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In pre-historic times people knew nothing of the causes of disease and very little about even the simplest surgery. Alongside this we can see modern day medicine, with the true understanding (or so we believe) of disease, and the ability of surgeons to perform the most complex and amazing of operations. Can we really compare these two times which appear so contrastingly different?
Despite the obvious progression in medicine in the present day compared with the pre-historic times, there are in fact many similarities. For example, the religious aspect: through the centuries people have prayed for healing from the pre-historic medicine men who cast spells to send away evil spirits, to the present day when people may attend miracle healing sessions or visit a holy place in hope of a cure.
Another example is the use of herbal remedies. This is now coming back into fashion as people prefer to use less in the way of manufactured chemicals and to rely more heavily on the Earth's natural resources. It is important to remember that these cures too were first used long ago during the pre-historic era.
Of course, there are major improvements in our understanding of medicine now compared with the past. We now think we know why people get ill and we can prevent and cure many diseases. The sections below explain the way medicine has changed over the years to the present day and the factors that have allowed this change to occur.
In pre-historic times, most people led a nomadic lifestyle. This made it difficult for ideas to be shared and developed as they could be in later civilisations. This prevented progression in medicine as a person might have a good idea or theory but the nomadic lifestyle prevented many people hearing about it or building on it.
Pre-historic times are times before there were any written records. This means that we have no sources from the time which describe people's feelings and beliefs. We can guess at them, however, by looking at other sources such as created objects and assuming that pre-historic people had the same ideas as people who live in a similar way today, such as the Australian Aborigines.
We know that most people of a nomadic culture today have strong beliefs in the spirits causing disease and use medicine men to cure banish these evil spirits. There is reason to believe that pre-historic people had these same ideas, for example man made objects have been found which look like charms used by modern day nomadic people. Assuming that pre-historic people did believe in evil spirits, this would have been a hindrance to medical progress as illness would have been treated by casting spells rather than finding practical cures.
We do know, however, that pre-historic people did perform some simple surgery. The most well known is trepaning or trephining which means cutting a hole in a person's skull. (It is believed that this was done to allow the evil spirit to leave the body, but may have been successful in curing diseases such as epilepsy.) We know that some patients survived the operation since skulls from the time have been found with the bone grown back over the hole.
Egypt was one of the first Ancient Civilisations. A civilisation such as Egypt had a much higher chance of progressing in medicine because ideas could be shared among the inhabitants who lived close together. They also had developed a writing system which allowed theories and ideas to be recorded for proceeding generations.
Despite this, the Egyptians were not a very advanced nation when it came to medical progress. The hindrance was religion. The Egyptians believed that their bodies were needed in the after-life. This meant that dissection was forbidden, hindering improving the knowledge of anatomy. It was not all bad news though, the Egyptians did learn the position of the main body organs such as the brain and the liver, because these had to be removed during mummification (the process applied to bodies when they died).
As well as preventing the Egyptians learning about human anatomy, religion also stopped them from looking for causes and cures for disease. The Egyptians worshipped a God of Healing called Impoteph and they prayed to him to cure their illness.
The next Ancient Civilisation was Greece. Greeks worshipped a number of Gods, including Asclepios, the God of healing. Many Ancient Greeks believed that all they had to do was to pray to Asclepios and to give him offerings and they would be cured. This prevented them looking for scientific explanations of disease, again hindering medical progress.
There were, however, people in Ancient Greece who did not just follow the Gods. One of them was Hippocrates; he was a Greek doctor who came up with a theory about the causes of disease. He believed that there were four Humours - blood, black bile, yellow bile and phlegm - and that disease was caused by an imbalance of these humours1.
Hippocrates' theory led to many cures that did not work such as bleeding to get rid of excess blood and of course the theory is now believed to be incorrect. However, Hippocrates is still known to be the Father of Modern Medicine because his theory was the first time doctors began to look for practical causes and cures of disease.
At around 300 BC, the Romans became a strong nation and their empire grew, taking over many other civilisations including Greece.
The most important thing for the Romans was to create an army fit to conquer nations. They soon realised that to do this they would have to make sure that their army was fit and healthy. This was done by the government providing public baths, toilets and clean water for the population to prevent them catching disease.
The Romans' main achievement was with public health, however if they did get ill, they would rely on the Greeks (part of their empire) for curing them. This could mean consulting a Greek doctor or even borrow the Greek God of healing, Asclepios!
Galen was a Greek doctor in Rome. He stressed the importance of knowing the anatomy of the human body and he told medical students that they needed to perform human dissection to really see for themselves what the body was like. If they could not do this, he advised that they dissect the bodies of apes which were similar. Galen made a number of mistakes by assuming that apes were identical to humans.
Early Middle Ages
With the collapse of the Roman Empire at around 500 AD, there was chaos in Western Europe. The area split into small tribes which were frequently at war with one another.
These wars hindered medical progress in two ways. Firstly, they prevented people communicating so widely and sharing ideas which meant that little further medical progress could be made at that time. The other hindrance was that wars destroyed many of the Roman public health systems, meaning not only that the people at the time were less healthy but that people in the future would have to re-discover Roman ideas before they could build on them2.
The Middle Ages
There were two main groups of people during the Middle Ages, those following Islam and those following Christianity.
Christians during the Middle Ages believed that the sick should be cared for and because of this the Christian Church set up hospitals. They were very different from modern day hospitals, since the main cure given to patients was prayer. (Some hospitals even banned people with contagious diseases from entering in case they infected other people.)
Galen's works were followed by Christians; this, along with the fact that they were allowed to dissect bodies, resulted in a good knowledge of anatomy. However, Galen's work was thought to be holy so Christians were unable to suggest that Galen had made mistakes. This meant that medical students who carried out dissections really only did this to prove that Galen was right or to understand better what they had already been told.
Christians did not tend to be very clean as many literally believed that once they had been baptised they never needed to wash again. This made them more likely to get ill.
Despite the obvious hindrances of Christianity to medical progress, it is important to remember that the Christian Church was really the only strong organisation left in Western Europe after the collapse of the Roman Empire. In this role it was very useful for medical progress as it brought people together so that they could discuss ideas. It was also in the Christian monasteries where the first experimental science took place, which would be useful to medicine in the future, and where libraries of books were collected, allowing medical ideas to be stored for the future.
The Muslims* also believed that it was their duty to care for the sick. There were a number of Islamic doctors, however, like the Christians, one of their most commonly used cures was to pray for healing.
Muslims were taught by their religion to wash before praying 5 times a day. This meant that Muslims were far cleaner than Christians and, as a result, more healthy.
Dissection was strictly forbidden in Islamic medicine, which hindered the knowledge of anatomy. Galen's books on anatomy were followed, but they were believed to be holy so that nobody could criticise them. When one doctor did dare to criticise them he was put to death.
Probably the most important contribution that was made to medical progress by Islamic medicine was the work of alchemists. They discovered many chemicals which later were used as cures for disease.
The Renaissance was a re-birth of Greek and Roman ideas. This included architecture, art and even medicine. This was very important because people began to think about medicine again, instead of just following the old ideas.
Other changes in the Renaissance helped medical progress as well as changes of ideas. Renaissance art was one example. It is far more realistic than the art in the middle ages and this influenced medicine in two ways. Firstly, doctors such as Vesalius could employ artists to draw realistic diagrams in their medical books to spread the ideas. Perhaps more importantly, however, for artists to draw realistically they really needed to know about what the human body was like inside so they pushed for more dissections - something which would obviously also help doctors.
Officially the world's first modern anatomist3, Andreas Vesalius was born in Brussels in 1514 and studied medicine in Paris and Italy. He was an early Renaissance doctor and one of the first doctors to openly criticise Galen. He corrected many of the mistakes that Galen had made on human anatomy, saying that he could now rectify Galen's errors because Galen had been formed to rely on dissecting apes while he could dissect humans.
William Harvey was born in 1578 in Kent and studied medicine in Cambridge (Gonville and Caius College) and Padua. He, like Vesalius, criticised Galen's idea, this time on the physiology of the human body.
Harvey's greatest discovery was on the circulation of the blood. The Greek doctors had believed that blood was created by the heart, then carried by veins to the limbs where it was used up. Harvey disagreed - he likened the heart to the water pump (a new invention at the time) and said that the heart pumped the blood around the body. He carried out many experiments and eventually proved the idea when he realised that the amount of blood leaving the heart every second was far too high to have been produced by the body.
Pare was born in France in 1510. He was a war surgeon for the French Army, and one of the first people to improve surgery. One day, when he was treating wounds (using the normal method of pouring burning oil into them) he ran out of the oil. Desperate to help the injured soldiers, he improvised with his own mixture of egg yolks, oil of roses and turpentine. When he came back later he found that the men who had been treated with the boiling oil were feverous while the ones he had treated with his own mixture were better. This made him decide always to use this new mixture when curing war wounds.
In this example, both chance and war played a role in the discovery. It was lucky that Pare ran out of the oil and even more lucky that his improvised ingredients were ones that worked. If there had not been a war, Pare would not have had so many wounds to deal with and so might well not have run out of the oil.
After this discovery Pare realised that what he had been taught was not always the best way of treating wound, so he began to try other ideas of his own. He noticed how painful men found the cauterising* of open wounds so he tried a new method of tying ligatures. Unfortunately, although this was a good idea, the ligatures were often dirty and introduced infection into the wound. This method was only to become useful once anti-septics had been discovered.
1750 - 1900
Government Intervention in Public Health
The 18th Century was the time of the Industrial Revolution in Britain, which was followed by similar revolutions in many countries across the developed world. The Industrial Revolution led to a sudden large number of people moving to the cities to be near the work in new factories. People were forced to live in tiny back-to-back slum housing, squashed together with other families. There was a large amount of pollution in the cities and public health became worse.
Edwin Chadwick was a British civil servant in the 1830s. He produced a report on the Sanitary Conditions of the Labouring Population. The report recommended a number of measures to improve public health among the working classes and led to the introduction of laws to improve public health such as the Factory Act, improvements in water supplies, compulsory vaccinations and laws about child labour.
This was the first time since the Roman times that the government was truly becoming involved again. However, many people resented this, preferring to be ill than to be forced to be clean.
One of the killer diseases of the 19th Century was cholera. There were major epidemics throughout the century, but nobody knew how to stop it, until Dr John Snow proved the link between cholera and water supplies.
John Snow was a London doctor. He researched an outbreak of cholera in the Broad Street area of London, and produced a map showing where people lived who had caught cholera. He noticed that the only people who caught the disease were people who had drunk water from one pump.
Snow had information that suggested that cholera was caused by drinking water from this source, but he had not proved it. He removed the handle of the pump so that people had to go to another pump for their water. Nobody else died.
Snow had proved that infected water caused cholera, so now people could stop the spread of cholera by identifying the infected water source, but this was not all; he had also developed the developed the epidemiological* approach to disease.
Jenner a country doctor in Britain. He discovered and introduced the first vaccines (against smallpox) at the end of the 18th Century.
Jenner noticed that milkmaids who caught cowpox, never caught the deadly disease of smallpox. This led him to wonder if cowpox prevented the development of smallpox in some way. After conducting experiments, he concluded that this must be the case and introduced a new vaccine which involved infecting patients with cowpox. This was followed by the discovery of other vaccines by doctors who followed Jenner's example.
Smallpox had been a deadly and extremely unpleasant disease. (If you survived you would be scarred for life by the disease.) It might have been expected that everybody would want to try the vaccine which might protect them from the disease. This was not the case and Jenner met a lot of opposition.
Jenner was a country doctor and most people in the 19th Century people felt that country people were not clever. This meant that people thought that the vaccine might not work.
The vaccine involved catching a disease which was usually present in cows. A lot of people were scared of this since it would be unnatural and might affect them in a strange way. (People opposed to the vaccine put up posters of people turning into cows as an example of the sorts of things that Jenner's vaccine might do.)
Finally, Jenner's vaccine was new, and many people were scared of the consequences of trying new things.
The Germ Theory
During this the 18th and 19th Centuries, people began to understand that germs caused disease.
Louis Pasteur first came up with the germ theory. Until Pasteur people had believed that germs occurred spontaneously in places where there was disease. Pasteur proved that it was, in fact the other way round - germs caused disease.
Pasteur was working for a brewery trying to find a way of preventing the alcohol going bad. He knew the germs found in alcohol were alive and that he could kill them by heating the alcohol to a high temperature. He also guessed that germs caused the alcohol to go bad. Pasteur organised an experiment to prove this.
He took two glass bottles containing alcohol and heated them to kill the germs. He then heated the spout of one and bent it to make a kink. Then he left the bottles. When he came back he saw that the alcohol had gone bad in the bottle without the kink and that this contained germs. When he looked at the bottle with the kink, he saw that the alcohol was the same as when he had left it. Further examination showed that there were germs stuck in the kink in the spout.
Pasteur's experiment had proved that the way to prevent disease occurring was to prevent germs getting in. Finally, he knew the cause of disease.
Pasteur's theory was important, but it was not yet related to medicine. Robert Koch was the doctor who related Pasteur's germ theory to human illness.
Koch was born in Prussia in 1843. He first became a surgeon in the Franco-Prussian war, then a country doctor. As a doctor, he made a study of anthrax* and managed to prove that anthrax was caused by a germ.
Following this, Koch searched for the germs which caused more diseases* and tracked down many, perhaps the most significant of all being the germ which causes tuberculosis. Koch was recognised for his work with many honours including the Nobel Prize for Medicine.
The Royal College of Surgeons
In the 18th Century the reputation of surgeons rose. Until 1745, the surgeons had belonged to the Royal College of Barbers and Surgeons, and as such had not been considered proper members of the medical profession, but in 1745 century surgeons broke away from this college as they found themselves earning more and more respect.
One of the reasons for this was education. Before, surgeons had mainly been the uneducated members of society but during the 18th Century they often attended the growing numbers of anatomy schools. This gained them a better reputation and more recognition so that in 1800 The Royal College of Surgeons in England was established. This college proved to the world that surgeons and their work was important in medicine, making it more likely that surgeons would be educated people who would be able to think of ways to improve surgery.
Improvements in Surgery
The 18th and 19th Centuries saw most of the problems in surgery solved, so that operations could finally be undergone with a reasonably high chance of survival. Pare had already solved the problem of bleeding, and in the 18th Century, doctors learned how to make surgery painless.
James Simpson invented the first anaesthetics to solve the problem of pain during surgery. Before this alcohol had been the only pain relief so many patients had died of the shock of the pain rather than the actual operation. Chloroform was probably the most widely used and was administered by holding a rag soaked in it over the mouth of the patient.
As with most medical progress, chloroform met opposition. There were two main reasons. The first was the fact that it was difficult to give the correct dose and there were some tragic cases where overdoses were given so that the patient never woke up. The other reason was religions. Some people believed that pain was sent by God and that it was irreligious to stop that pain.
Queen Victoria, the Queen of England challenged that attitude when she requested chloroform during the birth of her eighth son, Leopold. Since members of the Church of England believed that the Queen represented God, its members began to believe that God must be happy with the use of chloroform.
Joseph Lister helped the next major step in surgery when he invented the use of carbolic acid4 as an anti-septic to kill germs in operations. He got the idea of using this because carbolic acid was used in sewage works for killing germs. The carbolic acid was sprayed everywhere, however, many surgeons were opposed because it was very unpleasant and made their hands crack. Jokes were made about Mr Lister's microbes and a lot of surgeons did not take Lister's advice.
Surgeons that did follow Lister's advice often did not follow his methods carefully enough and so did not have such a high success rate. However, this was a major step forwards since it meant that the problem of infection had finally been solved.
Until the 20th Century blood loss in operations was a problem because blood transfusion was usually unsuccessful and very hard to perform, since blood could not be stored so on-the-spot donors had to be found.
In 1901 blood groups were discovered. Until then people were given blood transfusions from people of any group and even animals! No wonder they were rarely successful. There was still no known way to store blood, however blood transfusions could be performed successfully with on-the-spot donors.
The next discovery was thanks to World War I. During the war, large quantities of blood were needed for transfusion so doctors were under pressure to find a way of storing blood. Finally, somebody had the idea of separating the plasma from the rest of the blood so that blood could be stored effectively and given to patients who needed it after operations.
In 1928 in Britain, Alexander Fleming discovered that penicillium mould could fight bacteria when some landed on a petri-dish in his laboratory. World War 2 was imminent, and the British government realised that anti-biotics would be needed. They funded a team of scientists to extract the penicillin to a useable form and paid for a factory so that it could be mass produced.
During the early 20th Century, National Health Insurance was introduced in the UK. This was the idea that workers paid one penny in every pound of their wages to the government and in return they would be given free medical treatment when they were ill. This was a huge step forwards at the time, however, there were still problems since neither women nor children could become part of the scheme.
During WWII, the UK government introduced a temporary health scheme to deal with the problem that normal civilians of all social classes were being wounded by falling bombs and that they needed a healthy nation to win the war.
At the end of the war a Labour government was voted into power. They set up the British National Health Service to which everybody contributed in their taxes and from which everybody could get free treatment. Around the same time, other countries followed the same idea.
The NHS is still essentially the same principle as it was when it was first set up. However, major changes have been made, due to the increased cost to the government and limits on the funds that the government have put in. For example, once prescriptions were free for everybody, whereas now most people have to pay.
Recently medicine has been developing rapidly in all areas due to improvements in communication and teamwork between people all over the world. In surgery, keyhole surgery is being developed and chemists are always searching for new drugs*. Another area which is gaining a considerable amount of interest is the mapping of the human genome which could open up new ways of screening for diseases and creating donor organs etc.
Nevertheless, despite these massive steps forward, the factors which influence medical progress and regression are still the same as they have always been: religion, war, individuals, team work, government intervention and, perhaps most importantly, chance.