Medicine and treatment through time (1A)

Medicine and Public Health in Roman Britain to c.1350 (Extension Unit 1)

This topic is split into the following areas:

Ideas about the cause of disease Approaches to the treatment and prevention of disease and illness The influence of changes in society on medicine and treatment

The following is a checklist of things you should know for this topic:

The influence of Hippocrates (Greek) and Galen (Roman)

Hippocrates

Hippocrates is known as the Father of Medicine. He was a Greek doctor who did not believe that disease was sent by the gods; instead he believed that it had a physical and rational basis and could therefore be treated. His ideas were written down by his followers and had an influence on the way doctors were trained. Hippocrates said that a doctor should respect all life, if they did not know how to treat an illness they should not do anything that could be harmful. He introduced the Hippocratic Oath to give people confidence in doctors, but to also make it clear that doctors are not magicians. They had to keep high standards of treatment and behaviour and to work for the benefit of the patient as opposed to trying to make themselves wealthy. He developed the approach that became known as Clinical Observation, stating that a doctor should: study a patient’s symptoms (breathing, heartbeat, temperature and urine) and ask how their illness had changed. A doctor should make notes and use their knowledge of any similar cases to try and predict what may happen. Once any such predications were shown to be accurate, then they could correctly diagnose the illness and treat it, preferably through diet, exercise or rest. Hippocrates is famed also for his development of the Theory of the Four Humours as an explanation for illness. Hippocrates theories and teachings were popular in Roman Britain.

Galen

Galen was a Greek doctor who worked in Rome in the 2nd century CE. Like Hippocrates, Galen valued the importance of observation. He developed the ideas put forward by Hippocrates and suggested a new way of balancing the humours in the body through his Theory of Opposite. Galen gained experience as a surgeon treating gladiators. He also carried out dissections though most of these were carried out on animals. In a famous dissection he cut the nerves in a pig’s spinal cord to prove that movement and the voice were controlled by the brain. He produced a number of books that were studied for the next thousand years.

Though Galen had lived before Christianity became a major religion, he did believe in the soul and said that parts of the body had been created to work together. These ideas fitted in well with established Christian ideas and beliefs, meaning his teachings were approved by the Church. Since the majority of training in the Middle Ages and up to the Reformation was controlled by the Church, and most collections of books were in monasteries, it was very difficult to challenge Galen’s ideas. The Church did not however approve of the use of dissections.

The importance of Public Health and hygiene

The Romans placed little emphasis on medical knowledge but they did notice that disease seemed to increase if you lived near marshes and swamps. This led them to suggest that buildings and cities should be sited in healthy places, away from swamps, because bad air (which they called miasma) caused disease. They also recognised that there was a link between hygiene and disease, and although they could not explain what the like was, they stressed the need to provide clean water and to remove sewage. These features of the Roman way of life gradually spread throughout the Roman Empire, including Britain. Roman medicine had a very practical emphasis, they were interested in what they could do to improve health but less interested in what caused illness in the first place.

Roman public health placed an emphasis on hygiene and the provision of clean water and sanitation. Sewage systems were put into place, though in Roman Britain most towns and cities had open drains. Public baths were built, and admission was cheap enough to ensure most people could attend. Most people would visit these baths daily, the water was believed to have healing powers and they became a social meeting place. Water pipes brought fresh water to towns and aqueducts were built. Most ordinary people could collect water from a well or buy it from a water carrier.

Central government meant decisions could be made, resources organised and provide the funding and man power to build and maintain public health systems. Communication was also an important factor in Roman public health, ensuring officials kept Britain up to date with new ideas and the mixed population of the army mean vast knowledge of plants and herbs were spread.

The role of governments and the effects of war

War was responsible for the Romans settling in Britain. The control that the Romans imposed on much of Europe created prosperity for many and improved communications. In this way it could be said that war had a positive impact on medicine in Britain. Though a negative can be found in the way that the Romans supressed the Druids who lived in Britain, thus supressing a good knowledge of plant use in medicine that they held.

Government, as seen above, was extremely important to public health in Roman Britain. The Romans recognised that a good standard of public health and medicine was needed to sustain a strong army. The Roman Army contained a mixture of soldiers from across Europe bringing with them a variety of knowledge of plants and herbal remedies. The Army also provided the man power during peace time to build roads, baths, sewers etc. In Roman Britain the need to have a strong army provided the impetus to introduce and maintain high standards of public health.

When the Angles, Saxons and Vikings invaded Britain after the fall of Rome, there was still a strong emphasis on war, but a total disregard for public health, the link that the Romans had discovered on keeping the general populace healthy was lost on these new invaders. War now became a destructive factor. Money was spent on war and not of sewers or baths. Britain became increasingly fractured and lacked the central governance that had kept Roman Britain strong. Instead factions across the country fought with one another. War became a destructive force; travel was made more dangerous so doctors travelled much less to gain knowledge and experience, though the wars did mean plenty of practice for surgeons!

The role of religion and the work of the Catholic Church in the care of the sick

Religion was hugely influential in the Middle Ages; Christianity dominated society, were there was a strong belief that suffering was temporary, the aim was to get to heaven. The Church controlled society and

resisted new ideas. It controlled medical training, but also preserved medical knowledge. Christianity stressed the importance of caring for the sick, but caring rather than treating them. So for example prayer was more of a priority than seeking medical development. People might also go on pilgrimages to a holy shrine as well as making offerings and saying prayers.

In the Middle Ages, hospitals were originally guest houses and were usually part of a monastery or convent, offering hospitality to travellers. The first hospital to be set up that cared for the sick was the Hotel Dieu, in Paris, founded in the 7th century. Hospitals at this time were concerned with care and not cures. Over 100 hospitals were set up in England, many of which were founded through charitable donations such as St Bartholomew’s in London in 1123. These hospitals were usually run by monks and nuns as a part of their Christian duty. There was also thought to be a strong link between religion and ill health, as illness was often seen as a punishment for one’s sins. St Bartholomew’s didn’t even have a doctor, but instead had several priests as it was thought patients needed spiritual and not medical treatment.

Alms-houses were also set up for the ‘deserving’ poor and old. These people though were expected to follow live according to quite strict rules about their behaviour and prayer. Although they cared for people when ill they were not intended to be a hospital providing medical treatment. Galen continued to hold great influence as his theories fitted with the established Christian teachings.

Supernatural and rational explanations for diseases and illness

Hippocrates sought to find rational explanations for the cause of disease, however there was still a continued believe in supernatural causes. The Romans adopted and continued Greek ideas such as visiting the Asclepion, a temple for the God of healing. Herbal remedies were used extensively, which was continued throughout the Middle Ages. Despite the control and influence of the Catholic Church many people still carried lucky charms and carried out superstitious rituals, such as rubbing snail juice into your eyes to cure blindness, and astrologers were consulted to choose the right time to carry out operations.

The belief in the Theory of the Four Humours

The Ancient Greeks identified four different liquids, or humours, in the body:

Blood Phlegm Yellow bile (when you’re sick) Black bile (most likely when there was blood in vomit, which may have made it look black)

The Greeks though that every person had their own mixture of these humours, and it was when your mixture was unbalanced that you became ill. The humours were also believed to be linked to the seasons and the idea of the four elements (earth, air, fire and water). This theory helped to explain why people became ill and sometimes treatment tried to restore the balance of the Humours. However Hippocrates, the leading Greek doctor, suggested that most treatment should be based on rest, changes in diet and allowing the body to heal itself. Galen developed this theory in the 2nd century CE. He believed strongly in bloodletting as a cure for almost all illnesses and so suggested that the balance of a person’s Humours could be restored by the Theory of Opposites.

Changes in the training and work of doctors

If herbal remedies and prayer were not working then you could go see a doctor. They would be trained, though it would have cost people to go and see them. In many towns in the Roman Empire doctors had been employed to treat the poor, and this may have happened in Britain. Some doctors might even have been women. Doctors mostly trained by acting as apprentices to experienced doctors, however this was not always a good thing depending on how well the ‘experienced’ doctor was trained. Doctors would also read medical books by Hippocrates and Galen. Training though was not compulsory; anyone could call themselves a doctor!

After the fall of Rome trained doctors dropped in number. Instead people would gain help from their family, local wise women or ‘leeches’ – men who built up their knowledge through practice (think leech books). Many of these people may have been as good; perhaps even better than Roman doctors, however knowledge of Hippocrates and Galen almost totally disappeared.

Between 1000-1300 universities were being established in Paris, Oxford and Cambridge. In these institutions physicians would be trained, though few could afford this seven year training. Such qualified physicians, though few in number, could charge high fees to kings, nobles and wealthy merchants.

Medical students would attend lectures and read the books of Greek and Roman writers, particular of Galen. They would also read translations of Arab scholars. Students were expected to memorise what these great doctors had written, but they were not expected to challenge their ideas. When Richard Bacon suggested doctors should do their own research instead of just reading Galen he was thrown into prison by Church leaders.

Another crucial part of medical education was astrology. Students learned how each part of the body was affected by the movements of the planets and stars, believing these affected the balance of the humours in the body and so could cause illness, so a doctor needed to know the position of the planets before making a diagnosis.

The significance of key individuals and events: Galen; the Roman withdrawal from Britain

Galen

Please see the notes on the previous page for Galen

Roman withdrawal from Britain

After the Romans left Britain in 410 CE, there were huge changes. A number of local leaders took control, many towns and cities fell and Britain was attacked by various invaders. Traditional cures and remedies continued to be important however, as did magic as well as herbal treatments, such as prayers and charms. Doctors also continued to be trained according to Galen’s ideas, because they fitted with the established Christian teachings. Though much of the work by Greek and Roman thinkers were lost, the Church was able to preserve that which survived.

c.1350–c1750

This topic is split into the following areas:

Ideas about the cause of disease: belief in the supernatural; the search for a natural explanation of illness

Approaches to the treatment and prevention of disease and illness The influence of the Church and the Renaissance on medicine

The following is a checklist of things you should know for this topic

Medical ideas and practices at the time of the Black Death

People in medieval times lived in small villages and did not travel far, so epidemics of disease didn’t usually spread over the whole country. However in 1348 a disease reached England that had already killed thousands of people in Europe. About one-third of the population died in an outbreak of bubonic plague that became known as the Black Death.

The plague was carried by fleas that lived on black rats; if a flea bit a human, the disease entered the human’s bloodstream. As the body tried to fight the illness, the lymph glands swelled into ‘buboes’. Of those people who caught the bubonic plague, two of every three died.

Religion and medicine were closely linked at this time, and the idea that the plague was a punishment or a test from God meant that a group called ‘flagellants’ walked in procession to the church, whipping themselves, to show God how sorry they were and to ask for his mercy.

Planets were also blamed, as were poisonous fumes from volcanoes and earthquakes. Miasma from decaying refuse spread through movements in the air was also blamed. Imbalance in the Humours was blamed as were the actions from outsider groups such as strangers or witches, in Europe Jews were also blamed too.

As people didn’t know the true cause of the plague at this time, treatments and remedies were unlikely to be successful, but some people still managed to make a lot of money selling fake potions and remedies. Some treatments included fasting and praying, carrying herbs and spices to smell, cutting open the buboes to drain the puss and ringing bells or keeping birds flying around a room to keep the air moving.

Continuity with the Ancient World; the importance of Galen’s ideas

In the Renaissance there was a re-birth of interest in the Greeks and Romans. Educated people in the Renaissance identified themselves with the Greeks and Romans and sought to learn from them, whilst looking down on the ignorance of the Middle Ages. They made new translations of Galen, whose popularity had never waned. It was important for people to go back to the original texts and make new translations for fear that the translators in the Middle Ages may have got things wrong. Galen’s work was still the basis of all medical training and herbal remedies continued to be passed down through the generations. The Roman and Greek love of enquiry was also re-born in the Renaissance, as people began to challenge existing ideas. However some people still stuck to tradition, thinking it wrong to challenge Galen.

The influence of religion

The Church controlled education and training at the start of this period and discouraged dissection in training. The Church did however support the use of Galen, whose theories fitted in with established Christian teaching (except for the dissection). The influence of religion can be said to have been one of the major factors holding back progress in this period in ensuring that traditional ideas continued. Their preservation of Greek and Roman works, particularly Galen’s however was very important.

The Reformation led to a decline in the authority of the Church, though most people remained deeply religious. This was a period of challenges and divisions within the Christian Church.

The medical Renaissance: new knowledge, ideas and technology

The Renaissance is ‘shorthand’ for a period in European history when Ancient Greek and Roman ideas became fashionable, among the rich and educated. European exploration in Africa and the Americas led to new attitudes and a search for knowledge. Meanwhile changes in religion known as the Reformation, led to a decline in the Church’s authority, even though most people remained very strongly religious. The Renaissance is famous for discoveries in science, geography and art, and led onto the Scientific Revolution and breakthroughs in medicine. However by 1750 people were no healthier than they had been in the Middle Ages. The discoveries in the Renaissance were primarily concerned with anatomy and physiology as opposed to looking at what made people ill. Though developments in technology such as microscope and the printing press would serve to have great influence in later developments.

The development of printing and its significance

The printing press was invented by Johannes Gutenberg in the 1450s. By 1500 printing presses were being used throughout Western Europe. Highly detailed illustrations that were used to accompany medical texts could know be replicated and printed much more easily. The development of the printing press helped new ideas spread far more rapidly than ever before because books could be printed faster and less expensively.

The influence of Vesalius

In 1534 Vesalius, the Professor of Surgery at Padua University, in Italy, published an important book called The Fabric of the Human Body. This included drawings showing muscles, nerves, organs and the skeleton of the human body based on dissections of corpses. Vesalius’ book had two major impacts. First even if physicians did no dissections themselves, they could still learn a great deal about human anatomy from the illustrations. Second, Vesalius discovered that some of Galen’s teachings were wrong.

Galen said that the heart was divided by a septum that had holes in it to allow the blood to pass through, but Vesalius showed that the septum did not have holes in it.

Galen said that the liver had five parts or lobes, but Vesalius showed that the liver did not have any lobes.

Galen said the lower jaw was made up of two bones but Vesalius showed that, although this was true in monkeys and pigs, in humans it was a single bone.

The invention of the printing press meant oriented copies of Vesalius’ work could be produced quickly and cheaply.

Changes in the training of physicians and the reduction in Church influence

Physicians training changed during this period with the reduction of the Church’s influence. Training c.1500 would involve training at university, where they would concentrate of the books of Greek doctors, especially Galen and the work of Arab doctors such as Ibn Sina. Physicians learned how to diagnose illness by taking case histories and studying the patient’s urine. They sometimes learned about anatomy by watching dissections take place but this was rare. They believed all knowledge they needed was in the books. They used astrology to decide on the treatment and its timing.

A physician’s training in the late 1700s was influenced by the Renaissance, Vesalius, Harvey and the Scientific Revolution. Diagnosis by studying urine and the study of astrology was rarely used. There was little training universities in England. Students travelled to universities in Holland, France or Italy, or to

Edinburgh in Scotland. By the 1780s, Edinburgh had over 200 medical students each year. Training at Edinburgh involved some practical training in hospitals, examining patients. Students also took part in dissections, although there was always a shortage of bodies.

In 1768 William Hunter (big brother of John) set up his own medical school in his home in London, training physicians specialising in anatomy and obstetrics – care for women in childbirth. Hunter’s students studied six days a week for over three months. Other physicians also ran their own courses for medical students and were beginning to use hospital wards for training.

Women were not allowed to attend university so they could not become physicians. They continued to work as midwifes though that came under threat.

The Royal Society: a scientific approach

The first meetings of a group of people interested in discussing new scientific ideas took place in London in 1645. They continued until they were given a royal charter in 1662 and became known as the Royal Society. They met weekly to discuss new ideas in physics, botany, astronomy, medicine and other sciences. Members also demonstrated experiments because the Society had its own laboratory and equipment such as microscopes. It also published books and articles to spread new ideas and discoveries.

King Charles II attended meetings of the Royal Society to watch experiments. He had a laboratory and an observatory built in one of his palaces. After the Civil War, people were suspicious of private meetings, so Charles’s support for the Society protected the members from suspicion that they might be plotting a Revolution.

In 1665, Richard Lower, of the Society, made the first experimental blood transfusion. He transfused blood from a dog to another dog and later a sheep to a man, a ‘crackbrained’ student called Arthur Coga. It was said that people hoped it would make Coga cleverer!

Medicine and health care in the home and in hospitals

There were different choices that people could make if they were feeling ill. They could go to trained physicians, to the apothecary, to hospital, to a barber-surgeon, to a house-wife physician or rely on prayer and pilgrimage. You must remember that these different outlets were not all present throughout this period.

The trained physician – they would have been trained at medical school and would have passed exams. They could diagnose your illness using your urine and astrological information. Treatments tended to be based on Galen’s theories and so would likely include bloodletting or herbal remedies. It could be an expensive way to gain treatment as you would have to pay a fee for each visit, but you would be paying for the knowledge they held. The physician did not mix the remedies, people still needed to go to an apothecary, and not all physicians practiced bloodletting and you may be sent to a barber-surgeon. Physicians were male, woman physicians were very rare in this period.

The apothecary – these people were trained but had no medical qualification. They mixed various ingredients to produce medicines and ointments for the physician; they could also make up their own mixtures for people for a price. It was cheaper to go see an apothecary than to consult a physician, and then still have to pay the apothecary for some medicine after. Apothecaries were most likely to be male.

The barber-surgeons – these surgeons practiced lots of bloodletting, they could also pull out rotten teeth and lance boils. They were able to carry out some basic surgery such as cutting out bladder stones or amputating limbs. They did not use anaesthetics, and had a very low success rate for surgeries. They would not be trained and therefore were not respected by surgeons. They could also cut your hair.

Hospital – there was nothing modern about these hospitals, they were usually for the old or for specific illness, such as leprosy – sick people were usually looked after at home. Hospitals were run by monks and nuns, Christian values encouraged care for the sick. After the Reformation in the 16th century some free hospitals were set up in towns, funded by charities.

Housewife-physicians – they knew traditional remedies for things such as sore throats, stomach aches or a temperature. They would also be able to deal with broken bones and with child birth – they sometimes got the reputation as ‘wise women’. They used some remedies based on herbs and other plants, and others based on charms and spells. Sometimes these women may be the lady of the manor, who would treat the servants and those living on her land.

Prayer and pilgrimage – many people would also go on a pilgrimage to a holy shrine in the hope that they could be cured of illness

The significance of key individuals and events: William Harvey and the theory of the circulation of the blood

Harvey proved more of Galen’s ideas to be incorrect. He worked out through experiment and observation that:

Veins only carry blood, rather than a mixture of blood and air Blood is not constantly manufactured by the liver and is not used up as it moves around the body

(as Galen thought) but it is actually repeatedly circled around the body.

Harvey published a book in 1628 called An Anatomical Account of the Motion of the Heart and Blood in Animals, describing his experiments and explaining how the heart worked as a pump circulating blood around the body. He also suggested that blood must go through tiny vessels in order to move from arteries to veins, and he was right, but microscopes were not powerful enough to prove these capillaries existed until much later.

c1750–c1900

This topic is split into the following areas:

• Ideas about the cause of disease: the development of the Germ Theory; the identification of microbes•Approaches to the treatment and prevention of diseases and illness; the development of vaccination• The influence of industrialisation and science on changes in medicine

The following is a checklist of things you should know for this topic

New knowledge about the cause and prevention of disease.

New knowledge about the cause and prevention of disease saw a major turning point in this period, particularly after the publication of Pasteur’s Germ Theory. You will see other developments listed below.

The significance of the work of Pasteur and Koch on microbes and vaccines

The germ theory – that there are microbes in the air which cause decay – was an important breakthrough in scientific understanding. It disproved the theory of spontaneous generation (that disease was caused by germs that were produced by flesh and vegetables that rotted) and led to Koch identifying the specific microbes that caused some individual diseases. The inherent competition between the French and Germans proved to be a great motivator in this breakthrough. As a result of this improved understanding of the cause of disease, scientists hoped that they could find ways of treating them; this however was going to take some time, in order to indentify the microbe responsible for each separate disease.

In the 1850s Pasteur, a French chemist, investigated the probe of liquids turning sour in the brewing and vinegar industries. More powerful microscopes had recently become available, meaning that Pasteur could observe the growth of unwanted small organisms in the liquids. He discovered that heating the liquid killed the bacteria and stopped the liquid from going sour. In 1861 he published his germ theory showing that there were microbes in the air and that they caused decay, proving that spontaneous generation was wrong, as decay did not occur when the matter was in a sealed container, showing that the microbes causing decay where not from the matter itself but from the air around it.

In 1875, Robert Koch, a German doctor who had read Pasteur’s work, decided to investigate whether bacteria were linked to disease. Working with a team of scientists, funded by the German government, Koch identified the specific microbes that caused the disease anthrax in sheep.

In 1879 Pasteur’s team was studying chicken cholera microbes and injecting chickens with the disease. A culture of the bacteria was accidentally left on one side and when it was used, a couple of weeks later; it had become a weakened version, which didn’t harm the chickens. Pasteur realised that this could be used as a vaccine to create immunity from the disease for chickens. He called this process ‘vaccination’ in tribute to the importance of Jenner’s work.

Koch identified the microbes causing TB in 1882 and those causing cholera in 1883.

Koch also found that chemical dyes could be used to stain specific bacteria so they could be studied more easily under the microscope.

Germ theory’s importance could be said to have had a limited impact at the time because each disease had to be researched individually. Progress in the prevention and treatment was therefore very slow; however it proved to be a major turning point that laid the foundations for later developments. Its importance comes in its disproving of previous ideas of the cause of disease and in the way in which it acted as a spring board for future discoveries.

The importance of research teams

By the end of the 19th century, scientific research was usually carried out by a team rather than by individuals. A team was more likely to have funding and to be able to afford new expensive technology such as more powerful microscopes. Also working in a team made it easier to check each other’s work and carry out large scale testing. Furthermore, different members of a team could offer knowledge of different specialisms, for example medicine, biology and chemistry. An example of the importance of research teams can be seen in the breakthrough of Salverson 606.

The fight against smallpox: Jenner and vaccination

Smallpox killed more children than any other disease in the 1700s. Survivors of smallpox were often severely disfigured by scars from the scabs that formed on their skin. In China people had begun to

inoculate people against smallpox by taking a small amount of pus from a smallpox blister, then spreading it into a small cut between the thumb and forefinger, to give the person a mild form of the disease, from which the person should survive, making them immune from further attacks. This practice spread through Asia.

Lady Mary Wortley Montagu (wife of the British ambassador to Turkey) witnessed this procedure in Turkey in the early 18th century. She had nearly died from smallpox when she was younger and was keen to protect her own children, having them inoculated in 1721. The idea became very popular in Britain and people would often have smallpox parties to inoculate themselves together. Since doctors were paid for this they could stand to make a lot of money. Inoculation however did not completely solve the problem of smallpox because not everyone could afford to have it done, and it was not always effective or safe.

A handful of doctor’s realised that milkmaids who caught the mild disease cowpox never got smallpox. Some had even deliberately infected themselves and others with cowpox. However, they had not made this method widely known nor tested the idea scientifically. Jenner had long known this theory and kept it in mind, thinking about how to test and prove it. In the 1790s, he carried put experiments to test the theory, observing and recording all the details carefully. In 1798 he published his book, describing 23 different cases to prove his theory. Jenner could not however explain the link between cowpox and smallpox other than the fact it was there. He called his method ‘vaccination’ because the Latin word for cow is vacca. In 1802 and 1807, Parliament gave Jenner £30,000 to develop his work on vaccinations, and fifty years later in 1852 vaccinations were made compulsory. Some doctors opposed Jenner’s work as they lost money when the government provided a grant so that people could have free vaccinations. The discovery saved many thousands of lives in Britain and millions world-wide. The vaccination was not always successful though and some people did develop smallpox where the vaccination was not administered properly.

Improvements in hospitals and training and the professionalisation of the roles of nurses, midwives, and doctors

At the start of the 18th century and the industrial period, a doctor’s training continued to be mainly theoretical, but a small number of criminal’s bodies were allowed to be used for dissection in medical schools and hospitals.

Doctors could set up practices once they had been accepted by the Royal College of Surgeons, the Royal College of Physicians or the Society of Apothecaries. Medical training began to improve after 1815 when Royal College of Surgeons and the Society of Apothecaries introduced examinations before they awarded a certificate. In 1858 the General Medical Act said that a General Medical Council had to be set up and all qualified doctors had to be registered. However the fact that doctors could still do relatively little to treat disease meant that they were not always respected.

After Pasteur’s germ theory, more emphasis was placed on microbes and the understanding of illness, as well as gaining practical experience by observing doctors as they worked in one of the teaching hospitals. Important medical schools developed in Glasgow, Edinburgh, Oxford and London. Once qualified, doctors could apply for a position at a hospital, working under the supervision of an experienced doctor. They could also volunteer to work at a charity hospital in order to gain more experience. As medical knowledge advanced doctors tended to divide into general practitioners and those who specialised in specific areas of the body or types of disease, these doctors became known as consultants.

The value of dissection and the study of the human anatomy also grew. As a result body snatchers operated in the 18th and early 19th centuries, seizing the bodies of hanged criminals or digging up newly buried corpses, in order to provide human specimens for students.

John Hunter (you meet his brother William earlier) was also practicing in this period, and his scientific approach to training is very significant. His lectures on anatomy helped to develop a more professional approach to training, whilst he also emphasised the importance of observation and experiment. His students included Jenner, who followed Hunter’s methods when investigating cowpox. Hunter employed a secretary to write up his notes and paid an artist to draw the discoveries he made through dissection. He also published several important works, including one that charted the changes that occurred during pregnancy.

The significance of Elizabeth Garrett Anderson in the training of women

Elizabeth Garrett Anderson came from a wealthy family. She had been inspired by feminists in London and by Elizabeth Blackwell the first woman in the USA to qualify as a doctor. She was repeatedly turned away from medical schools that refused to accept women, and worked as a nurse whilst attending lectures for doctors until she was forced to stop. She needed to gain a certificate from one of the three medical organisations to become a doctor and in 1865 she was accepted by the Society of Apothecaries, the only one of the three that did not state that they would not accept women. They agreed to register her but then changed their regulations so no other woman could copy her. She set up a medical practice in London, but still wanted to gain a medical degree so she learned French and gained her qualification at Paris University.

In 1872 she founded the New Hospital for Women in London. In 1874 she helped set up the London school of Medicine for Women. In 1876 an Act of Parliament allowed women to enter medical professions.

Informal medical treatment: within the home; patent medicines

Home care still involved providing comfort, food and warmth, so long as the family could afford it! Some home carers did still use some herbal remedies were the knowledge had been passed down through the generations though during the 19th century there was probably less use made of herbal remedies as people moved away from the countryside. Apothecaries sold many ‘preparations’, which they advertised as being the cure for practically everything! These ‘cure-alls’ or patent medicines were big business. These preparations took the form of potions, ointments and pills, made from things such as coloured liquids, alcohol, lard, wax turpentine, ginger and arsenic. The ingredients for the pills were made into a paste and then would be shaped by hand, for rich customers they might even be covered in gold or silver leaf to make them look more attractive and easier to swallow. The use of pills in medicine however was revolutionised in 1844 when William Brockedon invented a machine to make standardised pills that were produced far more quickly than being made by hand.

Thomas Beecham began selling his pills in 1847 and Jesse Boot, a herbalist from Nottingham transformed a family shop into a chain of pharmacies in the late 19th century. By the end of the 19th century British government regulations stopped many harmful ingredients being used in medicine. Meanwhile the growth of chemical industry meant companies such as Wellcome, Boots and Beecham could produce their brand of medicines on a national basis, whilst making use of advertising in newspapers and posters to boost sale. The pharmaceutical industry started to grow

The contribution of improved communications and technology to medical research

Communications between research teams and scientists was extremely important in the development of ideas and practice in this period. This was aided by improvements in technology which allowed for more detailed and through research to be carried out. For example stronger microscopes enabled scientists to see bacteria that would have otherwise been not visible to the naked eye. Printing of books, particularly those with illustrations became cheaper and therefore more widely available and the introduction of medical journals encouraged the spread of ideas amongst scientists.

The importance of science in the search for microbes and the ‘magic bullet’

Improved understanding of the cause of disease also led to the search for ‘magic bullets’ that would cure disease. Emil von Behring developed Koch’s work to isolate the antitoxins used by the body to fight diphtheria – then found a way to inject them to cure the disease. Paul Ehrlich (a member of Koch’s team) set up his own research team to build on this work. Ehrlich knew certain dyes stained specific microbes (Koch’s work) and antitoxins only attacked the disease microbes (Behring’s work). Ehrlich tried to combine a de with other chemicals to find a cure for syphilis – a ‘magic bullet’ that would only target the disease microbe and not harm the rest of the body. Ehrlich researched for several years, made possible because of his government funding. In 1909 Dr Sahachiro Hata joined the research team and reviewed some of the previous experiments. Hata discovered there had previously been a mistake – the 606th compound had tested and dismissed had actually been effective! This treatment was given the name Salvarsan 606. The use of chemical drugs to target and cure illness was an important breakthrough, one that was developed by Gerhard Domagk in 1932.

It was not until 1932 that Domagk discovered that a particular red dye was effective against some cases of blood poisoning that he developed the second magic bullet, the drug Prontosil. Many people died after simple cuts or scratches had become infected, so a cure for blood poisoning could save many lives. Domagk had only tested Prontosil on mice, but when his daughter developed blood poisoning after pricking her finger, he risked testing it on her, and in doing so saved her life.

Research showed that the key ingredient in Prontosil was sulphonamide (a chemical compound) and other sulphonamide drugs were developed that could cure pneumonia, scarlet fever and meningitis. These discoveries were important because medicine could now cure many of the infections and disease that had previously lead to death. At first, treatment tended to be by injection, but the developments in technology in the late 19th century had made it possible to mass produce pills and now the pharmaceutical industry began to grow rapidly.

The significance of key individuals and events: the Germ Theory; Florence Nightingale

For Germ Theory see the previous notes on Pasteur

Florence Nightingale

Nightingale came from a wealthy family, which had very good connections. She horrified her wealthy family by wanting to become a nurse. She trained at Kaiserworth hospital in Germany in 1850 before returning to Britain to work as a nurse, eventually becoming Superintendent of nurses in a London hospital. When the Crimean War broke out she heard of the terrible conditions and asked the Minister of War, Sidney Herbert (a family friend), to lead a team of nurses at the military hospital in Scutari. Her presence was initially opposed by the doctors there. Appalled at the conditions, Nightingale concentrated on cleaning the hospital and patients. She emphasised hygiene and fresh air, believing that disease was caused by miasma. The death rate at Scutari fell from 42% to only 2%.

Her work was reported in British news papers, and the public contributed money that helped to establish the Nightingale School for Nurses in London in 1860. She published Notes on Nursing about practical care and high standards, which has since been translated into 11 languages. Altogether she has written over 200 books about hospital design and organisation. She was also influential in establishing a training school for midwives at King’s College Hospital in London in 1861. Nightingale did not however pay very much attention to Pasteur’s Germ Theory, believing still that it was miasma and poor hygiene that caused disease.

c1900 to present day

This topic is split into the following areas:

•Ideas about the cause of disease: growing understanding of microbes and of genetic conditions.•Approaches to the treatment and prevention of diseases and illness; high-tech medicine.• The influence of science and technology on changes in medicine.

The following is a checklist of things you should know for this topic

Increased understanding of the causes of disease and illness: the significance of Watson and Crick’s discovery of the DNA structure

Francis Crick and James Watson, two Cambridge scientists, worked together to investigate the structure of DNA. Crick was a physicist and Watson a chemist, but their work also made use of X-ray crystallography by Maurice Wilkins and Rosalind Franklin at King’s College Hospital in London. In fact it was one of Franklin’s photographs that suggested that genes were arranged in a double helix structure.

Crick and Watson had the latest and best equipment, using new technologies such as X-ray photography and improved microscopes. They also built on new knowledge in other types of science such as genetics and biochemistry. Their research was very expensive because of the cost of such complex equipment and the number of highly skilled people involved. Most of the money came from the government, but industries also made a contribution. In 1953 they discovered the structure of DNA, proving that it was present in every human cell and showed how it passed information on from parents to their children this acted as a launch pad for further discoveries.

Watson, Crick and Williams gained a Noble Prize in 1962 for their discovery, but not Franklin because she had died four years earlier and prizes were not awarded posthumously.

In 1990 the Human Genome Project led by Watson, set out to map the location of every single one of the 30,000-35,000 genes in the 23 chromosomes in every cell of the human body. The project involved hundreds of scientists working in 18 teams. The first draft was produced in 2000. Scientists have been able to identify certain genes that pass on specific hereditary conditions as a result of Watson and Crick’s discovery.

There are now better techniques for skin grafts, better production of insulin for diabetes and better vaccines. There is better understanding of heredity conditions, and of whether some people are more likely to catch certain forms of cancer. There has been further research to develop techniques to alter the faulty genes within the body and to prevent genetic illness from developing. The discovery has been made that stem cells (found in the bone marrow of long bones and the pelvis) can transform into various types of cells used around the body – which offers a chance of replacing faulty cells with healthy ones.

Developments in the fight against disease: a new pharmaceutical industry and improvements in treatment

The pharmaceutical industry started to grow in the 19th century with individuals such as Beecham and Boot taking their smaller stores and transforming them into national chains. This industry continued to grow in the 20th century. It was an American chemical company Pfizer that developed a method of freeze-drying that was eventually used for large scale production of Penicillin in 1944. Pharmaceutical companies began to invest in the discovery and developments of other antibiotics. The growth of scientific techniques and equipment were being used in this development, as was state funding. Scientists reported their ideas and communicated with each other so that they could learn from the benefits from each other’s discoveries.

The development of antibiotics

Antibiotics are drugs that stop infections caused by bacteria. Penicillin was the first antibiotic medicine. Since then other antibiotics have been developed which kill particular bacteria. Antibiotics have saved an estimated 200 million lives in less than 70 years. For detailed notes on the development of Penicillin please see the information on Fleming, Florey and Chain.

Increased use of vaccinations

After Jenner’s discovery of the small pox vaccination, the Government ordered compulsory vaccinations, and the number of deaths from small pox drastically reduced. Pasteur’s Germ Theory then proved to be a critical moment in medicine. It lead to Koch and his research team discovering that specific microbes that cause individual diseases. Pasteur and his team then developed vaccines for individual diseases. Both men and their teams, used high-technology equipment such as the latest microscopes, without which they would not have been able to see microbes. They also received funding from the government to pay for their work. Other scientists followed, producing vaccines to cut deaths for typhoid, tuberculosis, typhus, cholera and diphtheria.

Vaccines continued to be produced for specific diseases and in 1954 an American research scientist, Jonas Salk, developed a vaccine to protect people from polio. Then in 1964 a vaccine was produced to combat measles and which had been a major killer in the 1800s, when today it is to be not very dangerous. The vaccine did a great deal to wipe out measles and was aided by the free availably of vaccines under the NHS and widespread advertising campaigns. However the near whipping out of measles has led to people underestimating its effects and recently there has been a large increase in measles cases as the vaccines was stopped for fear (now disproved by research) that it led to other problems.

Influenza was also considered to be a major killer in the 1800s, and is a disease that can rapidly cause death, especially in the elderly and those who are already sick. This is why governments invest heavily in providing free flu jabs for many groups of people and for those who work in hospitals.

Work on genetic conditions

Study of genetics began in the 19th century, when Mendel showed how characteristics can be passed down from one generation to the next. During the 20th century, scientists could take photographs of human cells through two improvements in technology – electron microscopes and X-Rays (using a technique called crystallography). It became known that each cell in the body contains DNA, which is the set of codes controlling the genes that decide eyes and hair colour, height and so on. If scientists could work out how these genetic codes fitted together in a DNA strand, they might be able to identify which genes were

responsible for inherited conditions (such as sickle cell anaemia and cystic fibrosis) or conditions such as Down’s syndrome. Research into genetic conditions requires very specialised knowledge and expensive high-tech equipment, but offers exciting possibilities. There has been further research to develop techniques to alter faulty genes within the body and prevent genetic illness from developing.

Improved access to treatments available through state funding of medical and hospital care

State funding is particularly important in this period as the government became increasingly aware and concerned over the inequalities of health care in the early 20th century. The governments needed to provide to make improvements to medical and hospital care which could only be achieved through governmental funding and organisation. This meant increasing taxes in order to provide such funding. The cost of the NHS continues to be a problem every year for the Government, as it increases each year, due to people living longer and the increasing sophistication of diagnosis and treatments.

Changes in the roles of doctors, nurses and midwives and the increased regulation of training

At the start of the 20th century, doctors had to qualify and then register with the General Medical Council, but then they could set up their practices anywhere they wanted and choose which patients to accept. There was little specialisation at this stage and there was also limited opportunities for doctors to receive any further training. During the 20th century, as knowledge of disease and various conditions increased, and especially after the NHS was set up, many doctors in hospitals specialised much more than previously. GPs also became much more conscious of the need to update their knowledge and to understand new developments. Articles in medical journals, conferences and the internet have all helped to professionalise the training of medical personal.

Paramedics are now trained as a result of the discovery that quick medical intervention is particularly important in certain cases, such as heart attacks and strokes. Paramedics are trained to assess a patient then take action wherever possible before taking them to hospital

Training for nurses is a mixture of academic work and practical experience. Nurses must hold a degree or diploma in nursing which takes three years. They must them register with the Nursing and Midwifery Council. In training they receive practical training working on a range of hospital wards and in specialised situations, then further exams must be taken before they can administer drugs or chemotherapy.

Informal and alternative medicine: products available for use at home, for example medicines and monitoring devices from pharmacies, alternative medicine such as acupuncture

People can now, with the help of technology, monitor their own health, such as kits to test blood pressure and blood sugar levels which are available for home use. Partly as a reaction to some of the problems of science, there has been a move to natural and herbal remedies as well as alternative medicines such as acupuncture. Many of these treatments have been used for centuries and because they do not use mass-produced chemicals, some people feel that they are less likely to have dangerous side effects.

The contribution of science and technology to research, diagnosis and treatment, for example in enabling x-rays, radiotherapy, scans and monitors

Science and technology has contributed a great deal to medicine in this period. In the 20th century scientific research and knowledge has led to:

Chemical treatments of disease (magic bullets)

antibiotics, which used living organisms to fight disease More vaccines to prevent the spread of disease A better understanding of genetics: genetic changes that cause problems and genetic changes that

can help Treatments being developed for conditions, such as diabetes, which was previously incurable

In 1901 Karl Landsteiner discovered there were four blood groups, and that transfusions were only successful if the donor’s and patient’s blood groups were the same. In 1915 it was discovered that adding sodium citrate prevented blood from clotting but the blood cells soon deteriorated. In 1916, new scientific techniques made it possible to store blood for longer periods to establish blood banks.

Benefits of technology were wide ranging. Technology aided research; in 1931 the powerful electron microscope was invented. It aided treatment, such as the discovery of X-rays by Roentgen in 1895, and by 1902 people realised they could be used to ‘burn’ and shrink tumours, a technique known as chemotherapy. Pacemakers and kidney dialysis machines could keep people alive, and hypodermic needles and intravenous drips helped to give precise doses of medicine. People could now, with the help of technology, monitor their own health, such as kits to test blood pressure and blood sugar levels. Advances in technology could also be used to diagnose or monitor illness, such as scanning to diagnose internal problems, endoscopes, a flexible tube containing a camera can be passed through the body.

There were however some problems with science and technology. New technologies did not always have the effect that they were intended – sometimes the side-affects could be worse than the original conditions. For example a new drug in the 1960s called thalidomide was supposed to prevent morning sickness in pregnant women, but it was found to affect the growth of the unborn baby, particularly the growth of the arms and legs.

As well as the concerns of side effects there was a lot of debate surrounding whether scientists should ‘play God’ and use their knowledge of genetics to change people’s bodies. Religious and morale questions and debates are often raised when cell research is conducted.

The significance of key individuals and events: Alexander Fleming; the establishment of the National Health Service in 1948

Fleming, Florey and Chain

Fleming was a chemist working at St Mary’s hospital in London. In 1928 he noticed that a culture of bacteria in a Petri dish was being attacked and killed by an unknown mould growing in the same dish. This ruined his experiment but he decided to research the mystery killer mould before throwing it away. In his research he discovered that it was an excellent antibiotic, penicillin, but he only tested it on bacteria in the laboratory, not on bacteria in living organisms. Fleming published his findings in 1929 but he was unable to get funding to develop his work so he returned to his original research.

It was difficult to produce pure penicillin and so it did not seem practical to try to use it in medicine. However, Howard Florey and Ernst Chain, two scientists working in Oxford, read about Fleming’s research and in 1939 they set up a team including a range of specialists to develop penicillin.

In 1940 they tested it on mice, and in 1941 they conducted tests on a patient. The test showed that penicillin acted like a miracle drug on people who were dying from infection. Unfortunately, there was only a small amount of penicillin available and the patient died when the penicillin ran out.

Florey became determined to develop the mass production of penicillin but it could not be synthesised from chemicals (like Salvarsan and Prontosil). The mould had to be cultured on a broth and exposed to air in order to grow. This meant that they had to use a collection of containers, including baths, bedpans, milk churns and food tins, and had to hire six assistants just to deal with this stage of the work. No British firm was able to create the technology needed to mass produce penicillin – partly because many factories were being damaged by the bombing raids during WW2 or were already working to full capacity producing drugs needed during the war.

Florey refused to patent penicillin, believing it should be available for everyone, and in June 1941 Florey and Norman Heatley (another member of the team) went to the USA to see if drug companies there would fund their research. At first they were unsuccessful but in December 1941 the USA entered WW2 and the US government was now prepared to fund the mass production of penicillin. They knew that in war many soldiers were likely to die from infection rather than from actual injuries and so mass-produced penicillin could save many lives.

Florey had discovered that drying the mould at low temperatures was the most successful method of purifying penicillin. Scientists at the chemical company Pfizer, in New York, use an old ice-cream freezer to develop a method of freeze-drying that was eventually used for large scale production in 1944.

Fleming did not actually make a new discovery – there are records from the Middle Ages, and even earlier, of people using mouldy bread to fight infection even though they didn’t understand why.

The NHS

The government had become increasingly concerned about the inequalities of health care in the early 20th century, especially once women got the vote in 1918. The bombing raids in WW2 produced many causalities in the cities and the government set up a National Emergency Medical Service. This brought hospitals under the control of the Ministry of Health. Some new hospitals and 1000 new opening theatres were built and additional equipment was provided. The hospitals provided free treatment, a blood transfusion service was created and an ambulance service set up.

The Beveridge report in 1942 identified disease as a problem for the government to deal with after WW2. Plans were made for a National Health Service, which was set up in 1948. Aneurin Bevan, the Minister for Health, faced huge opposition from doctors who did not want to be organised by the government and were afraid they would be less well paid as part of the NHS.

Taxes were used to pay for a wide range of care offered to people including:

The right to see a GP and be referred to hospital Treatment by dentists and opticians Health care for pregnant women and young children Ambulances and emergency treatment Health care for elderly

This had a major impact on peoples’ lives. At first all treatments were entirely free and the government believed the cost of health care would go down because so much illness could be prevented. However the expense of running the NHS was soon much higher than expected and prescription charges were introduced in 1951.

The cost of the NHS is now a major problem for the Government as it increases every year. People now live longer and so are more likely to develop problems needing treatment. Improvements in medicine mean people come to expect a greater range of treatment. New drugs are being introduced but their costs are often high. Treatment is increasingly more complex and equipment expensive. Staff costing too is very high.

Public health c1350 to present day (Extension Unit 2)

This topic is split into the following areas:

• Problems of public health and their attempted solutions• The impact of industrialisation and the reasons for the growth of government intervention• The changing nature of state provision

The following is a checklist of things you should know for this topic

Changing approaches to the provision of water supplies and the disposal of waste from c1350

Although there were several attempts to improve access to water, there was little recognition of the need to improve sanitation. This proved to have a considerable effect on people’s health, especially with regards to sewage polluting the water. In the Middle Ages town councils passed by-laws ordering people to keep the streets clean and fined those who broke the rules. However no one expected the local authorities to organise the removal of rubbish and people had to pay for their cesspits to be emptied. During the Great Plague removal of waste became a greater priority, although the burden remained on local councils, this did not improve until the early 20th century.

For notes on the provision and dangers of water supplies please see John Snow notes.

The nature of public health provision and the role of government in c1350–1750, 1750–1900 and 1900–the present day

C1350-1750

In this period the government’s focus on preventing infectious disease started with some local authorities passing laws to stop people throwing waste into the streets.

1750-1900

By the 19th century a huge increase in the population had led to very cramped conditions and serious health problems. The pace of change started to increase in the late 19th century as the government began to pass laws to ensure the provision of fresh water supplies, the disposal of waste and improvements of hygiene.

c.1900-present day

By the early 20th century the government was starting to pass welfare reforms to improve the country’s health and this led to the creation of the NHS in 1948. In the second half of the 20th century the government became increasingly involved in health education so that people came to know more about the dangers of smoking, drugs and alcohol and the need for a healthy diet.

Industrialisation and the growth of towns and pressures on public health.

During the Industrial Revolution, in the late 18th century and early 19th century, the population of industrial towns grew rapidly. Housing for the workers in the factories was often very poor quality and many families could only afford to live in a single room. In these conditions, disease spread rapidly, especially as there was poor sanitation and limited access to water. In London the population grew from 957 in 1801 to 2362 in 1851, in Manchester it went from 70 in 1801 to 303 in 1851. There was already a great deal of concern over the death rate from typhoid fever and tuberculosis, but in 1831 a new disease appeared – cholera. Thousands died within weeks and as there were other epidemics later, the local authorise came under pressure to take action.

The contribution of industry and new technology to improved provision

The role of technology has been important in improving public health. Bazelgette’s sewers were vast in size and the construction work needed to build an underground system for London was very complex and required great planning and engineering. Technology was also used in the 19th century to pump water through towns and cities in great quantities. A vast pumping system was installed in 1868 in the north of England that could pump 3 million gallons of water a day. This would have been impossible to achieve before the technological developments of the Industrial Revolution.

Industry was also important in this period, highlighted perhaps most effectively by Pasteur’s discovery of the germ theory. Pasteur had been working on behalf of a brewer when he discovered his germ theory. It was his attempts to figure out why beer and vinegar went sour that lead to this development, perhaps if Pasteur had not been tasked with this role the discovery may have come later?

The impact of the cholera epidemics and the work of John Snow

In 1854 there was another outbreak of cholera in London, and Dr John Snow used it to investigate his theory that cholera was spread through infected water. He marked on a map all the deaths in one area, and there was a clear concentration of deaths around the water pump on Broad Street. Snow also found that a woman in Soho, who had her water delivered from the Broad Street pump, because she liked the taste, had also died, but that the men who worked at the local brewery, but did not drink the water (owing to the fact they had an allowance of beer from the brewer) did not die. Snow had the handle of the pump removed so that water could not be collected from this pump and found that the number of deaths dropped dramatically.

Parliament slowly became convinced that it should take action to improve public health and Snow’s discovery had helped to make the link between water and cholera.

Changing attitudes to government intervention: the public health acts of 1848 and 1875

Attitudes towards public health had, at this time, been that of laissez-faire, which was the belief that government should not interfere in the ordinary lives of people or business. Edwin Chadwick’s report drew a lot of attention, however not all of it was positive. Many people were angry at the idea that government should insist on piped water and sewers, their complaints led to these protesters being known as the ‘Dirty Party’. After another cholera epidemic in 1848 however led to the government trying out some of Chadwick’s ideas (see Chadwick below).

In 1848 The Public Health Act set up a General Board of Health, with Chadwick as one of the three commissioners. It also allowed towns to set up their own local Board of Health, appoint a local medical officer, organise the removal of rubbish and build a sewer system. But it did not force town councils to do

this. Only one third of towns set up a Board of Health and even fewer appointed a medical officer. Meanwhile the terms of the Act were only temporary so that in 1854 the three commissioners had to resign and the General Board of Health was abolished in 1858. Chadwick was not appointed to another official position.

In 1875 a Public Health Act stated that towns had to appoint Health Inspectors and Sanitary Inspectors; local authorities were given powers to enforce regulations on water and sanitation. By 1875 local councils were now responsible for ensuring that clean water was provided, streets were paved, rubbish was removed, sewers were built and the quality of housing was improved. This came after the Great Stink in London in 1858 and another outbreak of cholera in 1866. When working class men living in towns got the vote in 1867 it put even more pressure on local councils and government to take action.

Liberal welfare reforms in the early twentieth century; the National Health Service

The Liberal government that was elected in 1905 began to pass laws that they hoped would improve health among the poor. The 1911 National Insurance Act was particularly important; it offered free treatment and medicine, limited sick pay and unemployment support for some workers. Every worker earning less than £160 a year was expected to join the scheme, in which contributions by the worker, employer and government were made to a fund.

Prior to this several other acts were introduced. In 1902 the Midwives Act came in that stated all midwifes had to be trained and registered. In 1906 Free school meals were introduced for poor children. In 1907 a School Medical Service and health visitors to check on the health of young children were introduced. In 1908 the Old Age Pensions Act was introduced.

Although the 19th century idea of lassaiz-faire was less common now, there was still some resistance to government’s increasing involvement in people’s lives. The cost was off putting to some people. The Government did succeed in passing the National Insurance Act after in crisis in Parliament over the need to raise taxes. In 1919 a Ministry of Health was set up.

For more details on the NHS, please see the earlier section on its creation

The significance of key individuals: Edwin Chadwick and Aneurin Bevan

Chadwick

Local authorities were expected to use taxes to make provision in workhouses for those who were too old, too weak or too ill to support themselves. Edwin Chadwick was secretary to the commission in overall charge of the workhouses. In 1842 he published the results of his survey of housing conditions in towns called The Sanitary Conditions of the Labouring Population. He suggested it would be cheaper if local taxes (rates) were used to improve housing and hygiene rather than paying for sick people to be supported in workhouses. Specific suggestions made by Chadwick were about improvements in providing access to clean water, and the removal of sewage and rubbish. However Chadwick’s suggestions were criticised by some when his report were published, at this time the government’s approach to public health was lassies-faire.

Bevan

Aneurin Bevan was the Minister for Health who introduced the NHS in Britain Bevan faced huge opposition from doctors who did not want to be organised by the government and were afraid they would be less well

paid as part of the NHS. He publicised his ideas and persuaded patients they should ask to be registered as NHS patients, telling doctors to join or lose patients. He had to appease these doctors in order to push through the NHS, and agreed that doctors could continue to treat patients privately and charge them fees as well as working for the NHS. The NHS was then launched in 1948, but the cost was much greater than expected and in 1951 prescriptions charges were introduced. Bevan resigned feeling this was a betrayal of all he had worked for.