Medicine through time

What is Public Health?

Public Health are things that a government does to try and ensure that things are clean and healthy for the public. Things like providing sewers, clean water etc.

When was the Industrial Revolution?

Most of the events that I’ll be talking about here happened in the 19th century. Industrialisation started a little earlier than this, in the mid 18th century.

What was the problem?

Industrialisation led to a really rapid change in the way that people lived and worked. As factories developed people rushed into towns to get jobs in them. A lot of the housing that was provided had been built quickly and without enough consideration of things like cleanliness, removal of human waste, provision of clean water, education of access to a healthy diet. As these areas grew in size, the problem got worse. These areas, slums as they are known, were rife for the spread of infectious diseases and life expectancy in some of them fell as low as 11 or 12!

How did they solve the problem?

It took a while for much to be done. In the 1830’s there was a review of the Poor Law which led to some changes in the way that por relief was given out but it was quite limited. As diseases like Cholera and Typhoid hit different parts of the country in that decade there were a series of local reports produced about health. It started to become clear (to some!) that something needed to be done to ensure that there were minimum conditions. This belief was reenforced by edwin Chadwick’s report on Health, which painted a pretty bad picture of conditions for the people living in poorer areas. The people who felt like this formed the Health of Towns Association which acted as a pressure group trying to persuade government and local councils to take action. As a result the government passed a Public Health act in 1848. Improvements were limited though in many places and Cholera once again returned and ravaged parts of the country. Despite the work of John Snow little was done to improve conditions until after the second reform act, when ordinary men were given the vote. This now made Public Health a real political issue - it was a vote winner! Soon afterwards there was a Royal Sanitary Commission established (1869) and its findings led to a Second Public Health Act (1872). This act placed responsibility for health on local authorities. As the implications of Pasteur’s Germ Theory became more widely understood it was clear that further action was needed - as some authorities had done little. A 3rd Public Health Act was introduced in 1875 which made the requirements very clear. This act was followed by lots of legislation about all sorts of health and building issues. In the twentieth century these pieces of legislation were followed up with slum clearances (they’d stopped slums being built but hadn’t ordered existing ones to be knocked down in the 19th century) and work was done on improving the health of children. The Liberal Reforms of the early 20th century and later introduction of the Welfare State are more recent examples of Public Health initiatives.

Why did it take so long to solve the problem?

Remember: CAFE

Cost - who was going to pay for the huge amount of work needed?
Attitude - people should learn to help themselves (called a Laissez Faire approach)
Fear - what will the working classes want next?
Evidence - is there any proof that the spending will improve things? until Germ Theory, there wasn’t any…

What’s Renaissance and when was it?

Renaissance means re-birth. Its a period of time when lots of old ideas were challenged. When did it happen? Roughly the 14th to 17th centuries (AD).

What happened?

The churches power and authority were challenged! This might not seem to make much difference to medicine - but it did! Because the church had done most of the teaching about health, it had been hard to look for new ways of treating illnesses, or to explore the workings of the body. To do so could have been been seen as being anti-god (heresy). People who were thought of like that tended to get executed - so naturally people didn’t challenge the church often!

How did this affect medicine?

It meant that people were more willing to challenge the work of people like Galen, and also that they might be more willing to break some of the rules of the church. For example, dissection was still banned but now the authority of the church was questioned some anatomists were willing to take a risk and started dissecting. Results? Knowledge of the anatomy improved quite dramatically. Andreas Vesalius was able to produce a very detailed set of drawing of the human body and Wiliam Harvey discovered that blood circulated around the body: both were massive breakthroughs.

Massive breakthroughs? How did this help people at the time?

Heres the catch. People like Vesalius and Harvey made massive improvements to our knowledge about the way that the body worked and were able to spread their ideas quickly because of the printing press. However, neither of them knew what caused diseases so their findings were impressive but of little immediate use to doctors or patients. The area where there were breakthroughs that had an immediate and lasting effect on treatments was in the field of Surgery. Here a chance discovery in a battlefield hospital led to a massive improvement in the way that wounds were teated. A French surgeon, Pare, found that lotions he had concocted out of desperation, worked! He went on to gain a lot of support from the French monarchy and made several other breakthroughs - the use of ligatures, for example.

So, there were lots of new ideas - what about treatments?

Much the same as in earlier periods of time. Most people were still reliant on family members or trusted elders. There were an increasing number of trained doctors but they remained expensive. After the dissolution of the monasteries in the UK, there was also fewer places for the poor to go to receive help, though there were some more hospitals built. The doctors of King Charles II recorded the medicines they gave him in his dying days. They remained a combination of natural and supernatural attempts to tackle disease.

And Public Health, did that change?

Not particularly. There were some localised rules about waste and so on but in general investment was quite limited as other things remained more important to our rulers. The most significant chang in the UK came after the Great Plague and Fire of London. When the city was rebuilt, it was done so in a much more open and clean manner.

So did things get better during this period?

On a day to day basis for ordinary people with common ailments, probably not much. Scientists now had a lot more knowledge though, medicine was on the brink of being able to make massive leaps forward.

When was Ancient Rome?

Historians believe Rome was founded in 753BC. It grew from being a small kingdom into a large Republic. From the first century BC until the fifth century AD, Rome had a large empire - and its the spread of Roman ideas around this empire that we’re interested in!

How was Ancient Rome organised?
For the purposes of this post, we’ll look at the Empire. Unlike the Greek civilisation the Romans were quite rigid in their organisation. At the top of the pile was the Emperor and beneath him the senate. The members of the senate were elected by citizens of Rome. Around the Empire control would be handed to a governor. He often had a large military force at his disposal to ensure law and order. In Briton some areas retained their old rulers, who acted as tenant kings and governed locally under Roman supervision. In areas where there had been lots of opposition, Roman rule was direct and enforced by the Roman army.

What was Roman Culture like then?
The Romans were pragmatic and borrowed ideas from many of the areas that they conquered or controlled. This meant that a lot of Greek ideas were widely accepted by Romans, as were religions and ideas from elsewhere in the empire. The Romans also enjoyed gladiatorial games and chariot racing. In general though the Romans weren’t as big a set of ‘thinkers’ as the Greeks, they tended to be more focussed on the practical side of things and ‘got on with it.’

How did this influence medicine?
On a simple level the Empire results in the spread of ideas and practices from as far apart as the North of England to Palestine, Egypt and into Persia. Roman values also meant that they took their own way of life with them: this meant that their liking for baths, for example, spread quite quickly. The Gladiatorial games gave surgeons loads of opportunities to look at different kinds of wounds and the importance of the army meant that there were lots of hospitals, surgeons and roads - all of which help to improve health.

Did the Romans create anything new then, or was it just a lot of borrowed ideas?

They certainly borrowed a lot - supernatural ideas continued, for example - but they also created a lot as well. The two ‘big’ things that this period is best known for are a person and an idea. The person was Galen, the idea: Public Health.

Whats Galen important for then?
Galen wrote LOADS. He came up with lots of new ideas about how the body worked and developed the ideas of people like Hippocrates. His real claim to fame is that his ideas were accepted for so long - all the way into the Renaissance! He wasn’t always right - Vesalius later corrects some of his more glaring errors - but he provided fairly sound advise on all types of illness / surgical need and, as doctor to the Emperor, had the clout to get his message heard!

Whats important about Public Health?
Nowadays we’re reminded that ‘coughs and sneezes spread diseases.’ They do… but infected water does a pretty nasty job of spreading disease too! The Romans brought clean water into towns and cities using Aqueducts and took dirty water away using Sewers. They also invested in public toilets and bathhouses. Whilst they didn’t know it, in doing so they were limiting the number of germs that could be spread through the water supply. Result? Healthier towns and cities - though don’t for a second think that this means that all Roman towns were clean and disease free as that wasnt the case!

A Dummies guide to medicine in Ancient Egypt

When was Ancient Egypt?

The Ancient Egyptian civilisation was in existence from approximately 3000BC to 400AD. In reality the era is a number of different periods in Egyptian history, when different families (dynasties) ruled Egypt.

How was Society different to prehistoric times?

The Egyptians developed a system of writing things down. They used hieroglyphics to record their findings. They also lived in organised, permanent settlements and built towns and cities. Unlike prehistoric man, the Egyptians had also a system of law and order based on a system of government led by a ruling Pharaoh.

Other than writing, what advances were made in the Egyptian period?

The Egyptian period was very long so lots changed over the course of the era. The Egyptians developed a complicated set of religious beliefs and rituals, many of which related to medicine and the human body. They also became expert builders and engineers, building the great pyramids, temples and roads.

Religious beliefs? How do they affect medicine?

The Egyptians believed that life on earth was part of a cycle. Once a person died their spirit passed into the afterlife. The quality of the afterlife would be improved if the person’s remains were treated in certain ways. This meant that Egyptian doctors couldn’t dissect bodies as they had to remain intact for the afterlife. However the process of preserving the body, mummification, did mean that some knowledge of the human anatomy was acquired.

So, religion just prevented them from cutting up bodies?

No. Religious beliefs also required cleanliness in temples which had a knock on effect of improving health. Religion also meant that prayer was used extensively by doctors as their beliefs led them to require doctors to ask the gods for forgiveness and mercy. This belief in gods causing and sending disease meant that doctors would not look for alternative causes of illnesses.

What about surgery?

The Egyptians observed that water from the River Nile could become blocked in irrigation channels. They used this simple observation to establish that blockages in the veins could be removed in much the same way as a blocked channel was opened up. Based on these observations they began performing operations to remove cists and abscesses.

How would they try and cure illnesses then?

A combination of natural and supernatural cures was used. These were based on their beliefs about the cause of disease and an element of trial and error. Herbal remedies were used to help cure things such as stomach pains. Combinations of natural elements could be used to induce vomiting for example. These were often prescribed alongside a prayer though, as the disease was thought to have been sent by the gods. Sometimes the illness would simply be treated with a prescribed prayer.

Examples:

The following are all taken from the Papyrus Ebers, an Egyptian scroll that Doctors had to use when treating a patient.

Cure for Cataracts:
Mix brain-of-tortoise with honey. Place on the eye and say:
There is a shouting in the southern sky in darkness, There is an uproar in the northern sky, The Hall of Pillars falls into the waters. The crew of the sun god bent their oars so that the heads at his side fall into the water, Who leads hither what he finds? I lead forth what I find. I lead forth your heads. I lift up your necks. I fasten what has been cut from you in its place. I lead you forth to drive away the god of Fevers and all possible deadly arts.
Cure for Burns:
Create a mixture of milk of a woman who has borne a male child, gum, and, ram’s hair. While administering this mixture say: Thy son Horus is burnt in the desert. Is there any water there? There is no water. I have water in my mouth and a Nile between my thighs. I have come to extinguish the fire.
Head Wounds
If thou examines a man having a gaping wound in his head penetrating to the bone, smashing his skull, and rending open the brain of his skull, thou shouldst palpate his wound. Shouldst thou find that smash which in his skull like those corrugations which form in molten copper, and something therein throbbing and fluttering under thy fingers, like the weak place of an infant’s crown before it becomes whole- when it has happened there is no throbbing and fluttering under thy fingers until the brain of his skull is rent open and he discharges blood from both his nostrils, and he suffers with stiffness in his neck.

Feel free to ask questions or add further info by submitting comments. Dummies guides to each period will be added in chronological order.