Medicine through time

What is the role of Government?

The role of Government in the history of medicine through time is a look at Governments as a factor. This could be a governments decision to increase taxes to pay for healthcare; a government investing in medical research; laws that they introduce about public health or the medical profession or governments doing little or nothing about health issues.

How can Goverment affect the development of medicine?

Governments control what happens in a country. If the government wants to see an aspect of healthcare improved it can channel resources into that area. Likewise if other areas are priorities, funding for medicine and healthcare might be reduced. Since universal suffrage in the UK, governments have (generally speaking) reflected attitudes and beliefs of the people. This has meant that healthcare has been a political priority and funding, whilst still often criticised, has been a relatively high proportion of government spending. Before the vote was given to ordinary’ people the view of many governments was ‘Laisses-Faire’ or ‘leave them alone’ which meant that investment in public health, for example, was limited. Different governments and political parties have different views about what should and shouldn’t be funded by governments. One example of this is the current US debate about Healthcare. See this BBC article and analysis to see the arguments for and against increased investment by the US government.

In what ways have governments improved medicine over time?

An easy way to remember the main ways that governments have improved medicine and health over time is to use a mneumonic. For example
Healthcare
Education
Attitudes
Latrines and clean water
Technology
Housing

Ok, its a simple list but it covers most of the key points. A brief summary of each:

Healthcare: “From the Cradle to the Grave” was a phrase used to describe the Welfare State. It means that the government was willing to invest in healthcare provision for people of all ages, with any kind of illness.

Education: Governments write school curriculums. These can include all sorts of education about healthcare – think about the number of lessons you’ve had about healthy eating, the importance of exercise etc. It also extends to investing in public information broadcasting and advertising. Example: Government video advising people about Swine Flu.

Attitudes. Governments can help to shape attitudes and approaches towards healthy lifestyles and healthy living. This might be through promoting these via adverts etc but has also been the result of religious beliefs that have been central to some past civilisations (Ancient Egypt) or through a desire to ensure a strong and healthy army (The Romans).

Latrines and clean water. Ok, I mean Public Health here but latrines fits the mneumonic so much better…

Technology. Governments have invested in technology and scientific experimentation in order to achieve medical progress. Pasteur and Koch were heavily funded by their respective governments; Penicillin was mass produced as a result of Government investment and many governments through time have invested in the use of communications technology to inform people about health and medicine.

Housing. In the UK there have been many acts of parliament relating to the qualit of housing that is built. This stems from the Industrial Revolution and attempts to solve problems caused by the emergence of slums.

What makes governments invest in medicine and health?

In a democracy, the voters! Examples of this: the Liberal Reforms were influenced by the extended suffrage to working class men and the rise of the Labour Party. The Liberals realised that helping the poor was a vote winner – though they did believe it was the right thing to do.
What things might cause a government to limit its spending on health?

Investment depends on a economy being strong. If the government is struggling to raise taxes, it will struggle to invest in things like healthcare. Likewise there are times when other things are more important. If a country is at war, for example, it will have to prioritise military spending or rebuilding damaged areas. After the collapse of the Roman Empire there was a long period where there was little spent on Public Health. This was caused by the power struggles that occured after the empire collapsed; by the fact that there was no longer a strong government that could organise things and because of the lack of trained soldiers and engineers who could make the improvements.

What has war got to do with the history of medicine?

When wars happen people get injured. This means that surgeons get lots of experience of dealing with different kinds of wounds. As the nature of warfare has changed over time, through the use of new types of weapons, this has led to a greater understanding of the way in which to treat different kinds of injury. This understanding can then be applied in non military situations: for example, treatments for burns developed by military surgeons can be used for people who have been burnt in a house fire.

What examples are there of warfare leading to improvements in medical care?

There are lots of examples. Here I’ll provide one example from the Ancient World, one from the Renaissance and one from the Twentieth century.

The Ancient World: The Romans relied on their army to ensure the security of their empire and to expand it. They invested heavily in ensuring that the army was well trained, able to move around quickly and able to be treated quickly and effectively if injured. This in turn meant that the Romans invested in aqueducts and sewers in towns with a military presence and that they established a good communications network. The purpose was always to maintain military might but the outcome is a very good public health system that is of benefit to civilians as well as to soldiers.

The Renaissance: During the Renaissance Pare made his breakthroughs with the use of ligatures and of potions. Whilst chance played a role in his use of potions, neither of these developments would have happened if it was not for the fact that he was a battlefield surgeon.

Are the improvements all surgical?

There have been lots of surgical improvements as a result of warfare. From the development of different ways of extracting things from the body (arrows, bullets etc); dealing with burns; the development of ligatures and war leading to the introduction of blood banks and increased use of x-rays before surgery is performed. Medical developments caused by warfare aren’t all surgical though. The poor condition of soldiers signing up during the Boer war was one of the reasons why National Insurance was introduced, The First World War led to further welfare legislation and the Second World War was a factor leading to the introduction of the National Health Service.

How does the role of war link in with other factors?

Its very rare that only one factor leads to an improvement. Penicillin is a good example of this. It had been discovered by chance and researched later on by a scientific team. Warfare provided the reason why governments were willing to invest heavily in it and thats the reason why it became so widely available at that time. Without the war the funding might not have been sufficient for it to make much difference for quite a long time – but it was other factors that led to it being discovered and researched. Likewise warfare was one of the main reasons for increased government investment in welfare and health. However it also required factors such as changing attitudes, research and reports and public pressure to get the changes made.

Got another example of war affecting the development of medicine? Feel free to add it as a comment, there are plenty of examples not covered in this guide!

What are continuity and change?

Continuity is when something stays the same. This could be an attitude, belief of a medical practice. Change is when something different happens. This might be a new attitude or belief, or a new treatment.

Why is it important that we study continuity and change?

Medicine through time is a development study so its important that we look at how and why things have got from where they were in the past to how they are today. This allows us to compare the key features of different societies at different periods of time.

What examples are there of continuity over time?

Lots of things have stayed the same throughout time. Thing about what you do if you’re feeling unwell. The odds are that you’ll ask your parents for advice. This hasn’t changed through time. Usually its your mother that you’d ask, again this is something that hasn’t changed over time. For many ilnesses the treatment offered by a parent will be no different to treatments offered in the past. Simple but effective things like resting, having a hot or cold drink, some herbal remedies etc have been around for as long as we have recorded these things. Some beliefs have also continued to stay the same. Religion has always had an influence on medicine; there have always been superstitions; some people have always been frightened of new treatments and technologies. Similarly, ‘common sense’ has always had a role in medicine. For example the idea of isolating people with disease to prevent it spreading is nothing new.

Why have these things stayed the same?

One of the main reasons why something stays the same is the simple fact that it works! Other reasons are beliefs haven’t changed – people have always believed in spirits and gods, for example.

Why have some things changed over time?

New discoveries and technologies can lead to change. The invention of a new medical technique which is proven to work will, over time, lead to a change in the way that things are done. Attitudes can also change. This is often because the need for something to change becomes aparent. An example of this is the change in attitude of governments towards Public Health. As society changed, so did the attitude of those in power.

What might an examiner ask me about continuity and change?

All sorts! You could be asked to compare and contrast treatments in two different periods of time, in order to gauge the amount of change in that period. For example:

Comparing surgical techniques in 1800 with those in 1900 or the modern world.

Comparing methods of dealing with the Black Death with the way that people tried to deal with the Great Plague.

Comparing the treatments available in 1900 with those available today.

What is medical technology?

Medical technology refers to the machines that can be used to help identify an illness or treat it. This includes scanners that can look inside the body, X-Ray machines, Camera technology and equipment used to test samples.

What medical technologies have been developed in the Twentieth Century?

Just before the start of the Twentieth Century William Rontgen discovered how to make use of X-Rays. The use of X-Rays developed in the first part of the Twentieth Century and has improved the way that doctors identify broken bones etc.

One of the first X-Rays taken

In 1943 the first Dialysis machine was used. This was invented by Willem Kolff and replaces the functions of Kidneys which means that people with certain kinds of Kidney Failure can receive daily treatment for their condition.

In 1957 the EEG was introduced. This measures brain activity and is used to identify whether people have conditions such as Epilepsy.

1965 saw the first portable defibrilator. This allows ambulance crews to use the device to help reestablish a normal heartbeat.

Defibrilator

In the same year the first commercial ultrasound device was made available. This is another form of medical imaging which allows doctors to see the inside of the body. It is particularly useful when assessing how well a pregnacy is progressing, or for looking at the way in which specific parts of the body are functioning.

One of the best improvements to medical technology in recent years was the introduction of the CT Scanner in 1971. Invented by Godfrey hounsfield this machine scans the whole body and produces a 3D image of the inside of the body. This can be used to determine where disease is located and to see if it is spreading. In 1980 another improvement to medical imaging was made when the MRI scanner was introdced. This uses magnets to scan and can distinguish between healthy and unhealthy tissues, making it easier to spot things like Cancerous cells.

CT Scanner

What has been the impact of these machines?

Each of these machines makes diagnosis much easier and enables treatments to be accurate and undertaken at an early stage in an illness. This means that recovery is more likely and the quality of life of patients improves.

For a list of other new medical technologies, have a look at this timeline on Wikipedia.

What is the NHS?

The NHS is the National Health Service. This is a publically funded service that provides healthcare to people in the United Kingdom. This includes doctors, dentists, hospitals, health visitors and the ambulance service.

When was the NHS started?

The NHS started on July 5th, 1948. This followed a series of debates and government studies about provision of healthcare. Before the war the British Medical Association had published a pamphlet calling for a unified health service across the country. The outbreak of the second world war led to an Emergency Medical Service being estabished, which effectively nationalised the health service for the duration of the conflict. During the war the government set up an enquiry into healthcare and the resulting ‘Beveridge Report’ of 1942 called for a National Health Service, amongst other things. This was then put before parliament in 1944 and in 1946 a ‘National Health Service Act’ was passed. This legisation created the NHS, and set the timescale for it being established in 1948.

Why did the government start the NHS?

Before the NHS the health system was often based on the ability of someone to pay for treatment. There were free ‘voluntary’ hospitals and charity based hospitals but there was no guarantee of healthcare for all and services across the country were varied in terms of quality and availability. When the NHS was launched the minister in charge said that the NHS was based on three core prinicples:

* That it meet the needs of everyone
* That it be free at the point of delivery
* That it be based on clinical need, not ability to pay

What opposition was there to the foundation of the NHS?

At the time there was considerable opposition to the idea of a National Health Service. Some people argued that local authorities were better placed than the government to run hospitals. Opposition came from consultants who were concerned about the impact that the NHS would have on their income and ability to govern their own profession. There was also a fear that the poor would overburden the NHS and that there would be a prolongued ‘rush’ for pills, glasses and so on. These problems weren’t easily overcome and concessions had to be made to consultants in order to get the medical profession to accept the NHS.

What has been the impact of the NHS?

Life Expectancy in the UK has risen. In 1948 it was 71 for women and 66 for men. Now it is 81 for women and 77 for men.

Infant mortality figures have improved. Now just 6.2 deaths per 100,000 births compared with 86 in 1948.

This article on the Independent website provides further examples of the impact of the NHS.

What were the Liberal Reforms?

The Liberal Reforms were a series of government measures designed to help people who couldn’t help themselves. They included the introduction of National Insurance which included a contribution from the emplyee, employer and government which would be used to pay sick pay and unemployment benefits; Old Age Pensions were introduced; Free School Meals were given to children from impoversished backgrounds to make sure that they got at least one good meal a day and also included legislation covering medical checks of school pupils, limits to working hours and the opening of the first Labour Exchanges (job centres).

When did they take place?

The Liberal Reforms took place between 1906 and the outbreak of the First World War in 1914. The years of some of the key components are listed below:

1906 – Free School Meals
1907 – Medical Inspections in Schools
1908 – Young Persons Act
1908 – Old Age Pensions
1909 – Labour Exchanges
1911 – National Insurance

Why were the reforms introduced?

A number of factors led to the reforms. Many within the Liberal party were eager to help ordinary people and had campaigned with this as a key policy. The military had noted during the Boer War that many conscripts were not fit enough to fight – so something had to be done about it! As working class men could now vote, it was also very important to make sure that things were offered that they would vote for. The Liberals were also wary of the growing strenght of the Labour party. with whom they fored a coalition government in 1910. There was also further research into Public Health that showed that there was a need for intervention in some areas. Rowntree completed a survey of the working classes in York, for example, and Margaret McMillan was pioneering welfare work for children in Bradford at this time.

Were the reforms welcomed?

The ordinary people who benefitted from the reforms were obviously quite happy about things but there were opponents of these measures. Many people objected to the increases in tax to pay for the reforms; others complained at the National Insurance contributions they had to pay and politicians from other parties criticised the measures, to the point where there was a major consitutional crisis in 1909 when the House of Lords refused to approve the ‘Peoples Budget’ put forward by the Liberals. Some of these criticisms were from people who believed in the ideas of Laissez -Faire which basically means ‘leave them to sort it themselves’ whilst others criticised the reforms for not going far enough.

What impact did the Liberal Reforms have on health?

The Health of Children improved as a result of the reforms. By the outbreak of war around 150,000 pupils were receiving free school meals and regular medical inspections. This helped to reduce child mortality figures (as did the introduction of vaccines). Free medical care was available for some and this clearly helped to save lives. The quality of life for the elderly was also improved.

For further information see BBC Bitesize or complete the revision diagram at schoolhistory.co.uk.

What are infectious diseases?

Infectious diseases are illnesses that can be transmitted from person to person or spread through the air or water. They are spread by microbes which cannot be seen by the naked eye. Examples of infectious diseases in the past are the plague, smallpox and cholera. In recent years we have had outbreaks of swine flu, which is another infectious disease. See this youtube video for an overview of the history of infectious diseases.

How do we treat infectious diseases today?

In the western world there are vaccines available for many of the most dangerous infectious diseases. These vaccines mean that the spread of the disease is prevented. However these vaccines are not available in every country – something that the World Health Organisation is trying to rectify. For new variants, like swine flu, it is impossible to vaccinate in advance of the disease spreading. When this form of disease emerges scientists work hard to try and create a vaccine. Whilst they are doing this, people with symptoms are often quarantined, movements are restricted and painkillers and supressants are given to people who are ill.

Who discovered a way of tackling these diseases?

The first vaccinations were carried out by Edward Jenner who created a vaccine for smallpox. However he didn’t understand how the vaccine worked so it wasn’t until work by Louis Pasteur in the 1860’s that the cause of infectious diseases was proven to be germs. After this was established scientists like pasteur and Robert Koch were able to identify the microbes that caused certain diseases and develop vaccines for that disease.

What factors led to this discovery?

Eaxh of the scientists involved in the fight against infectious disease was a determined and highly motivated individual, so the Role of the Individual cannot be underestimated here. However the vaccines themselves were produced in huge quantities with governments funding both the research and the production of the vaccines. Often this has been prompted by involvement in wars. The development of vaccines has therefore been the result of a combination of factors.

How quickly did scientists manage to defeat different diseases?

Esward Jenner’s first experiment with a smallpox vaccine was in 1792. It took years for his ideas to be universaly accepted and smallpox was not eradicated until 1980! (Eradication of smallpox verified by WHO on 8th May 1980). Even after Jenner’s first use of vaccination it was not until the 1860’s that further breakthroughs were made. After Germ Theory (1862) there were a number of vaccines produced. Even these took time to create. A vaccine for Cholera was developed in 1879, followed by Rabies in 1885, Tetanus in 1890 and Typhoid in 1896. In the Twentieth Century vaccines have been developed for numerous other diseases – see http://en.wikipedia.org/wiki/Timeline_of_vaccines for a list of these.

How successful have scientists and doctors been in the fight against infectious disease?

In the modern world relatively few people die as a result of catching an infectious disease so it looks like scientists and doctors have been quite successful in the fight against these diseases. However not all infectious diseases have vaccines and they are not available everywhere yet. There are still outbreaks of infectious diseases that cause widespread concern. For example the spread of swine flu in recent years has caused much alarm and Bird Flu several years earlier also caused concern.

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 was the revolution in surgery?

The term ‘revolution in surgery’ is used to describe a period of time when a series of breakthroughs led to surgery becoming cleaner, relatively pain free and much safer. Before this period surgery was quick, dirty and dangerous with patients having a large death rate due to blood loss, pain and infection. After the revolution in surgery each of these issues was minimised.

What period of time are we talking about?

Really open to interpretation here as some would argue that we’re still in this period. Here, I’m talking about surgery from about 1750 to about 1900.

What was surgery like before this period?

In simple terms: it was QUICK (it had to be to prevent blood loss); DIRTY (because people weren’t aware of the causes of infection) and PAINFUL (because there were few effective painkillers). Each of these three problems combine to make it very dangerous – though it was sometimes successful!

How was the problem of pain overcome?

Throughout time people have tried to overcome the problem of pain during surgery. They used things ranging from alchohol to hemlock to try and numb the pain, but numbing it was all that it really did. In the 19th century surgeons made some huge advances. Through experimentation they developed anaesthetics that meant that surgery became much less painful. Early attempts were the use of carbon dioxide (1820’s) and nitrous oxide (laughing gas) in 1846. Both had some pain relieving qualities but weren’t highly successful. Around the same time Crawford Long secretly made use of Ether on a patient. The same anaesthetic was then used by William Morton in 1846. News of his successful use of Ether led to it being tried by surgeons around the world. Ether had drawbacks though – patients sometimes vomitted as a result of being given it and it was highly flammable. The use of Ether was largely replaced by the use of Chloroform in the UK. This was first used by James Simpson in 1847 and became popular after it was made known that Queen Victoria had used it as a painkiller during childbirth.

Use of these painkilling anaesthetics developed. Local anaesthetics were introduced in 1877 and in the 20th century ways of inducing sleep and relaxing muscles were discovered.

How was the problem of blood loss overcome?

Surgeons had always known that loss of blood was a real problem and attempts had been made to replace it for some time. For example, in the 15th century Pope Innocent VIII had blood from 3 young boys infused into his body (basically pured down his mouth). It didn’t work – but the notion of transfusion was clearly recognised by some at that time. Experiments on animals and several humans took place throughout the 16th and 17th centuries with small amounts of blood from animals successfully being infused into several humans. All attempts to place large amounts of blood into people failed though. The first successful transfusion was in 1818 when James Blundell extracted 4 ounces of blood from his arm and successfully transfused it into his wife. Between 1825 and 1830 he carried out a further 10 transfusions and in 1840 he was part of the team who performed the first whole blood transfusion.

Even though they had worked out how to replace blood during surgery many patients still died. This was because the wrong kind of blood was often used. In 1901 Karl Landsteiner discovered blood groups. After this, surgeons could match blood groups and reduce the risk of there being a fatal reaction / rejection of the blood.

This just left the problem of having enough blood available. This problem has largely been solved through the development of blood banks and improved storage methods that have been developed over the past 100 years.

How was the problem of infection overcome?

The ultimate frustration for surgeons must have been to successfully operate, reduce blood loss and make sure that pain didn’t overcome the patient, only to see them die a few days later from an infection. Of course until Germ Theory was developed and accepted, surgeons weren’t sure what caused these infections and so they could only guess at what to do to limit the risk. One of the first to do so successfuly was Ignaz Semmelweiss. He insisted on cleanliness and had much better survival rates than other surgeons doing similar work – but he wasn’t able to convince others to do the same. The breakthrough came in 1867. Joseph Lister was a surgeon in Glasgow. He read about Germ Theory and realised that this was connected to the infections he saw. When he heard about a spray being used in sewers to reduce the risk of disease he decided to investigate. He quickly came to the conclusion that using Carbolic Acid to clean wounds and bandages would significantly reduce infections. His ideas were adopted by the German army in the Franco-Prussian war and the positive outcome helped to convince people that his methods were effective. Following this, Robert Koch worked on sterilisation of surgical equipment, which led to further improvements. This ‘big idea’ is antiseptic surgery – and antiseptics are still widely used today. These ideas have been developed so that nowadays not only are the bandages, wounds and equipment clean, so is the air! Modern operating theatres have filtered air streams and are ‘asceptic’ (ie totally clean).

Did everyone approve of the changes?

Some of these developments encountered lots of opposition. becase some of them were quite experimental they didn’t always work. This cast doubt over the merits of the ideas and until scientists ‘got it right’ there were many who doubted them. There are also moral and religious objections to some of these ideas, for example, Blood Transfusion.

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.