclepius (of healing) for help.

Patients should live carefully and consider the seasons- in Spring and Summer bleed people, in winter people should eat a lot and drink a little.

Natural treatments- diet, exercise, warmth…

2. GalenMainly the same as the Greeks- exercise, diet...

Prescribed herbal remedies based on herbs and vegetables.

Opium given as a mild anaesthetic.

Used ‘opposites’ to treat the imbalance of the humours eg too much phlegm means they are cold and need to take a hot treatment like pepper.

He suggested daily exercise to prevent illness.

Doctors and Healers by 1750:Licensed Healers

Training and Methods

Physician Studied for 14 years at university- 7 studying medicine. All men. Knew Galen and other ancients as well as more modern doctors. Charged a lot.

Apothecary

Sold and made medicines prescribed by physicians. Not meant to treat sick or prescribe but many did for the poor- charged small fees.

Surgeon Trained by watching and copying other surgeons during long apprenticeships. Given licenses to treat by Bishops, could charge fees.

Midwife Also licensed by local bishops. If complications, handed patient over to physician.

Unlicensed Healers

Training and Methods

Family Usually mother or wife treated sick person first.

Wise Women

Local women trusted because of their knowledge of herbs and other treatments, passed down in family. If things went wrong, they could be called witches.

Housewife- physicians

Girls were expected to learn to treat common illnesses and injuries. Books were written to advise ladies and some read medical texts. These ladies treated people from their villages, families and their servants.

Travelling Quacks

At fairs and markets, tooth-pullers and herb-sellers would treat people. Some had built up knowledge and did good, most took money and ran.

What were hospitals like in 1350?Wardens on the door would not let people in who

looked too poor or if they were clearly infectious or seriously ill.

There were servants, monks to pray for the sick and nuns treated people.

Beds were set up in large halls and shared.People were kept fed, warm and clean. They were

given herbal remedies if necessary.Hospitals were run and paid for by the Church.

What were hospitals like by 1750?After the Reformation of the 1500s, town councils

and charities began to take over.In the early 1700s many new hospitals were

opened.By 1750 lots of people still had to pay doctors to

treat them at home rather than go to a hospital.Treatment was still looking after people and giving

them herbal remedies or bleeding them. Simple surgery could be done but things like amputation were only done in desperation. Treatments were still free in hospitals but patients were meant to pay for their recovery.

How Far Did Approaches to Treatment and the Prevention of Illness Change from 1750-1900?

Smallpox

Epidemics broke out every few years. Many died, survivors often lived with terrible scarring. It left families isolated as no-one would visit, houses and belongings had to be disinfected, and many lost their jobs. Many families tried to keep it secret.Date Total deaths in

MaidstoneDeaths from Smallpox

1740-51

1594 260

1764-75

1798 76

1788-99

2308 31

Developments in oreventionInoculation

Idea arrived in the 18th Century to avoid catching Smallpox from china where used for centuries. Their method of inoculation involved putting a small amount of matter from a smallpox scab onto a cut to give someone a mild form of the illness. They knew that this often prevented them from catching the disease again.

Trade brought this idea to Europe and a woman called Lady Mary Wortley Montague witnessed it in Turkey. She had survived smallpox but feared for her children so she had them inoculated.

Friends of hers were doctors and they saw the potential to make money. Mass inoculations were carried out in Maidstone during an epidemic in 1766.

Problems with inoculation:It saved lives without a doubt but also posed some risk.

Some people died from the mild dose they were given, others became carriers of the disease and probably passed it on to others. Some people refused the treatment because of the risks.

How does immunity work?1. Germs enter the body.2. The body creates antibodies.3. The antibodies ‘lock on’ to the germs and kill them.4. The antibodies stay in the body so that next time the

body meets similar germs, it can respond more quickly.

Edward Jenner and the development of Vaccination.

A doctor in Gloucestershire who was surprised how few people wanted to be inoculated. Local farmers explained that they didn’t need to be inoculated as cowpox protected them. Jenner looked into it and found dairymaids rarely caught smallpox. He wondered if cowpox could be used to protect people from smallpox.

What factors helped Jenner and the development of a smallpox vaccine?

Luck- he was working in the countryside with farmers.

Other factors:

Scientific investigation-

Government-

Communications-

Individuals-

The importance of Robert KochHe developed methods which could be used by

other scientists to study bacteria- a solid medium to grow them in and a method for staining them.

He therefore identified methods for identifying the causes of disease eg TB 1882, cholera 1883 and plague 1894.

He did not develop any new treatments or cures.

Louis Pasteur and Chicken CholeraPasteur had thought a lot about the work of Jenner on his

smallpox vaccine. In 1879 Pasteur was researching chicken cholera for

French farmers. He was injecting chickens with cholera as part of his testing when one day a chicken didn’t die. When Pasteur asked his assistant which germs he had injected the chicken with, they realised it was an old batch that had been exposed to the air for a long time. They injected the chicken with fresh germs and it didn’t get ill, they had discovered the second vaccine as the old batch protected the chicken. Pasteur called it a chicken cholera vaccination to show his debt to Jenner.

In 1882 Pasteur turned to rabies and developed a vaccine within two years.

Discovering the cause of disease

Jenner• Used cowpox to vaccinate against smallpox.

Pasteur

• Germ Theory linked germs to disease.

Koch• Studied bacteria to show which caused which

illnesses.

Pasteur

• Developed a vaccine for chicken cholera then chicken pox, cholera, anthrax and rabies. Other scientists followed suit.

What next?Behring, 1890s

Follower of Koch who found that animals produce anti-toxins to fight bad bacteria. He used animal blood to cure diseases like diptheria by taking out it’s clotting agents.

Ehrlich, 1900s

Searched for a chemical to kill bacteria but not the body. He ofnd some dyes stained bacteria but not the body so he tried to foind one that would kill them too. After years he discovered Salversan and called it his ‘magic bullet.’

How far did treatment of ordinary people change 1750-1900?

Change ContinuityHealer/ practitioner

Start 20th Century ¾ people practicing medicine unqualified. 1858 Medical Act set qualifications. General Medical Council set up to keep list of approved doctors and what students needed to know.

Physicians still only saw rich. Apothecaries less training but still helped most. Many methods the same for 1000s years eg bleeding and purging. Couldn’t help infectious diseases like whooping cough.

Domestic medicine

Development of the thermometer helped with diagnosis.

Most people still treated at home with comfort, food, warmth. Used herbal remedies, common sense and knowledge passed down.

Change ContinuityPatent and improved medicines

By 1800 more people visited ‘quacks’ and bought patent medicines. People bought ‘cure alls’ because to be honest, doctors had no better remedies. Till the 1880s there was no control over what went into patents.In the 1880s the first effective painkillers such as aspirin were developed and by 1900 companies like Boots and Wellcome were set up.

The training of doctors 1750-1900.From the 1750s people could call for a local doctor

or general practitioner. Training- doctors were trained by apprenticeship,

they went to lectures and learned to use new devices like the stethoscope from 1816 and thermometers.

They were generally respected and had standard charges though they usually let the very poor off. They had a combination of private patients and had contracts with local parishes.

Doctors delivered babies, carried out vaccinations and made up medicines.

Treatment in hospitals 1750-1900Hospitals were often cramped and stuffy,

infections spread quickly. There were few toilets and sewage systems were often poor.

Nurses were often dirty or drunk and were not trained.

Only the poor went to hospitals as they couldn’t afford a doctor to visit them at home. Hospitals were where people went to die.

How far did the role of women in medicine change 1750-1900? Florence Nightingale

Born to a rich family. Believed God wanted her to be a nurse. 1851 she went to Germany to work in a hospital for three months, she learned how they were trained and kept patients healthy.

1854 war broke out in the Crimea between Russia and Britain. The public were horrified to hear half the wounded soldiers were dying in hospitals. A government minister asked Florence Nightingale to lead a group of trained nurses to the Crimea.

Florence reorganised the army hospitals, new wards were built and scrubbed regularly, they also gave the wounded good food. In 6 months the death rate fell from 42 to 2%.

When she returned to Britain, Florence raised £50,000 to improve hospitals and the training of nurses. She published a book and used statistics to support her arguments.

1859 she published ‘Notes for Nursing’ stressing the importance of air, light, warmth, quiet etc 1860 she set up the first training school for nurses.

What other factors helped the improvement of hospitals?

Communications- the invention of the Telegraph.Attitudes- people began to see nursing as an

acceptable job. They gained more respect and young women wanted to become nurses.

Money- was raised by the Florence Nightingale Fund.Science and technology- the development of

antiseptics and anaesthetics.

The impact of the Magic Bullets

Salversan 606- first chemical compound used to kill a disease but didn’t hurt the patient.Prontosil- cured blood poisoning.The sulphonamides- drug companies raced to find other drugs nased on coal tar and develop drugs to cure illness eg scarlet fever, meningitis. Maternal mortality reduced massively as infections could be controlled.

What factors aided the development of penicillin?

Individuals- Fleming, Florey and ChainWar-WWII and new weaponsGovernment- US governmentMoney- Funing from US gov and Pharmaceutical

companies Science and technology- freeze drying technology

for mass production

Drugs and treatments since 1945:

Drug companies spend millions on research, there are 1000s of antibiotics and vaccines for many illnesses such as polio and german measles.

There are also drugs based on the body’s hormones such as the pill.

However, we cannot attack viruses and there have been problems such as with Thalidomide which led to birth defects in children whose pregnant mother took the anti-sickness drug.

Some bacteria are increasingly resistant to antibiotics.Genetic engineering means DNA can increasingly be

used to develop drugs and genes can be manipulated.

Medicial Practitioners:The role of doctors:By 1930- some knowledge of causes of disease.

Few cures. Respected, paid by patients, does some charity work. Little equipment- stethoscope, thermometer, X-ray… Few were women. Visit patients at home.

Today-

Medical Practitioners: The Role of Nurses:Before 1948- General nursing Council set

standards. Trained in hospitals. Respected. Pay fairly low. Cleaned, looked after comfort of patients and followed doctors directions. 1919 Nursing Act set standards.

After 1948- Degree/Diploma needed, study for 3 yrs at least. Must be registered. Train in a range of wards and specific situations but then need further exams to administer drugs or chemotherapy.

HospitalsEarly 20th century: Few women, people only used if

necessary as expensive so they used patents and chemists, did minor surgery at peoples homes.

Charitable hospitals: offered basic care, some were fever houses or asylums. Dependent on fundraising.

Role of government: Increased after Boer War embarrassment, Liberal gov 1905-11 increased access to care. 1911 Health Insurance Act meant employers and gov helped pay for sick cover.

1919: Ministry of health set up to overview whole health provision in Britain.

1948 : Most hospitals taken over by NHS, but some still private or charitable