 Hello and welcome to our video summarizing all you need to know about the history of medicine. My name is Barbara and in this video we'll examine the history of medicine from its early beginnings in the medieval period through the renaissance of Victorian eras. We'll also look at the evolution of modern medicine, ending with the role of medicine in Britain and perhaps the UK's most famous medical establishment which is the NHS, the National Health Service. This video is useful if you're studying history of medicine for your history exams or as part of your history coursework studies. You may also find this video useful if you're studying this as part of an aspiration of yours to enter the world of medicine, be it as a nurse, doctor, surgeon or a health professional. So let's get started. Now let's begin with medicine in medieval Britain, between 1000 and 1500. Now it's really important to understand that during this time illness rather was seen as a disease of the supernatural. Many people believed that disease was a punishment from God for people's sins and they thought that it existed to show them the error of their ways and to make them better people. Therefore, they thought the way to cure disease was through prayer and repentance and disease was thought by a lot of medieval people to be caused by the evil supernatural beings like demons and witches. Witches were believed to be behind the outbreaks of disease and many people were tried as witches and executed as a result. People also believed that some diseases could be caused by evil spirits living within someone and members of the church often performed exorcisms using chance to remove the spirit from the person's body. When it came to medicine during this time, the role of the church was really important and specifically the Roman Catholic Church. They were an extremely powerful organization in medieval Europe and they dominated the way people studied and thought about a range of topics including medicine. The church encouraged people to believe that disease was really a punishment from God rather than having any natural causes and this therefore prevented people from trying to find cures for the disease. If disease was a punishment from God all you could do was pray and repent. The church also made sure that scholars of medicine learned the works of Galen as his ideas fit the Christian belief that God created human bodies and made them to be perfect. It also stopped anyone from disagreeing with Galen and the church outlawed dissection in other words cutting up somebody's body to examine their insides if they were dead. This meant that medieval doctors couldn't really discover ideas about human anatomy for themselves. They instead had to rely on ideas from Galen which were mainly incorrect. There was also a lot of use of astrology when it came to diagnosis during this time so astrology is the idea that the movements of the planets and stars have an effect on the earth and on people. Doctors in medieval England believed that these movements could cause disease and astrology was a new way of diagnosing disease during this time. It was developed in Arabic medicine and brought to Europe between 111100 and 1300. Medieval doctors owned a type of calendar called an almanac which included information about where particular planets and stars were at a given time. Doctors then used this information to predict how patients health could be affected and different star signs were thought to affect different parts of the body. Now there were also lots of natural explanation during the medieval period when it came to medicine and illness. So the first of course which really dominated thinking was this four humus theory. Now this theory really has its roots for earlier than the medieval period and after the fall of the Roman Empire much ancient Greek and Roman medical knowledge was lost in the west. The theory of the four humus however was brought back to Western Europe via the Islamic world and it dominated a lot of people's ideas about disease. Many medieval doctors based their diagnosis and treatment on this theory. The theory of the four humus was created by the ancient Greek doctor Hippocrates who lived from 466 BC to 377 BC. Hippocrates believed that the body was made up of four liquid which he called humus. These were linked to the four seasons and the four elements according to his theory and they needed to be in balance for good health. This theory was then further developed by Greek doctor Galen who I've mentioned earlier and he was born in AD 129 and worked for much of his Korean broom. Galen believed that diseases could be treated using opposites and he thought that different foods, drinks, herbs and spices had a humour which could balance the excessive humour that was causing this disease. There was also another important theory that was seen as causing disease and this was the miasma theory. This was the idea that bad air or miasma causes disease when someone breathes it in. This bad air may come from human waste or dead bodies, anything that creates a bad smell. This miasma theory originated in ancient Greece and Roman it was incorporated by Galen into the theory of the four humans. The idea became extremely popular in medieval Britain and this theory was so influential that it lasted until the 1860s when it was replaced by the germ theory eventually. Miasma often prompted people to do hygienic things unknowingly like cleaning streets which sometimes did help stop the spread of disease but for the wrong reasons. Of course as I've mentioned, Hippocrates and Galen were really important and they wrote down the beliefs about medicine. These were translated into Latin books which are considered important texts by Roman Catholic Church. Like the Bible, Hippocrates and Galen's ideas were considered the absolute truth and many of the ideas were taught for centuries after the deaths including the incorrect ones. For example, Galen only ever dissected animals. Don't forget of course that the church prevented the dissection of human bodies because it was rooted in the idea that the body was sacred. So a lot of his work was rooted in dissecting animals. However, animal and human bodies are very different so some of his ideas about anatomy were plainly wrong. Medieval doctors were not allowed to perform their own dissections therefore they continued to learn Galen's incorrect ideas. Some of Hippocrates and Galen's ideas were so influential that they still continue to be used today. Consider the Hippocratic Oath which is a promise made by doctors who qualify to work in the medical profession to obey rules of behaviour in the professional life and a version of it is still in use today. Hippocrates and Galen also believe that doctors should observe their patience as they treat them. Now also during this period Islamic medicine had an impact on disease and Arab doctors kept classical knowledge alive. Now when it comes to Islamic medicine, while a lot of medical knowledge was lost in the west after the fall of the Roman Empire, medical ideas like the four humours and treatments by opposites were kept alive by Islamic scholars. In the 19th century Hunan bin Ishaq, known by his Latin name Johann Nittis, travelled from Baghdad to Byzantium to collect Greek medical texts and he translated these into Arabic. This classical knowledge was eventually brought to Europe by Avincenna or Ibn-Sinna, a Persian who lived from around AD 980 to 1037. Avincenna wrote the Canon of Medicine which brought together ideas of Galen and Hippocrates and was the most important way that classical ideas got back to Western Europe. This work and other Islamic texts translated into Latin in Spain which was particularly Christian and partly Islamic or Italian. The Crusades also made Europeans aware of the scientific knowledge of Islamic doctors. Thus Islamic doctors did make new discoveries. So Abu Qasim, born in AD 936, wrote a well thought out book describing things like amputations, the removal of bladder stones and dental surgery, as well as methods for handling fractures, dislocations and the stitching of wounds. In the 12th century, Avincenna or Ibn-Zur, described the parasite that causes scabies and began to question the reliability of Galen. Ibn-Al-Nafis, who lived in the 13th century, also questioned Galen's ideas and he suggested, correctly, that blood flows from one side of the heart to the other via the lungs and it doesn't cross the septum which is a dividing wall between the left and the right side of the heart. Ibn-Al-Nafis' work wasn't recognised in the West until the 20th century. Also the autobiography of Usama Ibn-Mundiq, a 12th century Muslim doctor, suggests the difference between Islamic and European medicine. Usama describes how he treated a knight with a saw on his leg by using a poultice and a woman who was feeble-minded by advising a new diet. Then a French doctor arrived and claimed Usama knew nothing. He cut off the knight's leg with an axe and cut the woman's head with a razor and rubbed the skull with salt and of course both patients died. Alchemy was another thing that really had an influence on medicine and the idea of disease at this time and this was essentially the attempt to turn base metals into gold and discovered the elixir of eternal life. Unlike modern chemistry, much superstition was included. An unsuccessful experiment was as likely to be blamed on the position of the stars or the spiritual purity of the alchemists as anything else and even so, Arabic alchemists invented useful techniques such as distillation and sublimation and prepared drugs such as laudanum, benzone and camphor. Now when it came to treating disease during the medieval period, prayer and repentance were major treatments. So disease of course as mentioned earlier was believed to be a punishment from God so six people were encouraged to pray and they often prayed with saints in the hope that they would intervene and stop the illness. Medieval people also believed that pilgrimages to holy shrines could cure illnesses. Others took the repentance one step further. Flagellants were people who whipped themselves in public in order to show God that they were really sorry for the past actions. This was particularly common during epidemics such as the Black Death. Many doctors also at the time of course had superstitious beliefs. Some used astrology to diagnose and treat illnesses or believed that saying certain words while giving a treatment could make that treatment more effective. Another way that disease was treated during this time was bloodletting and purging which aimed to make the humus balanced. Bloodletting and purging were popular treatments because they fitted in with the four humus theory and that someone apparently had too much blood inside of them the doctor would take blood out of the body through bloodletting that might make a small incision to remove the blood or use blood-cerking leeches. However as a result of this some people were accidentally killed because too much blood was taken. Purging was also the act of getting rid of other fluids of the body by excreting so doctors gave their patients laxative to help the purging process. Purifying the way was also rather purifying the air was thought to prevent disease so of course this stems from miasma theory and therefore a lot of people believed in the power of purifying or clearing the air to prevent sickness and improve health. Physicians carried posties or oranges around with them when visiting patients to protect themselves from catching the disease and during the black death juniper, myrrh and incense were burned so the smoke or scent would fill the room and stop bad air from bringing disease inside. Remedies were early natural medicines at the time so remedies bought from an apocrythory or a local wise woman or made at home were all popular ways of treating people and these remedies will pass down or written in books explaining how to mix them together and some of these books are called herbals. Other remedies were based on superstition like glocky charms containing powdered unicorns horns. Of course healers were important in this process so physicians were male doctors who had trained at university for at least seven years. They read ancient texts as well as writings from the Islamic world but their training improved very few people's lives and they proved little practice practical experience. Also a lot of these people whilst they went to university they didn't have lots of practical training and they used instead hand mooks and clinical observations to check patients conditions. There were fewer also than a hundred physicians in England in 1300 and they were also really expensive. Most people saw an apothecary who prepared and sold remedies instead and they gave advice on how best to use them and therefore apothecaries were most common form of treatment in Britain as well very accessible for those who couldn't afford a physician. Apothecaries were trained through apprenticeships and most of them were men but there were also several wise women who sold herbal remedies. Also during the medieval period there were very few public hospitals. Most of the public hospitals that existed were set up and run by the church and they were very popular and highly regarded. The main purpose of these hospitals wasn't really to treat disease but to care for the sick and elderly. They served as some types of hospices. The hospital provided its patients with food, water and a warm place to stay. Most hospitals were also more hygienic than elsewhere because they had developed water and sewage systems. Some monasteries also cared for the sick the elderly or the poor and most sick people were treated at home by members of the family. Of course there was some surgery that was conducted during the medieval period however it was really dangerous and there was no way to prevent blood loss and fractional pain. It was therefore only attempted quite rarely and for very minor procedures such as treating hernia or cataracts. There were a few university trained highly paid surgeons but surgery as a whole was not a very respected profession during this period and most operations were carried out by barber surgeons so barbers who on the one hand cut people's hair but also cut people apart. Some progress was made in surgery during this time so for instance Hugh of Luca and his son Theodoric worked as surgeons in Italy in the early 13th century and they recognized the importance of practical experience and observations and did question some of Galen's ideas. They began dressing wounds with bandages soaked in wine because the notice that the wine helped to keep the wounds clean and prevent infection and they made this discovery just by chance. They also realized that pus was not a very healthy sign and like other doctors at the time who might try to cause wounds to pus because they believed it might release toxins from the body. Some surgeons tried to find ways to reduce pain during operations so for example John of Ardene created a recipe for an anaesthetic in 1376 which included hemlock, opium and hembrane which is a relative of deadly nightshade. In carefully controlled doses this may have worked but it was very likely to kill. Now when it came to health in towns and monasteries most towns at the time were small especially after the black death when a lot of people died. Houses were usually made of wood and were crammed together overcrowding therefore and fires were very common. A lot of towns didn't also have clean water supplies or sewage systems waste was just thrown into the street or into rivers to be washed away. Thus sewage from latrines leaked into the ground and got into wells and businesses and homes weren't really separated but chas, tanners and dryers threw toxic waste into rivers and residential streets and people had to get their drinking water from these same rivers and wells which are contaminated. In the 13th century a water channel called the Great Conduit was built to bring clean water into London as the Thames was getting too toxic. In 1388 the government ordered town authorities to keep the streets free of waste. Towns introduced public health measures to tackle waste, sewage and pollution and to create a clean water supply. Monasteries were also very wealthy so they could afford to build infrastructure, black latrine buildings and waterways to keep the water clean. Towns had to rely on wealthy individuals to fund these kinds of projects and monastery populations were quite small and had one leader, the Abbott, and he had the power to enforce rules about cleanliness and waste disposal. Getting hundreds of townspeople to adopt cleaner habits however was tricky. Towns didn't have one person in charge who could easily enforce public health measures. Of course we were alluded to this but the Black Death in Britain had a huge impact on lots of people at the time. It vastly reduced the population and of course it highlighted how ineffective a lot of beliefs around disease treatment was. So the Black Death was a series of plagues that swept Europe through Europe in the 14th century. It was really two illnesses. Firstly the bubonic plague which was spread by the bites of fleas from rats carried on ships. This caused headaches and a high temperature followed by pus filled swellings on the skin. The second plague was the pneumonic plague which was airborne. It was spread by coughs and sneezes and it attacked the lungs making it painful to breathe causing victims to cough blood. This disease first arrived in Britain in 1348 and some historians think that at least a third of the British population died as a result of the Black Death in 1348-1350. There were further outbreaks of the Black Death throughout the Middle Ages. Some people believe that the Black Death was a judgment from God. They thought the cause of the disease was sin so they tried to prevent the spread of the disease through pro and fasting. Some blamed humour and balances so tried to get rid of the Black Death through bloodletting and purging. Those who thought that the disease was caused by miasma carried strong smelling herbs or lit fires to purify the air. Some people also carried charms or used magic potions containing arsenic. Some people in Winchester thought one could catch the plague from being close to the bodies of dead victims. Therefore in Winchester when the town cemetery became too full to take any more plague victims in the townspeople refused to let the bishop extend the cemetery to the town centre. Instead they insisted that new cemeteries be built outside of the town away from houses. In the town of Gloucester they tried to shut themselves off from the outside world after hearing of the Black Death and its reach in Bristol. This suggests that people at the time thought the plague was spread by human contact. Their attempt at prevention was ultimately unsuccessful and many people in this town of Gloucester died of the Black Death. November 1348 the disease reached London and in January 1349 King Edward III closed Parliament. The Black Death for all the ravages that caused society also caused social change so after the Black Death there were far fewer workers around because a lot of people had died. This meant that the few workers that were left could actually demand higher wages from their employers and move around to find even better work. The cost of the land also went down allowing some peasants to buy land for the first time. These changes threatened the power of the elites the government created laws such as the 1349 ordinance of labourers to try and stop peasants from moving around the country. Some people think the Black Death helped cause the peasants to revolt in 1381 and eventually the collapse of the feudal system in Britain. So now let's move into the second major era in the evolution of medicine 1500 to 1700s the medical renaissance in Britain. Now of course there was some continuity but also a little bit of change. In the Renaissance there was a rediscovery from classical Greek and Roman times. Western doctors gained access to the original writings of Hippocrates, Galen and Avicenna a Persian physician who lived between 1980 and 1037 AD. These ideas hadn't been available throughout the medieval period. Thus they led to greater interest in the four humus theory and treatment by opposites. However the Renaissance also saw the emergence of science as we know it from the magic and mysticism of medieval medicine. People thought about how the human body worked based on direct observation and experimentation. This was partly because many of the new books that have been found said that anatomy and dissections were really important. This encouraged people to examine the body themselves and to come to their own conclusions about the causes of disease. People began to question Galen's thinking and that of other ancient doctors however his writings continued to be studied. Protestant Christianity also spread across Europe during this time and this is of course due to the Reformation of Henry VIII and do watch our other video which summarizes Henry VIII in detail. This Reformation reduced the influence of the Catholic Church and although religion still played an important role in society the church no longer had so much control over the medical teaching in the medical world. This of course led to improvements in medical knowledge. So many doctors in the Renaissance trained at the College of Physicians which had been set up in 1598. Here they read books by Galen but also studied recent medical developments dissections showing how the body actually work also became part of medical training. The College of Physicians encouraged the licensing of doctors to stop the influence of quacks who sold fake medicines and some of the colleges physicians such as Harvey made important discoveries about disease in the human body. Weapons like cannons and guns were also used in war which meant that doctors and surgeons had to treat injuries in ways that happened to have been seen before forcing them to quickly find new treatments. Explorations abroad from Britain brought new ingredients for drugs back to the country including guacium which was believed to kill Philips and quinine a drug familiaria from the bark of the chinchonutri. In the 1530s Henry VIII closed down most of Britain's monasteries this was called the Dissolution of Monasteries. Since most hospitals have been set up and run by monasteries this led to the closure of a large number of hospitals and the sudden loss of so many hospitals was really bad for people's health. The monastic hospitals were gradually replaced by some free hospitals which were paid for by charitable donations. Unlike the monastic hospitals however which had been run by monks these new hospitals were run by trained physicians who focused more on getting better from illnesses. Of course this therefore during the Renaissance period led to the spread of new ideas. Firstly one of the things that really had a massive impact on medicine was the invention of the printing press. Printing meant that books could be copied more easily as in the past new ideas had to be widely accepted before someone would rather copying them by hand. Students and universities could now have their own textbooks for the first time letting them study these ideas in detail. People could question existing ideas and have scientific debates and at least 600 different editions of Galen's books were printed between 1473 and 1599 as a result of Caxton's printing press. Lots of people knew these theories with so many but there were so many different versions around and therefore it was unclear what Galen had originally written which made his writing seem less reliable and easy to question. The Royal Society was also really important during this time. It was founded in 1660 and its motto is Nilius in Verba which means take no one's word for it. The society wanted to encourage people to be skeptical and question scientific ideas and they helped spread new scientific theories and got people to trust new technology. The Royal Society's scientific journal Philosophical Transactions allowed more people to read about new inventions and discoveries. Also Umbra's Paré was really important in improving surgical techniques when it came to treating people. So Paré was a French barber surgeon born in 1510. Surgery at the time when he was born and at the time he lived was seen as a very low-status profession and he worked for a public hospital then became an army surgeon. As an army surgeon Paré treated many serious injuries caused by war and he improved the treatment of amputations. Before Paré the severed blood vessels left by amputations were sealed by burning their ends with red hot iron. Paré invented a method of tying off the vessels with threads which were called ligatures. This was seen as less painful than the previous way of burning the ends with red hot iron and thus it reduced the chances of a patient dying simply from the shock of the pain. However it did increase the risk of infection. His experience treating these wounds led him to develop some improved surgical techniques. At this time gunshot wounds often became infected. Doctors didn't understand why this happened or how to treat it. The usual treatment was to burn the wounds with the red hot iron or pour boiling oil into it. This may have worked in some cases but it often did more harm than good. During one battle Paré ran out of oil and sorted by chance to a simple call salve instead. To his surprise the patients treated in this way did way better than those who were scarred with oil. Paré published his ideas to enable other doctors to read about them. British surgeons then used his methods and took inspiration from his work and over time his ideas helped improve surgical techniques. Paré's ideas were resisted by doctors though who felt that a lowly barber surgeon shouldn't be listened to. He eventually became surgeon to the king of France and it was only with the king's support that his ideas became gradually more accepted. However of course during this period all treatments were still used so many doctors were reluctant to accept that Galen was wrong. This meant they continued to use similar treatment to the medieval ages like bloodletting and purging. Doctors also were expensive and as a result most people used healers such as apothecaries and barber surgeons like the medieval period. Others turned to quack doctors who sold medicines and treatments in the streets and the kills were often fake though some may have worked by sheer luck. Superstition and religion still played an important role. People thought for example the king's touch could kill a skin disease and thousands of people with this skin disease were thought to have visited King Charles I in the hope of being killed. Of course there were still vastly poor living conditions for a lot of people during this time so living conditions in Renaissance towns were terrible they were less healthy than medieval ones. Overcrowding was a huge problem and there was a lack of light and fresh air in lots of houses. Streets were also unclean there weren't many sewage systems of any sort or rubbish collection facilities. Finding clean water was also quite hard and local authorities however tried to improve conditions. They used acts of parliament to get power to do things like keep roads clean. Housing also improved and some towns planned with living conditions in mind. Hospitals are still fairly basic however so Miss Renaissance hospitals were for the sick and the deserving poor those who led hard working respectable lives. People might have to work in hospital not just be treated and those with incurable infectious disease like smallpox were not allowed in. An example is St Murray's Bethlehem hospital or bedlam which was Britain's first lunatic institution. Many of its inmates actually just had simply learning disabilities epilepsy or they were just poor. People even visited this hospital to watch patients for entertainment. Other hospitals like St Bethlehem's in London became centres of innovation research. Important people during this period were Vesalius and Sydenham so Vesalius was born in 1514 and he was a medical professor in Padua Italy. He believed that successful surgery would only be possible if doctors had a proper understanding of human anatomy. He was therefore able to perform dissections and criminals who'd been executed and this let him study the human anatomy more closely and he wrote books on his observation using accurate diagrams to illustrate his work. The most important were six anatomical pictures published in 1538 and the fabric of the human body published in 1543. His works were printed and copied allowing lots of people to read his ideas. Vesalius's findings encourage others also to question Galen. Doctors realised that there was more to discover about the body because of Vesalius's questioning attitude. He showed that dissecting bodies was important to find out exactly how the human body was structured. Thomas Sydenham was another important person and he was born in 1624 and died in 1689. He was a Renaissance physician who worked in London and he was a son of a country squire and fought in the English Civil War before becoming a doctor. He's been called the English Hippocrates because of the large impact of his medical achievements. Sydenham didn't believe in the value of theoretical knowledge in other words reading about medicine rather than actually practically applying it. Instead Sydenham thought that it was more important to gain practical experience in teaching patients. As a doctor he made detailed observations of his patients and kept accurate records of the symptoms. Sydenham thought that diseases could be classified like animals or plants but different types of disease could be discovered using patient symptoms. Sydenham is known for showing that a scarlet fever was different to measles and for introducing Lordenham to relieve pain. He was also one of the first doctors to use iron to treat anemia and quinine for malaria. Sydenham wrote a book called Medical Observations published in 1676 which was used as a textbook by doctors for 200 years. His description of medical condition like gout helped other doctors to diagnose the patients more easily. William Harvey is another really important person during this period to be aware of. He made hugely important discoveries about how blood circulates around the body and his work helped advance people's knowledge of anatomy. Also importantly he discovered the circulation of blood. He was born in 1578 and he worked in London at the Royal College of Physicians before becoming a Royal Physician to James I and King Charles I. Harvey studied both animals and humans for his work and he realised he could observe living animal hearts and actions and his findings would also be applied to humans. A new type of water pump was invented at around the time of his birth and this new technology gave Harvey a comparison and inspiration for how the heart worked. Before Harvey people thought that there were two kinds of blood and that they flowed through two completely separate systems of blood vessels. It was thought before him that purple nutrition carrying blood was producing the liver and then it flowed through the veins to the rest of the body where it was consumed. People also thought that bright red life-giving blood was producing the lungs and it flowed through arteries to the body where it was also consumed. This may also show that continuing influence of Galen who had suggested this kind of system about 1400 years earlier. Harvey however realised that this theory was wrong. From experiments that he conducted he knew that too much blood was being pumped out of the heart for it to be continually formed and consumed. Instead he thought that blood must circulate. It goes round and round the body. Harvey's research was a major breakthrough in anatomy and it understood and rather changed how people understood the anatomy. His discoveries gave doctors a new map showing how the body worked and without this map blood transfusions and complex surgery couldn't be attempted. Harvey also showed that Bacillus had been right about how important dissection was. However his work had a limited impact on diagnosis and the treatment of disease as not everyone believed his theories. Indeed it took a long time for doctors to accept it and when people did attempt blood transfusions they were really successful because of blood loss, shock and because the wrong blood types were used. Bloodletting was just supposed to keep the four humans in balance therefore continue to be performed. The Great Plague also struck during this time. In 1665 London was struck by this plague and it was a rare but deadly recurrence of the medieval black death. London's death toll was about 100,000 people which is 20% of the city's population. Many people fled the city but only richer people had this option. Doctors and priests were most affected because the sick went to them for help. During this time superstitions still dominated treatment so just like the responses to the black death 300 years before most treatments for the Great Plague were based on magic, religion and superstition. This included wearing lucky charms or amulets saying prayers and fasting and special remedies were made using ingredients like dried toad. Bloodletting was also used even if this made the plague worse as it created wounds which could become infected. Other people thought that miasma created the disease and they carried around poses of herbs or flowers to improve the air. Perhaps the most extreme treatment was strapping a live chicken to swellings. People thought the disease could be transferred from the plague victim to the chicken. When it came to preventative measures that were taken councils tried to quarantine plague victims to prevent them from passing the disease on to others. The victim's house was locked and a red cross was painted on the door along with words Lord have mercy upon us. The areas where people crowded together such theaters were closed. People tried also not to touch other people for example if someone had to give money in a shop coins might be replaced placed in a jar of vinegar. The dead bodies of plague victims were also buried in mass graves away from houses. Cards, organized authorities roamed the city to the infamous cry of bring out your dead collecting corpses for burial. Local council also paid for lots of cats and dogs to be killed because they thought they carried the plague. Now shifting into the 1700s 1900s period which is medicine in the 18th and 19th century Britain. So vaccination was one of the major breakthroughs. So until the 1970s people had few effective ways to prevent the spread of the disease. Edward Jenner's discovery of the smallpox vaccine was a landmark in the development of preventative medicine. Before Jenner the only way to prevent smallpox was inoculation. In the 1970s smallpox was one of the most deadly diseases and in 1751 over 3500 people died from smallpox in London alone. At the time the only way to prevent smallpox was through inoculation. This was introduced into Britain from Turkey by Lady Mary Wortley Montague in 1718. Inoculation involved making a cut in a patient's arm and soaking it in pus taken from the swelling of somebody who already had a mild form of smallpox. Now let's look at the role of Edward Jenner in inventing small vaccinations and helping cure smallpox. So Edward Jenner who was born in 1749 was a country doctor in Gloucestershire. He heard that milkmaids didn't get smallpox but they did catch the milder cowpox. Using careful scientific methods Jenner investigated and discovered that it was true that people who had cowpox didn't get smallpox. In 1796 Jenner tested this theory. He injected a small boy called James Phillips with pus from the sores of serenelms and milk made from cowpox with cowpox. Jenner then infected him with smallpox. He found that James didn't catch this disease. Jenner published these findings in 1798 and he coined the term vaccination using the Latin word for cow vacca. Of course there was a huge opposition to Jenner's vaccination during these 1700s. Some people resisted vaccination. Some doctors who gave the older type of inoculation saw it as a threat to the livelihood and many people were worried about giving themselves a disease from cows. However Jenner's discoveries soon got the approval parliament which gave him £10,000 in 1802 to open a vaccination clinic and a further £20,000 a few years later. In 1840 vaccination against smallpox was made free for infants in 1853. It was made compulsory for infants. The vaccine was a success. It contributed to big fall in the number of smallpox cases in Britain. Jenner didn't know why his vaccine worked. His lack of understanding meant he couldn't develop any other vaccines. This was only possible after the germ theory was published much later on when Louis Pasteur and others worked to discover vaccines against other diseases like chicken cholera and anthrax. The germ theory of course during this period the 1700s and 1900s was really important although people's understanding of anatomy had improved greatly during the Renaissance there was still plenty to learn. The causes of disease was an area that still needed proper explanation. Louis Pasteur was the first to suggest that germs caused disease. Germs and other microorganisms were discovered as early as the 17th century. Scientists thought that these microbes were created by dire and decaying matter like rotten food or human waste. This theory was known as spontaneous generation. It led people to believe that disease caused germs. Louis Pasteur was a French chemist who was employed in 1857 to find the explanation for the souring of sugar beet used in fermenting industrial alcohol and his answer was to blame germs. Pasteur proved that there were germs in the air. He showed that sterilized water in a closed flask stayed sterile while sterilized water in an open flask bred germs. In 1861 Pasteur published his germ theory. In it he argued that microbes in the air caused delay not the other way around. He also suggested that some germs cause disease. In 1867 Pasteur published evidence proving there was a link between germs and disease demonstrating that germs caused a disease in silkworms. At first this germ theory was met with skepticism. People couldn't really believe that tiny microbes caused disease. It didn't help that the germ responsible for each disease had to be identified individually as this meant it was several years before the theory became useful. However it did gain popularity in Britain and this theory helped inspire Joseph Lister to develop antiseptics. The theory confirmed John Snow's findings about cholera and it linked disease to poor living conditions like contaminated water. This put pressure on the government to pass the 1875 Public Health Act. Robert Koch was another important theorist and this German scientist built on Louis Pasteur's work by linking specific diseases to the particular microbe that caused them. This technique was called microbe hunting. Koch identified anthrax bacteria in 1876 and the bacteria that caused septicemia in 1878, tuberculosis in 1882 and cholera in 1883. He used revolutionary scientific methods. He used the agar jelly to create solid structures allowing him to breed lots of bacteria. He also used dyes to stain the bacteria so they were more visible under the microscope. He employed the newly invented photography to record his findings and Koch's techniques were important as they allowed other microbe hunters to find the specific bacteria which caused other diseases. There was therefore an ensuing fight against germs so Pasteur and Koch weren't friends. In 1871 Germany beat France in the Franco-Prussian War so there was a great national and personal rivalry between the two men. This competition thus fueled the next series of discoveries. So Louis Pasteur developed vaccines for anthrax and rabies. In 1877 after hearing of Koch's discovery of the anthrax bacteria Pasteur started to compete in the race to find and combat new microbes. His assistant Charles Cumberland injected some chicken with cholera culture that had been weakened by being accidentally left out on the desk while he was on holiday. The chicken survived and the team tried again with some newly cultured cholera but the chickens still survived. They inferred that the weakened cholera had made the chicken immune. Cumberland's error had produced a chance discovery. The team produced an attenuated version of the anthrax bacteria to make sheep immune. They produced this in a public experiment in 1881 and they used a similar method to find a vaccine for rabies. Koch's method helped other microbe hunters. Other scientists used Koch's methods to find and combat the bacteria that caused other diseases. For example the diphtheria germ was discovered by Edwin Kelbs in 1883. Friedrich Luffer cultured the diphtheria germ and thought that its effect on people was due to a toxin it produced. Emil Ruh proved law-flow right. In 1891 Emil von Behring produced an antitoxin which is a substance that cancels out the toxins produced by germs from the blood of animals that had just recovered from diphtheria. This could be used to reduce the effect of the disease. Ronald Ross received the Nobel Prize in 1902 for the discovery of how malaria was transmitted and his Nobel Prize was disputed by Giovanni Battista Grassi who also discovered how malaria was transmitted. However Koch supported Ross's claim and so he retained the prize. Paul Erich was another important uh physician. He discovered the first magic bullet the Salverson 606. Antibodies were identified as a natural defense mechanism of the body against germs. It was known that antibodies only attacked specific microbes in the body so there were nicknamed magic bullets. In 1889 Paul Erich sought out to find chemicals that could act as synthetic antibodies. First he discovered that dyes could kill the malaria and sleeping sickness germs. In 1905 the bacteria that caused the sexually transmitted disease syphilis was identified. Erich and his team decided to search for an arsenic compound that was a magic bullet for syphilis. They hoped it would target the bacteria without poisoning the rest of the body. Over 600 compounds were tried but none seemed to work. In 1901 1909 rather Sahachiro Hatta joined the team. He rechecked the results and saw that compound number 606 actually appeared to work. It was first used on a human in 1911 under the trade name Salverson 606. After Erich and Hatta's discovery more magic bullets were discovered. The second magic bullet Prantasil was discovered by Gerhard Domac in 1932. Prantasil was used to combat strepsis a type of bacteria that can cause blood poisoning. Of course there were also improvements when it came to surgery in hospitals. So over time surgeons became more important and they developed the approach to surgery. From the 18th century hospitals also focused more on treating patients rather than just caring for them as well as teaching them. In the middle ages surgeons weren't really respected compared to doctors. In the 17 and 1800s surgeons however began to gain the same status of doctors and in 1800 the London College of Surgeons later renamed the Royal College of Surgeons was created which set training standards for surgeons for the first time. John Hunter who was born in 1728 to 1793 joined his brother William a doctor at his anatomy school in London where the dissected human corpses. Over 12 years Hunter developed an unrivaled knowledge of the human body. He became an army surgeon and a popular teacher. He made several important discoveries and he learned more about venereal disease, sexually transmitted infection, a major cause of illness at the time and introduced a new approach to the treatment of gunshot wounds. In 1785 Hunter introduced a new way to treat an aneurysm evolved in the blood vessel in a man's thigh. He tied off the blood vessel to encourage the blood to flow through other vessels in the leg stopping it from having to be amputated. Hunter encouraged better approaches to surgery which included good scientific habits, lack of learning about the body to understand illnesses, experimenting to find better ways to treat disease and testing treatments such as on animals before using them on people. Now when it came to surgery on hospitals from the early 18th century several charity hospitals opened including the London Hospital and Guy's Hospital. They were funded by the rich and offered largely free treatment to the poor. Some specialised in treating certain illnesses or provided somewhere for mothers to give birth. Only those who were likely to recover quickly were admitted. This was because of a lack of space and the risk of illness spreading. The deserving poor, those who led hard-working respectable lives, had more chances of being admitted. Dispensaries also provided free non-residential care to poor people and medicines and non-surgical services from people like dentists and midwives are given without charge. Most poor people were treated in workhouses and which were large buildings that people went into if they couldn't afford to look after themselves because of unemployment, illness or old age. Conditions were poor in these workhouses but from the 1850s a particularly successful movement began to improve conditions in workhouse infirmaries. In the 19th century some hospitals were founded alongside universities or medical schools including Chair and Cross Hospital, University College Hospital and King's College Hospital. These hospitals were used as training source for doctors and for conducting scientific research. Cottage hospitals run by GPs opened from the 1860s and they provided care for people in rural areas. There are also significant developments in nursing during this time. So before the 1800s hospitals are often dirty places that people associated with death and infection. Florence Nightingale helped change that by improving hospital hygiene and raising nursing standards. A little bit about Florence Nightingale herself. She was born in 1820 to 1910 and she brought a new discipline and professionalism to a job that had a negative reputation at the time. Despite opposition from her family Florence Nightingale studied to become a nurse in 1849. When the Crimean War broke out in 1853 to 54 horror stories emerged about the barric hospital in Skatari where the British wounded were treated. Sydney Herbert who was both the Secretary of War and a friend of her family asked for Nightingale to go to Skatari and sort out the hospital's nursing care. The military opposed however female nurses as they were considered distraction and inferior to male nurses. Florence Nightingale went anyway with 38 handpicked nurses. Using methods she'd learned from her training in Europe Nightingale made sure that all the wards were clean and hygienic, water supplies were adequate and patients were fed properly. Nightingale significantly improved the hospital and before she arrived the death rate at the hospital was 42%. Two years later after her work it had fallen to just 2% which is impressive. In 1851 Florence Nightingale published a book called Notes and Nursing. This explained her methods it emphasised the need for hygiene and a professional attitude. It was a standard textbook for generations of nurses. The public raised £44,000 to help her train nurses so she set up the Nightingale School of Nursing in St Thomas's Hospital London. Another really important woman who revolutionised the nursing industry and the nursing profession was Mary Seacole who was born in 1805 to 1881. Mary Seacole learnt nursing from her mother who run a boarding house for soldiers in Jamaica. In 1854 Seacole came to England to volunteer as a nurse in the Crimean War. However she was rejected, very likely on racist grounds but she went on anyway paying for her own passage. Financing herself by selling goods to the soldiers and travellers she nursed soldiers in the battlefields and built the British Hotel a small group of makeshift buildings that served as a hospital, shop and canteen for the soldiers. Mary Seacole couldn't find work as a nurse in England after the war and sadly went bankrupt though she did receive support due to the press interest in her story. Anesthetics also saw improvements during this period so nitrous oxide which is laughing gas was identified as a possible anesthetic by British chemist Humphrey Davy in 1799 however he was ignored by surgeons at the time. This gas had been dismissed as a fairground novelty before American dentist Horace Wells suggested this using his area of work. He did a public demonstration in 1845 but had the bad luck to pick a patient unaffected by nitrous oxide thus it was ignored. In 1842 American doctor Crawford Long discovered the anesthetic qualities of Ether but didn't publish his work. The first public demonstration of Ether was an anesthetic carried out in 1846 by American dental surgeon William Morton. Ether is an irritant and is also fairly explosive so using it in this way was quite risky. James Simpson was a professor of midwifery at Edinburgh University looking for a safe alternative to Ether that women could take during childbirth. He began to experiment on himself. In 1847 he discovered the effects of chloroform. After Queen Victoria gave birth to her eighth child using chloroform in 1853 it became widely used in operating theatres and to reduce pain during childbirth. Chloroform sometimes affected the heart causing patients to die suddenly. General anesthesia which is complete and consciousness is risky so local anesthesia numbing the part that's being treated was better for many operations and in 1884 William Hampstead investigated the use of cocaine as a local anesthetic. His self experimentation however led to a severe cocaine addiction. Antiseptics had solved the problem of pain but surgeons still faced with a high death rate from operations due to the amount of infections. Antiseptics and later asepsis helped prevent this by killing germs. Antiseptics and asepsis reduce infections and their two main approaches to reducing infection during an operation. Antiseptic methods are used to kill germs that get near surgical wounds and the aseptic surgical methods aim to stop any germs getting near the wound. Joseph Lister pioneered the use of antiseptics. Ignaz Cholines showed that doctors could reduce the spread of infection by washing their hands with chloride of lime solution between patients. However it was a very unpleasant therefore it wasn't widely used. That being said Joseph Lister had seen carbolic acid sprays used in sewage works to keep down the smell. He tried using this in the operating theatre in the early 1860s and saw reduced infection rates. Lister also heard about the germ theory in 1865 and thus he realised that germs could be in the air. Surgical instruments as well as people hands could also be infected by germs. As a result he started using carbolic acid on instruments and bandages. The use of antiseptics immediately reduced death rates which were as high as 50% in 1864 to 166 to around 15% in 1867 to 1870. Antiseptics also allowed surgeons to operate with less fear of patients dying from infection. The number of operations increased 10 fold between 1867 and 1912 as a result. Asepsis also reduced the need for nasty chemicals. Since the late 1800s surgeons have changed the approach from killing germs to making a germ-free aseptic environment. Instruments were now carefully sterilised before use usually with a high temperature steam 120 degrees celsius. Theatre stuff also sterilised their hands before entering and the wore sterile gowns, masks, gloves and hats. Surgical gloves were also invented by William Halstead in 1889. The theatres themselves were also kept scrupulously clean and fed with sterile air. Special temps were placed around the operating table to maintain an area of even strict hygiene and high-risk cases. Aseptic surgery also reduced the need for carbolic spray which is unpleasant to get on your skin or breathe in and many doctors and nurses didn't like to use it. The industrial revolution also began in the 18th century and lots of people moved into cities like London to work in factories. The places they lived in were cramped, dirty and great for spreading diseases like cholera therefore public health really deteriorated during this time. Overcrowding in towns led to poor living conditions. Towns grew so quickly that good housing couldn't be built fast enough instead. Houses were built as close together as possible with little outside space and poor ventilation. Workers had little money so they tried to live in the smallest possible spaces. Families with four or more children often live in the single room and the poorest lived in cellars. Workers had little money so they tried to live in the smallest possible space and people didn't understand the need for clean water or good sewage systems. Missed houses had no bathroom instead they shared an outside toilet called a privy. Each privy was built above a cesspit and cesspit and household waste was collected by nightmen who threw the waste into rivers or piled it up for the rain to wash it away. Water companies also set up water pumps in the streets which are shared between many people per house and the pump's water supply was often contaminated by waste from these cesspits or rivers. This of course predictably led to huge cholera epidemics which killed thousands of people. Cholera really reached Britain in 1831 and by 1832 it was an epidemic. Over 21,000 people in Britain died that year. Cholera spreads when infected sewage gets into drinking water and it causes extreme diarrhea. Sufferers often die from loss of water and minerals. Both rich and poor people caught this disease during this time. During this period people didn't really know what caused cholera the best theory was miasma which essentially was quite useless. The government started regulating the burial of the dead but this did little to halt the spread of cholera. The 1832 epidemic declined and interest then was lost. However in 1842 the social reformer Edwin Chadwick published a report on poverty and health. The report showed that living conditions in towns were worse for people's health than conditions on the countryside. His report suggested that the government should pass laws for proper drainage and sewage systems funded by local taxes. His report and another cholera epidemic that broke out in 1848 which killed 53,000 people this time put pressure on parliament to pass a public health act. The 1848 act set up a central board of health which included him as a member and allowed any town to set up its own local board of health as long as the town's taxpayers agreed to it. John Snow is also another important figure at this time. He was a London doctor who showed that there was a connection between contaminated with native water and cholera. For a long time he'd suspected the disease was waterborne but had very little to prove it. When cholera broke out in the Broad Street area of London in 1854 Snow set out to test his theory. He interviewed people living in Broad Street and made a map of the areas showing when causes or cases of disease have been. His investigations showed that all victims used the same water pump on Broad Street and he convinced the local council there to remove the handle from the pump. This instantly brought cholera to an end in that area. It was later discovered that a nearby cesspit had a split in its lining and its waste had leaked into the pump's water supply. There was also another great incident called the great stink which had a massive impact in public health. Industrial cities during this industrial revolution had poor sewage systems and in London the introduction of flush toilets made this problem worse as they increased the volume of waste entering cesspits. A lot of waste overflowed and was drained into the tens. In the summer of 1858 hot water caused the river's water to level to drop and bacteria to grow in the waste. This produced a smell that was so bad it affected large parts of London and stopped Parliament from meeting. The situation in other words the great stink pushed authorities in London to agree to build an expensive sewer system. The government knew that the sewage system needed improving but the great stink persuaded them to act sooner than planned. A key figure in this was Joseph Bazalget who was a chief engineer of the Metropolitan Board of Works which was responsible for public works in London. To reduce the stink he was appointed in 1859 to build a new sewer system. The sewers were transported waste that was normally dumped in the Thames away from heavily populated areas to the Thames estuary. About 1300 miles of sewers were built and the sewer system was officially open in 1865. Now public opinion during this period started to shift. Evidence from Chadwick and Snow as well as Pasto's germ theory showed that cleaning towns could stop the spread of disease and in 1867 the second reform act was passed giving nearly one million more men vote the vote most of whom were industrial workers. Several reformers helped change attitudes towards health as well. William Farr was a statistician who recorded causes of death and used his statistics to press for reform in areas where death rates were high. Mounting evidence of the need to clean up towns and a breakdown in lacy fair beliefs caused the government to take action on public health. This eventually resulted in another public health act being passed in 1875. The government also began taking action so in 1871 to 72 the government followed the Royal Sanitary Commission's proposal to form the local government board and defied Britain into sanitary areas administered by offices for public health. In 1875 Benjamin Disraeli's government passed another public health act. It forced councils to appoint health inspectors and sanitary inspectors to make sure the laws on things like water supplies and hygiene were followed. It also made councils maintain sewage systems and keep the town streets clean. The 1875 Public Health Act was more effective than the one passed in 1848 because it was compulsory. Also Disraeli brought in the Artisans Drilling Act in 1875. This let local council buy slums with poor living conditions and rebuild them in a way that fit new government backed housing standards. However few councillors used the Act. An exception was Joseph Chamberlain who became the Mayor of Birmingham in 1873. Chamberlain persuaded the city authorities to buy the local gas and water companies to make sure people had good supplies of boats. In 1875 Chamberlain cleared an area of the city slums and built a new street in their place. He also improved some of the slum housing. It's now shifting into the 1900s to the present day medicine modern Britain. Now of course one of the major catalysts that caused improvements in the way treatment and medicine was administered was the First World War between 1914 to 1918 which caused a huge devastation in Europe. The soldiers injuries gave surgeons however opportunities to find new techniques for diagnosis and carrying out more complex operations and the First World War made X-rays more reliable and mobile. Wilhelm Rontgen discovered X-rays in 1895. The pass easily through soft flesh but less well through the bone. X-ray images could thus be produced by directing X-rays at body parts in front of a photographic plate. X-rays were used from the start of the First World War to find broken bones but the equipment included glass tubes that were unreliable and often stopped working. Also it was often located in hospitals miles away from the battlefield. The American scientist William Coolidge had invented a more reliable X-ray tube in 1913. The Coolidge tube became widely used by the end of the war and is still used today. In 1914 the Polis scientist Marie Curie developed mobile X-ray units ambulances equipped with X-ray machines which allowed doctors to transport X-ray equipment. Also the problem of blood loss was overcome. In 1900s Carl Landstoner discovered blood groups. He found that certain blood groups couldn't be mixed together as a blood would clot, blocking the blood vessels. This discovery was crucial as it meant that doctors could perform more successful blood transfusions as long as the donor's blood group was the same as a patient's. During World War I the seriousness of wounds from gunshots and explosive shells meant that many soldiers died of blood loss. This made being able to store blood really vital. In 1914 doctors found that sodium chrocycitrate stopped blood clotting so it could be stored. In 1917 the discovery allowed the first ever blood depot to be set up in the battle of Cambrai. In 1946 the British National Blood Transfusion Service was established. Also the First World War interestingly sped up the development of plastic surgery. Doctors in France and Germany had been working on scrim grafting techniques since before the First World War. The work helped pave way for Harold Gillies who set up a plastic surgery unit for the British Army during the war. Gillies was interested in reconstructing fatal injuries so that patients could have a more normal appearance after being damaged. He developed the use of pedicle tubes and kept detailed records of his achievements. His work was continued during the Second World War which was between 1939-1945 by his assistant Archibald Meckendo. A lot of Meckendo's patients were pilots who had been tracked inside burning aircrafts. Now when it comes to considering modern ideas about causes of a disease in 1892 the Russian microbiologist Dmitry Ivanovsky investigated mosaic a disease that was killing tobacco plants. He found that the cause was extremely small microbes that remained in water even after bacteria was removed. In 1898 the Dutch scientist Martinu Birgenig found that these microbes had different properties to bacteria. He labeled these microbes viruses. The discovery of viruses led to the successful treatment. Unlike bacteria viruses aren't destroyed by antibiotics instead doctors can prescribe antiviral drugs that only prevent a viral infection from growing. Only the body's immune system can destroy a virus for good. DNA was another important discovery in the modern day period. Genes are the chemical instructions that plan out human's characteristics including the gender and the hair color. These genes are stored in cells as DNA. Your DNA is a mix of your parents DNA which made you. The structure of DNA a double helix a kind of spiral that can reproduce itself by splitting was first described and discovered in 1953 by Francis Crick and James Watson. Watson and Crick's discovery allowed other scientists to find the genes that cause genetic conditions diseases that are passed on from one generation to another. These include cystic fibrosis hemophilia and sickle cell anemia. The knowledge of genetic conditions has improved diagnosis and treatment of them. Scientists can now produce a synthetic protein that can replicate the work of 40 gene and treat inherited conditions using techniques such gene therapy. One of the biggest breakthroughs in genetic research was made in 2001 with the completion of the human genome project. This identified all the genes in human DNA. Also lifestyle factors became increasingly understood when it came to their linked disease. A healthy diet exercise and other lifestyle factors have long been suggested as ways to prevent illness but it was only in the 20th century that lifestyle choices were linked to particular health conditions. For example smoking was shown to cause lung cancer, obesity was shown to increase the chances of getting heart disease and diabetes and drinking too much alcohol was shown to be a cause of liver disease. There are also developments in diagnosis. New causes of disease demanded new ways of diagnosing them. These new methods were introduced rapidly in the 20th century due to innovations in science and technology from computers to x-rays. Also blood tests saw improvements so they were first introduced to test blood groups before blood transfusions. Since then blood tests have been used to test for a range of diseases and they can be used to check a patient's cholesterol level and this can help to diagnose a chance of suffering a heart attack or stroke. Blood tests could also be used to check a patient's DNA which can help diagnose a genetic condition like hemophilia or cystic fibrosis. Some blood tests can also be used to show whether a patient has a certain type of cancer including ovarian cancer, prostate cancer and breast cancer. Symptoms can also be monitored more easily so devices have been introduced to allow doctors and patients to monitor symptoms. Blood pressure monitors were invented and developed in the 1880s and 1890s. The doctors and patients see whether disease, lifestyle factors or medicines are causing high blood pressure which can damage the heart. Blood sugar monitors were also introduced in the mid 20th century. They allowed those with diabetes to make the blood sugar to ensure that the blood sugar was at the right level. Medical scans were also introduced so doctors can see more of the body with medical scans. The use of medical scans interestingly began in 1895 when Wilhelm Rontigan discovered x-rays. X-ray images improved with the invention of the Coolidge tube in 1913. Advances in computers also allowed doctors to use ultrasound scanning. This uses high frequency sound waves which bounce off the patient's organs and other tissues to create an image of them on the computer. Computed tomography CT or CAT scans were invented in 1972 by Godfrey Houndsfield. They use x-rays in the computer to make detailed images of parts of the patient's body. Magnetic resource imaging or MRI scans were initially invented in 1970s but became widely used in the 1980s and these use extremely powerful radio waves and magnetic fields to construct images. Penicillin was also another discovery so in the 1800s Louis Pasteur discovered that bacteria causes disease but it wasn't really until the 1900s that doctors were able to treat bacterial diseases. This was partly due to the discovery of penicillin the first antibiotic. Now Fleming discovered penicillin and in other words Alexander Fleming saw many soldiers during the First World War die of septic wounds caused by a certain type of bacteria when he was working in the army hospital. Searching for a cure he identified the antiseptic substance in tears Lyosin in 1922 but this only worked in some germs. One day in 1928 he came to clean up some old culture dishes on which he had been growing a specific bacteria for his experiments and by chance a fungal spore had landed and grown on one of the dishes. What caught Fleming's eye was that the colonies of this bacteria around the mold had stopped growing. The fungus was identified as penicillin notatum. It produced a substance that killed the bacteria and the substance was given the name penicillin. Fleming publishes findings between 1929 and 1931 however nobody would further research so he couldn't take his work further. The industrial production of penicillin still needed to be developed. However Flory and Chain found a way to purify penicillin. Since it's a natural product penicillin needs to be purified. Thus a breakthrough was made by Howard Flory's team in Oxford between 1938 and 1940. Ernst Chain, a member of the team, devised the freezing drying technique which was an important part of the purification process. At first Flory and Chain didn't have the resources to produce penicillin in huge amounts. The main penicillin was the first clinical trial but growing the penicillin notatum and every container they could find in the lab. The patient became to recover only to die when the penicillin ran out. Flory knew that penicillin could be vital in treating wounds and soldiers in fighting World War II. British chemical firms were too busy making explosives to start mass production so he went to America. US firms were also not very keen to help until America joined the war in 1941. In December 1941 the US government began to give grants to businesses that manufactured penicillin. In 1943 British businesses also started mass reducing penicillin and mass production was sufficient for the needs of military medics by 1944. After the war the cost of penicillin fell making it more accessible for general use and Fleming, Flory and Chain were awarded the Nobel Prize in 1945. Today penicillin is used to treat a range of bacterial infections and other antibiotics were discovered after 1945 including treatments for long infections, acne, bacterial meningitis. Now when it comes to modern treatments for new treatments like magic bullets and antibiotics to make an impact they need to be made available to lots of people. This means that they had to be manufactured on the large kill. By the late 19th and 20th centuries the booming chemical industries in Britain, Germany, Switzerland and the US were best placed to mass produce these new drugs and medicines. The success of mass-produced drugs in the 1940s particularly penicillin helped the modern pharmaceutical industry to take off. Pharmaceutical companies have played an important role in researching and developing new medicines and they also mass produced these drugs to sell worldwide. These companies have been important in helping to cure new diseases and research new forms of treatment. Chemotherapy has also been pioneered during this period. This is the treatment of cancer using drugs. It began to be developed during World War II when doctors found that nitrogen mustard, a chemical in mustard glass, could be used to reduce cancer tumours. Other drugs were later discovered including a compound in folic acid that blocks the growth of cancer cells. Pharmaceutical companies have been producing cancer drugs since the 1960s. However, another downside during this period was the resistance that people began to develop to antibiotics which made drugs less effective. Antibiotic resistance is when a certain type of bacteria adapts so well within the body that it's no longer affected by antibiotics. This resistance develops when doctors and patients overuse antibiotics. The more antibiotics are used the more likely it is that the bacteria will become resistant to them. Antibiotic resistance stops antibiotics from working properly making it more difficult to treat some diseases and this has increased the levels of disease and the time taken for patients to recover. Now when it comes to alternative treatment mistrust and medicine and technology means that some people use alternative therapies instead. For example acupuncture is the method of putting needles in specific points of the patient's skin to relieve pain. Homeopathy is treatment using extremely weak solutions of natural substances and unlike mainstream treatments alternative therapies aren't based on evidence gathered from scientific research. As a result there's little scientific evidence that alternative treatments work effectively and some doctors believe they might do more harm than good. However some doctors are now working with alternative therapists to see if using a mix of alternative and mainstream medicine might result in benefits to the patient. When it comes to modern surgery surgery has improved rapidly during the 20th century. It's become far less risky and transplants have been made possible. Nowadays the emphasis on precision technology has been an important factor. Also transplants have been made far more successful. In 1905 the first successful transplant of the cornea of the eye was performed. During the First World War surgeons developed techniques for skin transplantation. Also the first complete organ to be successfully transplanted was a kidney. Livers, lungs, pancreases and bone marrow now can also be transplanted and the first successful heart transplant was carried out by the South African surgeon Christian Bernard in 1967. The patient however only survived for 18 days as he died of pneumonia. The problem for transplants mainly is rejection. The immune system attacks the implant as if it were a virus. The success of early transplant operations was limited because doctors lacked effective immunosuppressants, drugs that stopped the immune system from attacking. Since the 1970s researchers have developed increasingly effective immunosuppressants which are safer and more likely to be successful. Technology has also improved modern surgery so advances in sizes and technology have led to the improvements in the treatment of diseases like cancer. The discovery of radiation in 1896 to 1898 by Antoine Henri Bekel, Marie Curie and Pierre Curie led to the creation of radiotherapy. Radiotherapy essentially is the use of radiation to kill cancer cells. The development of lasers since the 1950s led to the widespread use in medicine in the 1980s and laser surgery was used to correct vision problems and lasers also used in cancer treatment and dentistry. Advances in technology since the 1980s have really led to the development of even robot assisted surgery and keyhole surgery. Now when it comes to robot assisted surgery the first surgical robot was introduced in 1985 but robot assisted surgery only became widely used after 2000 with the launch of the Da Vinci system. Robot assisted surgery allows surgeons to make smaller cuts. This means less scarring, less infection and quicker healing of wounds. Also keyhole surgery has been another innovation in surgery. A type of camera called an endoscope is put through a small cut letting the surgeon see the inside of the body. Other surgical instruments are then introduced through even smaller cuts in the skin. Keyhole surgery is useful for investigating the causes of pain or infertility. It's also used for vasectomies, removing cysts or their appendix, mending hernias and other minor operations. Keyhole surgery leaves patients with far smaller scars and allows them to recover more quickly with less risk of infection and these new surgical methods have improved surgeons precision leading to less infection. There've also been lots of reliberal reforms. In the 19th century people believed that the government should have little involvement in public health however this began to change after 1900 when the liberal social reforms were introduced to deal with poverty. Now two important people showed their effective poverty, Booth and Round Tree. Now slums and other poor overcrowded housings were still common in industrial towns in 1900s and the poor people worked long hours for very low wages and many people couldn't afford doctors or medicine they could barely afford to provide for their children with three decent bills a day. Two reports were produced which showed how widespread poverty was in England during this time. The first was Booth's report and the second was Round Tree's report. Now Charles Booth in 1889 produced a report called Life and Labour of the People of London and showed that 30% of Londoners were living in extreme poverty and it was sometimes impossible for them to find work however hard they tried. He showed some wages are so low they weren't enough to support a family. Also Sir Booth Round Tree had a factory in York. He didn't believe the problem was as bad there as in London as so he did a survey of living conditions. His report called Poverty a Study of Town Life which was published in 1901 showed that 28% of people in York couldn't afford basic food and housing. The lack of access to good health care meant that most people's health was quite poor and when the war broke out in South Africa in 1899 army officers found that 40% of volunteers were physically unfit for military service mostly due to poverty related illnesses linked to poor diet and living conditions. The government realised that it needed to improve basic health care in order to have an efficient army. Therefore liberal reforms improved health by tackling poverty. Booth, Round Tree and the Boor War showed that there was a link between poverty and ill health and the newly elected Liberal government and its Chancellor David Lord George realised it had to take action. So in 1906 the free school meals that were introduced in Britain. In 1907 local educational authorities started giving children free school meal free medical inspection. In 1908 old age pensions were introduced for the first time in the UK. People aged over 70 years old and it was the first ever welfare scheme to be paid by national taxes. In 1901 labour exchanges were introduced to help unemployed people find work and in 1911 the National Insurance Act was passed. The National Insurance Act was introduced and it introduced health insurance for workers both the worker as well as the employer and the government all contributed to a central fund that the workers could use for sick pay or pay for a doctor. Now the National Insurance Act which introduced health insurance for workers as well as the employees and the government all contributed to a central fund that workers could use for sick pay. Now the world wars really influenced how the government approached public health. So after world war two which was between 1939 and 1945 housing standards really began to improve. The beverage report argued that the state should provide support to people resulting in the creation of the welfare state in the UK and the national health service. Both the first and the second world wars really broke down social distinctions and brought people together whose lives had been very separate and this put a pressure for social change in England. Raising mass armies made government and military officials more aware of health problems of the poor because so many recruits were in poor health. Powerful people were more concerned with solving these health problems or not war because of the need for a strong army to defend the country. The evacuation of children during the second world war also increased awareness and ritual rural communities of how disadvantaged many people in other parts of the country were. So after the second world war people looked for improvements in society and such feelings led to the 1945 victory of the Labour Party which promised healthcare for everyone and for employment. Towards the end of the first world war Prime Minister David Lloyd George had promised to tackle poor quality housing by building homes for heroes to tackle bad housing and some new council houses were built between 1920s and 1930s but many of them were still too expensive for poor families who still lived in slums. However during the second world war destruction from bombing and a lack of construction also led to severe housing shortages which made the situation worse. After the second world war the Labour government built 800,000 homes between 1945 to 1951 and in 1946 it passed the New Towns Act which created a completely new towns near major cities. Governments in 1950s and 1960s demolished over 900,000 old cramped slums around 2 million inhabitants were rehoused. In 1961 a report called Homes Today and Tomorrow gave specific standards for new houses including adequate heating, flushing toilets and enough space inside and outside and this was the final step in tackling the issues of overcrowding, poor nutrition and waste disposal that caused major public health problems. The Beveridge Report as stated earlier did lead to the welfare state. The welfare state meaning the state looks after the people and takes more of an active role in tackling issues like unemployment and poor health. In 1942 during the second world war economists and social reformer William Beveridge published his famous report. This report became a bestseller and it's still widely read. This report said that the government had a duty of care for all its citizens not just the poor and unemployed. To achieve this he suggested the creation of a welfare state, a system of grants and services available to all British citizens. In 1945 the labour government was elected with a promise to implement Beveridge's proposals and one of the first acts was to pass a new national insurance act in 1946 to support anybody who couldn't find work whether it is a result of sickness, pregnancy, unemployment or old age. Of course as we mentioned earlier the national health service really revolutionised the medical healthcare sector in the UK. Now it was established in 1948 and the labour government implemented his last proposal which was the NHS and there is in Bavan who is the Labour Minister of Health at the time after a lot of negotiation introduced the NHS and the government essentially nationalised hospitals and put them under the local authority control. Treatment was then made free for all patients and there were arguments of course for and against the NHS and even today these arguments still are very vociferous. Now when it comes to people who really supported the setup and the NHS and even today people who support the NHS stated for example now the government took control of all hospitals creating an emergency medical service and its success led many to support the creation of the NHS. Those who supported this were delighted because they believed that medical care should be free so that it's accessible to everyone and it guaranteed that hospitals can also receive government money rather than having to rely on charities for money which leads to hospitals having very very standards in terms of what they can provide people who go to them. However of course there's still lots of people who are against the NHS so at the time many conservatives opposed its establishment as they believe the costs would be huge to the taxpayer. Doctors also at the time saw themselves as independent health professionals and they didn't want to be controlled by government. They're also worried that they would lose a lot of income by essentially working for a public sector organization and many doctors threatened to go on strike to protest against the NHS. However in spite of all its shortcomings it became really popular and it still to some degree remains popular today. Although many conservatives at the time were opposed to its creation they couldn't abolish it when they came into power in 19 when they came into power in 1951. The conservative government found that it was too popular. The NHS increased the number of people with access to healthcare, the number of doctors doubled between 1948 to 1973 to keep up the demand and today the NHS provides a range of health services most of which are free and accessible to everyone. They include accident emergency care, maternity care and major surgery as well as pharmacies, dentists, mental health services, sexual health services and general protection practitioners. However of course the NHS faces several challenges. The increase in life expectancy means that there are many older people in Britain today than there were in 1948 who are more likely to suffer from long-term conditions like diabetes and heart disease and they need regular medical condition and require therefore a lot of NHS time and resources. Also many people's lifestyle choices are putting a strain on the NHS. Smoking, obesity and alcohol consumption harm people's health and these luxuries are far more available today than they were before the First World War and of course even before the onset of the Second World War. This as a result is putting a lot of pressure on the NHS which is more needed than ever today. Many modern treatments, equipments and medicines are also really expensive and the NHS has had to face rising expectations of what it can and should offer and as a result of these factors the cost of the NHS is rising rapidly. Between 2015 and 2016 the NHS budget was £116 billion overall. In order to say within its budget the NHS has sometimes had to make difficult choices about which treatments it can and can't provide. Now when it comes to the government's role in health care since 1900 it has focused on improving health people's health. There have been vaccination campaigns which have successfully eradicated some diseases in the UK and since 1900 the government has launched several national vaccination programs to help prevent people from catching deadly diseases and these have been successful in reducing the number of deaths such as diabetes. Diphtheria for example is one of these conditions so it's a contagious disease that is caused by bacteria in the nose and throat and it can eventually attack the heart muscles causing paralysis or heart failure. Before the 1940s Diphtheria was a major killer. In 1940s there were over 60,000 cases of disease and over 3,000 deaths. After fears that wartime conditions could lead the spread of this disease the government started a vaccination campaign in 1940. It ran publicity campaigns, used posters, newspaper ads and radio broadcasts and this campaign was a success. By 1957 the number of diphtheria cases had dropped to just 38 with only six deaths. Another really successful campaign for public health by the government is polio. Now polio is an infection that can attack digestive system, bloodstream and nervous system and the disease can cause paralysis and it particularly affects children. In the late 1940s and early 1950s Britain suffered a series of polio epidemics. Diseases made over 30,000 people children at the time disabled between 1947 and 1958. The first vaccine was introduced in Britain in 1956 alongside a national campaign aiming to vaccinate every person under the age of 40 and the campaign was successful with a disease all but eradicated by the late 1970s. In the period 1985 to 2002 only 40 cases were reported of polio in Britain. Also there have been several lifestyle campaigns by the government. Now in the 20th century scientists showed a link between people's lifestyle choices and their health. Thus the government ran several campaigns to make people aware of the dangers and changes in lifestyles. In 1952 a great smog caused by coal fires resulted in 4,000 deaths in London. It thus showed the dangers of air pollution which can cause breathing conditions like asthma and bronchitis. The government passed laws in the hope of limiting air pollution. An increase in less active lifestyles also has led to an increase in obesity. In 2009 the government launched a change for life campaign with the aim of improving diets and promoting daily exercise. Also excessive alcohol intake was caused has been linked to several diseases most notably liver cirrhosis. Alcohol intake rose between 1950-2004 but has since fallen. This may be due to the government's Drink-Aware campaign which was launched in 2004 and the logo appears on many alcohol ads. So that's all. If you found this video useful we'd really appreciate it if you gave it a like and also subscribe to our channel. But also don't forget we offer lots of useful revision and exam materials on our website which is www.firstreadtutors.com. There you can find model answers, exam papers and revision material for your coursework or exams. Make sure you visit our website and if you have any questions do ask these questions in the comment section on the YouTube page below. Thank you so much for listening.