Welcome to Medicine and Change! (c800 – the present day)

Hello Historians! This chapter is one of the most exciting parts of the course because it shows massive change over a long period. We are going to track how people understood sickness and health, from the days of believing in magic cures to modern DNA analysis.

Understanding this journey of change is key to success in the "Studies in Change" section. We won't just learn *what* happened, but why it happened, and what sped up or slowed down progress!

1. Medicine in the Medieval World (c800 – c1500)

In the Medieval period, change happened very slowly. People relied on old ideas and religious beliefs. If you felt sick, the explanation was rarely scientific.

Causes of Illness: The Dominance of Ancient Ideas

The most powerful medical idea came from two ancient Greek thinkers: Hippocrates and Galen.

  • The Four Humours: This was the primary explanation for illness. Galen believed the body contained four liquids: Blood, Phlegm, Yellow Bile, and Black Bile.
  • Balance is Key: If these humours were balanced, you were healthy. If they were unbalanced (e.g., too much blood), you were sick.
  • Miasma Theory: People believed that Miasma (bad air or foul smells) caused disease. This theory lasted for over a thousand years!
  • Religious Explanations: Many believed illness was a punishment from God for sin, or sometimes caused by witchcraft or the movement of the stars.

Quick Memory Tip (Four Humours): Think of it like a four-sided balanced scale. If one side drops, you have to try and remove the excess weight!

Treatment and Prevention

Since doctors believed the humours caused illness, treatments focused on rebalancing them:

  • Bloodletting (or Leeching): Removing blood to deal with an excess of the Blood humour.
  • Purging: Making the patient vomit or using laxatives to remove excess bile or phlegm.
  • Herbal Remedies: Used often, though usually based on trial and error rather than understanding the cause of the disease.

Did you know? Medieval surgery was very dangerous. They had no effective anaesthetic (painkiller) or antiseptic (to stop infection), so operations were quick, brutal, and often fatal due to shock or infection.

Key Takeaway: Medieval Medicine

Progress was stalled by the dominance of the Church (who promoted Galen's ideas because they fit Christian belief in divine design) and a lack of scientific methods. The focus was on theory, not observation.

2. The Renaissance and Early Modern Period (c1500 – c1750)

The Renaissance was a "rebirth" of learning. People started questioning old texts. This period saw the foundations of modern science being laid, though actual medical cures still lagged behind.

Key Changes in Anatomy and Diagnosis

The biggest breakthroughs in this period were in understanding Anatomy (the structure of the body) and Physiology (how the body works).

  • Andreas Vesalius (Anatomy): In the 1540s, Vesalius performed detailed human dissections. He published On the Fabric of the Human Body, correcting over 300 of Galen’s long-held mistakes. This was revolutionary because people finally started trusting observation over ancient texts.
  • Ambroise Paré (Surgery): A battlefield surgeon who ran out of boiling oil (the standard treatment to seal wounds). He improvised a mixture of egg yolk, rose oil, and turpentine. He noticed the wounds healed better and were less painful. He also designed ligatures (tying off blood vessels) instead of cauterising (burning) them.
  • William Harvey (Circulation): Published his findings in 1628. He proved that the heart acted as a pump, and that blood circulated around the body, flowing in one direction. This completely destroyed the basis of the Four Humours theory (which assumed blood was constantly being made and consumed).

Don't worry if this seems tricky at first: Although Harvey proved the Four Humours theory was physically impossible, treatments like bloodletting continued for another 200 years! Changing belief systems takes a long time.

Slowing Factors

Why didn't medicine suddenly get brilliant?

Despite the breakthroughs in anatomy, doctors still did not know what caused disease. They couldn't see the germs. Without the microscope being fully developed and accepted, the true cause of sickness remained a mystery, meaning effective treatments couldn't be designed.

Quick Review Box (Renaissance)

What changed? The map (Anatomy) and the instructions (Physiology).
What stayed the same? The understanding of the cause of disease (still Miasma/Humours), and therefore, most treatments.

3. The Industrial Era and the Germ Theory Revolution (c1750 – c1900)

The 19th century was the period of the fastest medical change ever. Cities were growing (leading to huge public health problems), and technology (like improved microscopes) finally allowed scientists to see the unseen world.

From Miasma to Microbes: The Germ Theory

  • Louis Pasteur (The French Connection): Initially hired to solve problems in the French beer and silk industries, Pasteur proved in the 1860s that tiny microbes (germs) caused decay and fermentation. Through his famous swan-neck flask experiments, he proved that germs in the air caused contamination.
  • Pasteur’s Conclusion: If germs can make wine 'sick', they can probably make humans 'sick'. This idea became the Germ Theory.
  • Robert Koch (The German Rival): Koch developed methods to stain and photograph bacteria. He identified the specific bacteria responsible for diseases like anthrax and tuberculosis. This was vital because he showed that specific germs caused specific diseases.

Analogy: Before Koch and Pasteur, doctors knew people were dying (like knowing a house burned down). After Germ Theory, they knew exactly which faulty wiring (which specific germ) caused the fire!

The Surgical and Prevention Revolution

Germ Theory immediately led to massive improvements in two areas:

A. Infection Control (Antiseptics)
  • Joseph Lister: Read Pasteur’s work and realized that surgeons were bringing germs into the patient’s body via unwashed hands and instruments. He began using carbolic acid (a chemical disinfectant) on wounds, instruments, and bandages. Death rates from infection plummeted.
  • Key Term: This method of killing germs before they enter the body is called Antiseptic Surgery.
B. Prevention (Vaccination)
  • Edward Jenner (1790s): Although he worked before Pasteur, Jenner’s discovery paved the way for modern immunology. He noticed milkmaids who caught harmless Cowpox never caught deadly Smallpox.
  • Jenner deliberately infected a boy with Cowpox, and later tried to infect him with Smallpox (which failed). This proved that exposure to a milder disease could prevent a serious one. This process was called vaccination (from vacca, Latin for cow).

Public Health Reforms

Industrial cities were filthy. The Miasma theory, while wrong about the cause of disease, led to the right actions: cleaning up!

  • Edwin Chadwick: His 1842 report highlighted that poor living conditions and lack of sanitation led to massive disease outbreaks and high mortality.
  • The Public Health Acts (1848 and 1875): The 1875 Act was mandatory, forcing local councils to provide clean water, proper sewers, and rubbish removal. This massive government intervention was key to improving health for everyone.
Key Takeaway: The 19th Century

Germ Theory was the pivot. It allowed doctors to stop guessing and start targeting the *actual* cause of disease, leading to antiseptic surgery and effective public health measures.

4. Modern Medicine (c1900 – Present Day)

The 20th and 21st centuries saw medicine become a global industry driven by high technology, government funding, and large-scale teamwork.

Advances in Diagnosis and Treatment

The Chemical Revolution: Magic Bullets and Antibiotics
  • Paul Ehrlich (Early 1900s): Searched for a chemical compound that would kill the germ causing disease without harming the human body. He discovered Salvarsan 606, the first 'magic bullet' for syphilis.
  • Alexander Fleming (1928): Accidentally discovered Penicillin when mould drifted onto a petri dish and killed the bacteria around it.
  • Florey and Chain (1940s): Developed methods to mass-produce Penicillin during World War II. Penicillin became the first widely available antibiotic, revolutionizing the treatment of bacterial infections.

Common Mistake Alert: Students sometimes forget that Fleming only *discovered* Penicillin. It took the work of Florey and Chain (and US funding) to make it useful.

Technology and War
  • X-rays: Developed in 1895, X-rays were crucial during World War I for quickly diagnosing broken bones and locating shrapnel.
  • Blood Transfusions: The discovery of blood groups by Landsteiner (c1901) and the ability to store blood (blood banks) meant successful transfusions saved countless lives on the battlefield and in modern surgery.
Understanding Genetics

In 1953, Watson and Crick discovered the structure of DNA. This unlocked the field of genetics, leading to new ways to diagnose and treat inherited diseases, and paving the way for advanced gene therapy today.

Modern Public Health and Government Role

The biggest factor affecting 20th-century health was the role of the government.

  • The National Health Service (NHS), 1948 (UK example): Provided free healthcare "from the cradle to the grave." This ensured that everyone, regardless of wealth, could access the latest treatments, leading to massive overall improvements in national health.
  • Lifestyle Campaigns: Governments now focus on prevention through education (e.g., campaigns against smoking, promoting healthy eating).
  • Global Eradication: Vaccinations (like the polio vaccine) are now administered globally, showing a vast change from the localized treatments of the past.
Key Takeaway: The Modern Era

Change is driven by massive funding, specialized teams of scientists, and high technology (like lasers, scanners, and genetic sequencing). The shift is towards prevention, targeted chemical cures, and treating the root causes of disease (genetic or environmental).

5. Factors Influencing Change (Review for "Studies in Change")

When studying change in medicine, you must be able to discuss the factors that promoted or hindered progress in different eras.

A. Key Individuals (The Pioneers)

  • Promoted Change: Vesalius, Harvey, Jenner, Pasteur, Koch, Lister, Fleming.
  • Impact: They provided crucial breakthroughs that altered the direction of medicine (e.g., Germ Theory).

B. Technology (Tools for Discovery)

  • Promoted Change: The printing press (spreading Vesalius’s and Harvey’s ideas), improved microscopes (allowing Pasteur and Koch to see germs), X-ray technology, and modern computing/scanners.
  • Impact: Technology allowed people to observe, communicate, and diagnose things that were previously invisible.

C. War (Necessity is the Mother of Invention)

  • Promoted Change: War forces quick solutions to mass injury and infection.
  • Examples: Paré’s improvements in battlefield surgery (Renaissance), Lister’s adoption of antiseptics to treat soldiers, the rapid development and mass production of Penicillin during WWII, and the development of triage systems.

D. Government and Public Health

  • Promoted Change: Government action turns discovery into widespread benefit.
  • Examples: Passing the Public Health Acts (ensuring clean water), funding scientific research, and establishing the NHS (making treatment accessible).

E. Religion and Attitudes (Often a Slowing Factor)

  • Hindered Change: In the Medieval period, the Church promoted Galen’s work and sometimes discouraged dissection, slowing anatomical progress for hundreds of years.
  • Hindered Change: Lack of acceptance of new ideas (e.g., it took decades for doctors to adopt Lister’s antiseptic methods, even after the evidence was clear).