Download What Causes Illness and How is it Treated

What Causes Illness and How is it Treated?
8000 BC : Prehistoric
Cave paintings and symbolic artefacts found by
archaeologists suggest the earliest humans believed in spirits
and supernatural forces. Animals, the stars, the land in which
they lived and dead ancestors all inhabited a spirit world that
was connected to their everyday life. Special individuals,
like Shaman, were thought to be able to contact the spirit
world and seek their guidance when they entered mysterious
trances. These men and women would call upon the spirits to
bring good hunting or heal the sick and were possibly the
first doctors.
Spirit healers would perform ceremonies and cast spells to
treat the sick. We also believe that they dispensed the first
medicines. Drinking the blood of a wild animal killed in the
hunt would give hunters special powers or eating special
plants known only to the shaman could treat sickness. It is
possible that these treatments would sometimes have a
beneficial effect and it is thought that drugs like digitalis and
morphine were first discovered in this way.
2000 BC : Egyptians
Religious beliefs dominated the ancient Egyptians' view of healing. Doctors were often priests who were
able to communicate with the gods responsible for the health of different parts of the body. Illness was
due to the presence of evil spirits or poisons and removing these from the body with prayers to the gods
would cure the disease. Medicines were used to help relieve pain but were not thought to play any other
role in the healing process.
As today, the Egyptians suffered from the common cold.
Here is a remedy taken from an ancient papyrus:
To make them feel better, the patient should be given the milk
of a mother who has given birth to a boy.
The following spell was to be made to get rid of the cold:
May you flow out, catarrh, son of catarrh, who breaks the
bones, who destroys the skull, who hacks in the marrow, who
causes the seven openings in the head to ache.
The Egyptians had doctors who specialised in treating
particular parts of the body as well as researching the
properties of herbal medicines. Their detailed records of the
symptoms and treatments of illnesses formed some of the first medical textbooks.
Egyptologists have found documents, written on a type of paper called papyrus, that describe medical
techniques similar to those used today. The Egyptians used compression on a wound to stop bleeding and
had specialists in obstetrics and gynaecology who were the forerunners of modern midwives.
Egyptians believed in an afterlife. They mummified the bodies of Pharaohs and important people.
Embalmers would carefully remove body organs, which were preserved in jars and buried with the
mummified body. They would have gained knowledge of the internal structure of the body but this was
not seen as important in the treatment of diseases, which were thought to be caused by the gods.
What Causes Illness and How is it Treated?
450 BC to 300 AD : Greeks and Romans
Greece was home to one of the earliest civilisations. Writing, mathematics,
philosophy and the arts all flourished. The Greeks believed in many
different gods but they also tried to understand their world in a much more
scientific way.
Possibly the most famous name in medicine belongs to the Greek
philosopher Hippocrates. He is seen as the father of modern medicine and
gives his name to the Hippocratic oath that doctors take.
At this time, most people believed that diseases were sent as a punishment
from the gods. Treatments were aimed at pleasing the gods so that the
disease would be cured.
Hippocrates went against this conventional thinking and looked on the body
as having a balance between four humours: blood, phlegm, black bile, and
yellow bile. If a person was ill, it meant that there was an imbalance in their humours and so they would
take a treatment to return the balance back to normal. This often included bleeding or induced vomiting.
This radical approach took medicine out of the spiritual world and the four humours formed the basis of
medical treatments well into medieval times.
Blood:
gave a person a lively personality and lots of energy. They enjoyed life and the arts.
Phlegm:
made a person feel lethargic or have a dull personality.
Black bile:
caused depression and sadness.
Yellow bile: influenced a person's temperament. It caused anger and a fiery temper.
It is unusual to think of doctors working like this but in Greek times, the workings of the body remained
very much undiscovered. We no longer believe in the four humours but many Greek practices still remain
today. Greek physicians would talk to their patients to take
careful case histories and find out as much from the patient as
possible about their disorder. They would then examine them
carefully to make a considered diagnosis of the problem before
recommending a course of treatment. This method of
examination and diagnosis is the basis of modern treatments.
The Romans realised that there was a link between dirt and
disease. To improve public health, they built aqueducts to supply
clean drinking water and sewers to remove wastes safely.
Improved personal hygiene helped to reduce disease and Roman
baths were places to socialise as well as stay clean.
What Causes Illness and How is it Treated?
500 - 1400 AD : The Middle Ages
The fall of the Roman Empire meant that many of their public hygiene practices were soon lost. The
Middle Ages in Europe saw most people without access to clean drinking water, regular bathing or a
sewage system. This meant that health conditions were often worse than during the Roman occupation of
earlier centuries. Most people were farmers and food was not
as plentiful as today. Starvation and disease were common.
Medicine in the middle ages was dominated by religion.
Sickness was believed to be a punishment from God for sins
committed and the only way to cure someone was to pray for
their forgiveness. Doctors in the middle ages were usually
priests or other religious scholars. Hospitals often sprang up
in monasteries and other religious establishments. The
patients were given food and comforted by religious nursing
staff but little else was done to cure their illness.
Traditional cures, using herbal remedies and potions were
seen as witchcraft and outlawed by the church. Laws stated that only trained and registered people could
practice medicine. Schools and universities began to educate wealthy individuals in religion, the arts, law
and medicine. Generally men, and occasionally a few women, were trained and allowed to become
physicians. As universities developed, more and more came from a non-religious background and
eventually it was not necessary to be a cleric to practice medicine.
The biggest challenge to medieval medicine came in the form of the Black Death, or Bubonic Plague. In
1347, an outbreak of bubonic plague broke out in Istanbul (modern day Turkey). Traders soon carried the
disease throughout Europe and records show that in some areas it killed up to 90% of the population. That
is the equivalent of 49 million people in the UK today.
We now know that bubonic plague is a form of highly contagious and fatal pneumonia. During the middle
ages, the only treatments were superstitious remedies, prayer, herbal medicines and recipes for clearing
the air of miasma (poison). The plague was considered to be a punishment from God and so public health
was not considered important. There was never any attempt to control the many rats that infested villages
and towns and carried the disease (1 of the main reasons the plague was so devastating).
Ibn Sina (Avicenna) wrote
a book of healing in 1010
700 - 1500 AD : Arabic Medicines
For many centuries after the fall of the Roman Empire, the Arabic world was
the centre of scientific and medical knowledge. Texts from Greece and Rome
were translated into Arabic and studied by Islamic scholars. They developed
and refined Hippocrates’ theories and Islamic physicians began to use the
regulation of diet, exercise and the prescription of medicinal herbs in the
treatment of their patients. Arabic pharmacists became skilled in the
formulation of medicines from plants and minerals. Even though they did not
know about microbes, they used alcohol to clean wounds, which healed better
and did not become infected.
Hospitals were not just for the wealthy. They treated rich and poor alike.
Islamic hospitals of the time would not look out of place today, with medical and surgical wards as well
as operating theatres and pharmacies for the dispensing of medicines. By 931 AD, large hospitals were
involved in the training and licensing of doctors and pharmacists. Officials tested medicines to certify that
they were safe and visited pharmacists to make sure that prescriptions were being made correctly. All this
was at the time when medicine in Europe was still governed by religion and superstition.
What Causes Illness and How is it Treated?
1400 – 1700 : The Renaissance
The Renaissance was a period in European history during which there
was a revival in the ideas of ancient Rome and Greece. Aristocrats and
scholars, who prized themselves on their education, studied culture, art,
science and medicine. Ideas flourished and the newly invented printing
press allowed books to be produced quickly. Before this, books were
slowly and painstakingly copied by hand. Although very few people
could read and write, the printing press was a revolution in information
technology and resulted in ideas spreading around Europe like never
before. It is hard to believe its impact but the printing press was the
information superhighway of its day.
Medicine remained dominated by the teachings of the church but
physicians began to learn more about the human body. They read books
translated from Arabic medical texts and began to study anatomy in a
scientific and systematic way. Leonardo Da Vinci dissected human
bodies and made the first anatomical drawings (see right).
During this time, the human body was regarded as a creation of God and
the ancient Greek view of the four humours prevailed. Sickness was due
to an imbalance in these humours and treatments, such as bleeding the
patient or inducing vomiting, were aimed at restoring the balance of these four humours.
As the understanding of the body increased, so did the development of new medicines. Building on
knowledge of herbs and minerals taken from Arabic writings, Renaissance pharmacists (or apothecaries)
experimented with new plants brought from distant lands by explorers like Christopher Columbus. The
bark of the Quina tree contained an ingredient called quinine, which is still used in the treatment of
malaria. The leaves of the tobacco plant were thought to have medicinal properties, although we now
know it is responsible for an enormous number of deaths. Laudanum, an opium-based painkiller, was
prescribed for many disorders and remained in use up until Victorian times. However, progress was slow
and many medicines remained little more than superstitious potions containing ingredients like worm's
livers and tongue of newt.
As new continents were explored, and trade between different parts of the world increased, it allowed the
global spread of disease. This often had devastating effects as whole populations were exposed to
pathogens against which they had no natural immunity. Bubonic plague moved along trade routes from
China and killed more than a third of Europe's population. When the Spanish colonised South America,
they brought smallpox, which killed many native Aztecs and Incas.
Up until this time the prevailing view was that life arose from Spontaneous Generation. E.g. maggots
arise in this way from rotting meat. In 1668 Francesco Redi tested this by putting meat in jars with and
without corks (that excluded flies). Maggots only appeared in the open container. A more refined view of
the Scientific method developed out of the ensuing furore.
In just this way, people's understanding of the body increased tremendously and finally dispelled ideas
that had remained from ancient Greek times. Scientific knowledge spread rapidly because scientists began
to publish their work in books. In 1661 the Italian scientist Marcello Malpighi identified capillaries,
which finally showed the link between arteries and veins and proving Harvey's theory for the circulation
of blood. A Dutch clockmaker, Anton Van Leeuwenhoek, made one of the earliest microscopes to use a
glass lens in 1677 he later saw, but did not recognise, bacteria. The detail the revolutionary microscopes
could see allowed the English scientist Robert Hooke to observe cells for the first time.
What Causes Illness and How is it Treated?
1700 – 1900 : 18th and 19th centuries Part 2
The industrial revolution of the 18th and 19th centuries saw a massive change in the way people lived and
how this affected their health. People moved from small villages and an agricultural lifestyle to live in
towns and cities that sprang up around the new factories, where they could work. People lived in dirty,
overcrowded conditions with poor sanitation and dirty drinking water. Many died from diseases such as
cholera, tuberculosis, and pneumonia – infections that could spread quickly and easily in these conditions.
One of the big medical advances of this time was vaccination. Edward Jenner pioneered the earliest
vaccinations and discoveries by Louis Pasteur and Robert Koch led to
the understanding that infections were caused by certain bacteria or
germs. The study of microbes, or microbiology, was born and the
increased knowledge of pathogenic microbes led to the development of
new medicines to tackle infectious diseases. The pharmaceutical
industry was born.
Louis Pasteur demonstrated that fermentation is caused by the growth of
microorganisms, and that bacteria do not arise by spontaneous
generation. His research also showed that the growth of microorganisms
was responsible for spoiling beverages, such as beer, wine and milk.
With this established, Pasteur invented a process in which liquids such
as milk were heated to kill most bacteria and moulds already present
within them. This process is now known as pasteurization. Beverage
contamination in 1857 led Pasteur to the idea that microorganisms
infecting animals and humans could cause disease. He proposed
preventing the entry of microorganisms into the human body, which got
Joseph Lister thinking.
Joseph Lister realised that infections caught during an operation often lead to death by septicaemia. He
pioneered the use of carbolic acid as the first antiseptic to clean wounds and surgical instruments.
Operations were performed with a fine spray of carbolic acid passed over the patient to kill any microbes
in the air. In one Newcastle hospital, use of Lister's antiseptic technique reduced deaths from infection
from nearly 60% down to just 4%.
Pasteur was convinced that microbes caused diseases in humans but he was
never able to directly link one microbe with a disease. Robert Koch
succeeded in doing this with anthrax, TB and blood poisoning. To do this
he would isolate the suspected microbe from a diseased victim, culture it,
infect a healthy host, which then got the disease, then isolate the same germ
from the new victim. These steps comprise Koch’s Postulates.
Perhaps the most famous nurse ever, Florence Nightingale, worked in a
military hospital during the Crimean war. Conditions were poor and 80% of
soldiers died from infections they caught in the hospital rather than their
original wounds. Florence Nightingale improved standards of hygiene and
sanitation, which dramatically reduced the infections in her hospital. When
she returned from the war, Florence Nightingale embarked on a campaign to modernise and improve
hospitals. She set the foundations of hospital design and nursing practice that are still seen today.
What Causes Illness and How is it Treated?
1700 – 1900 : 18th and 19th centuries Part 1
Smallpox was a killer disease in the 18th century. Infected people
became covered in horrible skin sores and often die a painful death.
Those who recovered were left with terrible scars or pockmarks on
their skin. We now understand that it is caused by the Variola virus.
It infects the internal organs, causing severe blistering of the skin
and death due to blood poisoning or secondary infections.
Edward Jenner is credited with the development of vaccination but
in fact it was first introduced into England by Lady Mary Wortley
Montagu in 1721. She tried a method that was used in Turkey where
people deliberately infected themselves with a mild form of
smallpox. This was the first form of innoculation. Sadly, many people died from the smallpox they were
using to protect themselves. Clearly something different needed to be done.
Jenner was a doctor who worked in Gloucestershire and the great advance he made was to notice that
individuals who had contracted cowpox (the cow's equivalent of
smallpox) rarely caught the deadly human version. In 1796 he
deliberately infected an eight-year-old boy called James Phipps with
the pus from a cowpox sore. The boy became ill with cowpox but
recovered. He then infected him with the normally deadly smallpox.
As Jenner had predicted the earlier infection with the cowpox
actually protected the boy who never caught smallpox. The practice
of modern vaccination was born.
Jenner’s results were met with scepticism and many doctors still carried out the more dangerous practice
of innoculation with live smallpox pus. Eventually this dangerous practice was banned and in 1853
vaccination by Jenner's method was made compulsory. Protestors argued against compulsory vaccination,
saying that it limited their personal choice; a similar debate to the one raging today over the MMR
vaccine.
Nearly 200 years after Jenner's discovery, a programme of vaccination
by the World Health Organisation (WHO) was started with the aim to
completely eradicate the smallpox virus. It is estimated that smallpox
killed 500 million people worldwide during the last century. The last
case of naturally transmitted smallpox was reported in Africa, in 1977.
In 1980, the WHO officially announced the end of smallpox. There
remain two highly guarded stocks of the virus in laboratories in the
USA and Russia. These are preserved for research purposes. Some
authorities speculate that other laboratories have stocks that could be
used in germ warfare but these claims are yet to be proven.
What Causes Illness and How is it Treated?
1900 - 2000: The 20th century
In 1901, the average life expectancy in the Britain was 47 years. By
the year 2000 it had risen to 77 years. New medicines, improved air
quality and better public hygiene have contributed to this 64%
increase in the life expectancy. The twentieth century has seen some
major advances in healthcare, including the development of
penicillin and antibiotics.
After being first described by Edward Jenner in the 18th century,
mass vaccination programmes were undertaken to prevent deaths
from diseases such as yellow fever, poliomyelitis, measles, mumps and rubella. In 1980 the World Health
Organisation announced that the deadly smallpox virus had been completely eradicated. Sadly, diseases
like HIV/AIDS, cholera, tuberculosis, pneumonia and malaria remain major killers in third world
countries where he levels of healthcare are below those found in the more well off Western nations
At the start of the 20th century, many people still died from infectious diseases that today are easily
cured. It was a discovery by Alexander Fleming in 1928 that would lead to the range of modern
treatments for such diseases. In 1871, Joseph Lister noticed that some moulds could make other microbes
grow more weakly. He did not realise the potential of this observation and did not follow it any further. It
was over fifty years later, in 1928, that Alexander Fleming made a similar observation.
Fleming was trying to find ways of killing the bacteria that caused cuts and
wounds to become infected and turn septic. This was a serious condition and
could cause death if the infection spread to the blood. He noticed that the
growth of bacteria had been inhibited on a petri dish that had been accidentally
contaminated with the mould Penicillium Notatum. He immediately realised
that the mould must be producing a chemical that prevented the bacteria from
growing. He cultivated the mould and investigated its properties on bacteria
that caused diseases such as anthrax, meningitis and diphtheria.
Fleming's discovery was not fully exploited until the outbreak of World War II in 1939. Infected wounds
had caused many deaths in previous wars and two researchers from Oxford University, Howard Florey
and Ernst Chain, set out to find new medicines to treat wounded soldiers. They realised the importance of
Fleming's work and had the resources to grow large amounts of the Penicillium mould. This allowed them
to isolate the active antibiotic in sufficient quantities to try it on patients suffering from severe infections.
Before antibiotics, a simple throat infection could easily spread to the lungs and throughout the body.
There was little that could be done for these patients and many died from complications of what we
would now think of as a trivial infection. Florey and Chain showed that Penicillin could be used to save
lives. The production of Penicillin became a wartime priority and pharmaceutical factories in the USA,
United Kingdom and Russia manufactured large quantities of Penicillin, which was used to save the lives
of wounded soldiers.
There are now many different types of antibiotics, which are specialised to treat a wide range of bacterial
infections. However, the widespread, and sometimes unnecessary use of antibiotics is leading to the
evolution of strains of bacteria that are able to survive all but the most powerful antibiotics. These socalled superbugs can cause real problems, especially in hospitals where patients may become infected
after surgery if the highest standards of hygiene are not maintained.
Suggestions
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Put the class into 7 groups and give each group a different era to investigate. All students will need a
copy of the sheets for their era. Some groups have 2 era, some have 1.
The students need to read through the sheet and make sure everyone understands the terms (scientific
/ biological dictionaries may be useful).
They try to answer the 2 questions at the top for each of the eras on their sheet.
Then discuss any interesting/unexpected things that came up in their reading.
Each group feeds back their findings to the class – key ideas only – in chronological order.
Students could record a timeline of key people or key understandings.
Some questions that may foster discussion:
1. In 2003 a new viral disease emerged called Severe Acute Respiratory Syndrome or SARS. How
would an outbreak like SARS be treated in modern times compared to medieval times?
2. How did medical procedures in the Arab world compare with those in Europe during the Middle
Ages?
3. How did explorers affect the development of medicine and also the new peoples that they visited?
4. How did the living conditions in towns affect the health of people living there?
5. Suggest some medical developments which improve the quality of health and life, rather than being
only life-saving.
6. What does this activity tell you about the work of scientists?