or lay practitioners, attended to the ills of the popular classes. the spanish crown began regulating the medical profession just a few years after the conquest, setting up the royal tribunal of the protomedicato, a board for licensing medical personnel in 1527. licensing became more systematic after 1646 with physicians, druggists, surgeons, and bleeders requiring a license before they could publicly practice. crown regulation of medical practice became more general in the spanish empire. elites and the popular classes alike called on divine intervention in personal and society-wide health crises, such as the epidemic of 1737. the intervention of the virgin of guadalupe was depicted in a scene of dead and dying indians, with elites on their knees praying for her aid. in the late eighteenth century, the crown began implementing secularizing policies on the iberian peninsula and its overseas empire to control disease more systematically and scientifically. spanish quest for medicinal spices botanical medicines also became popular during the 16th, 17th, and 18th centuries. spanish pharmaceutical books during this time contain medicinal recipes consisting of spices, herbs, and other botanical products. for example, nutmeg oil was documented for curing stomach ailments and cardamom oil was believed to relieve intestinal ailments. during the rise of the global trade market, spices and herbs, along with many other goods, that were indigenous to different territories began to appear in different locations across the globe. herbs and spices were especially popular for their utility in cooking and medicines. as a result of this popularity and increased demand for spices, some areas in asia, like china and indonesia, became hubs for spice cultivation and trade. the spanish empire also wanted to benefit from the international spice trade, so they looked towards their american colonies. the spanish american colonies became an area where the spanish searched to discover new spices and indigenous american medicinal recipes. the florentine codex, a 16th-century ethnographic research study in mesoamerica by the spanish franciscan friar bernardino de sahagún, is a major contribution to the history of nahua medicine. the spanish did discover many spices and herbs new to them, some of which were reportedly similar to asian spices. a spanish physician by the name of nicolás monardes studied many of the american spices coming into spain. he documented many of the new american spices and their medicinal properties in his survey historia medicinal de las cosas que se traen de nuestras indias occidentales. for example, monardes describes the "long pepper" (pimienta luenga), found along the coasts of the countries that are now known panama and colombia, as a pepper that was more flavorful, healthy, and spicy in comparison to the eastern black pepper. the spanish interest in american spices can first be seen in the commissioning of the libellus de medicinalibus indorum herbis, which was a spanish-american codex describing indigenous american spices and herbs and describing the ways that these were used in natural aztec medicines. the codex was commissioned in the year 1552 by francisco de mendoza, the son of antonio de mendoza, who was the first viceroy of new spain. francisco de mendoza was interested in studying the properties of these herbs and spices, so that he would be able to profit from the trade of these herbs and the medicines that could be produced by them. francisco de mendoza recruited the help of monardez in studying the traditional medicines of the indigenous people living in what was then the spanish colonies. monardez researched these medicines and performed experiments to discover the possibilities of spice cultivation and medicine creation in the spanish colonies. the spanish transplanted some herbs from asia, but only a few foreign crops were successfully grown in the spanish colonies. one notable crop brought from asia and successfully grown in the spanish colonies was ginger, as it was considered hispaniola's number 1 crop at the end of the 16th century. the spanish empire did profit from cultivating herbs and spices, but they also introduced pre-columbian american medicinal knowledge to europe. other europeans were inspired by the actions of spain and decided to try to establish a botanical transplant system in colonies that they controlled, however, these subsequent attempts were not successful. united kingdom and the british empire18th-century medical remedies collected by a british gentry family the london dispensary opened in 1696, the first clinic in the british empire to dispense medicines to poor sick people. the innovation was slow to catch on, but new dispensaries were open in the 1770s. in the colonies, small hospitals opened in philadelphia in 1752, new york in 1771, and boston (massachusetts general hospital) in 1811. guy's hospital in 1820 guy's hospital, the first great british hospital with a modern foundation opened in 1721 in london, with funding from businessman thomas guy. it had been preceded by st bartholomew's hospital and st thomas's hospital, both medieval foundations. in 1821 a bequest of £200,000 by william hunt in 1829 funded expansion for an additional hundred beds at guy's. samuel sharp (1709–78), a surgeon at guy's hospital from 1733 to 1757, was internationally famous; his a treatise on the operations of surgery (1st ed., 1739), was the first british study focused exclusively on operative technique. english physician thomas percival (1740–1804) wrote a comprehensive system of medical conduct, medical ethics; or, a code of institutes and precepts, adapted to the professional conduct of physicians and surgeons (1803) that set the standard for many textbooks. late modern medicine germ theory and bacteriology in the 1830s in italy, agostino bassi traced the silkworm disease muscardine to microorganisms. meanwhile, in germany, theodor schwann led research on alcoholic fermentation by yeast, proposing that living microorganisms were responsible. leading chemists, such as justus von liebig, seeking solely physicochemical explanations, derided this claim and alleged that schwann was regressing to vitalism. in 1847 in vienna, ignaz semmelweis (1818–1865), dramatically reduced the death rate of new mothers (due to childbed fever) by requiring physicians to clean their hands before attending childbirth, yet his principles were marginalized and attacked by professional peers. at that time most people still believed that infections were caused by foul odors called miasmas. louis pasteur experimenting on bacteria, c. 1870 statue of robert koch, father of medical bacteriology, at robert-koch-platz (robert koch square) in berlin french scientist louis pasteur confirmed schwann's fermentation experiments in 1857 and afterwards supported the hypothesis that yeast were microorganisms. moreover, he suggested that such a process might also explain contagious disease. in 1860, pasteur's report on bacterial fermentation of butyric acid motivated fellow frenchman casimir davaine to identify a similar species (which he called bacteridia) as the pathogen of the deadly disease anthrax. others dismissed "bacteridia" as a mere byproduct of the disease. british surgeon joseph lister, however, took these findings seriously and subsequently introduced antisepsis to wound treatment in 1865. german physician robert koch, noting fellow german ferdinand cohn's report of a spore stage of a certain bacterial species, traced the life cycle of davaine's bacteridia, identified spores, inoculated laboratory animals with them, and reproduced anthrax—a breakthrough for experimental pathology and germ theory of disease. pasteur's group added ecological investigations confirming spores' role in the natural setting, while koch published a landmark treatise in 1878 on the bacterial pathology of wounds. in 1881, koch reported discovery of the "tubercle bacillus", cementing germ theory and koch's acclaim. upon the outbreak of a cholera epidemic in alexandria, egypt, two medical missions went to investigate and attend the sick, one was sent out by pasteur and the other led by koch. koch's group returned in 1883, having successfully discovered the cholera pathogen. in germany, however, koch's bacteriologists had to vie against max von pettenkofer, germany's leading proponent of miasmatic theory. pettenkofer conceded bacteria's casual involvement, but maintained that other, environmental factors were required to turn it pathogenic, and opposed water treatment as a misdirected effort amid more important ways to improve public health. the massive cholera epidemic in hamburg in 1892 devastated pettenkoffer's position, and yielded german public health to "koch's bacteriology". on losing the 1883 rivalry in alexandria, pasteur switched research direction, and introduced his third vaccine—rabies vaccine—the first vaccine for humans since jenner's for smallpox. from across the globe, donations poured in, funding the founding of pasteur institute, the globe's first biomedical institute, which opened in 1888. along with koch's bacteriologists, pasteur's group—which preferred the term microbiology—led medicine into the new era of "scientific medicine" upon bacteriology and germ theory. accepted from jakob henle, koch's steps to confirm a species' pathogenicity became famed as "koch's postulates". although his proposed tuberculosis treatment, tuberculin, seemingly failed, it soon was used to test for infection with the involved species. in 1905, koch was awarded the nobel prize in physiology or medicine, and remains renowned as the founder of medical microbiology. nursing the breakthrough to professionalization based on knowledge of advanced medicine was led by florence nightingale in england. she resolved to provide more advanced training than she saw on the continent. at kaiserswerth, where the first german nursing schools were founded in 1836 by theodor fliedner, she said, "the nursing was nil and the hygiene horrible.") britain's male doctors preferred the old system, but nightingale won out and her nightingale training school opened in 1860 and became a model. the nightingale solution depended on the patronage of upper-class women, and they proved eager to serve. royalty became involved. in 1902 the wife of the british king took control of the nursing unit of the british army, became its president, and renamed it after herself as the queen alexandra's royal army nursing corps; when she died the next queen became president. today its colonel in chief is sophie, countess of wessex, the daughter-in-law of queen elizabeth ii. in the united states, upper-middle-class women who already supported hospitals promoted nursing. the new profession proved highly attractive to women of all backgrounds, and schools of nursing opened in the late 19th century. they were soon a function of large hospitals , where they provided a steady stream of low-paid idealistic workers. the international red cross began operations in numerous countries in the late 19th century, promoting nursing as an ideal profession for middle-class women. statistical methods "diagram of the causes of mortality in the army in the east" by florence nightingale. a major breakthrough in epidemiology came with the introduction of statistical maps and graphs. they allowed careful analysis of seasonality issues in disease incidents, and the maps allowed public health officials to identify critical loci for the dissemination of disease. john snow in london developed the methods. in 1849, he observed that the symptoms of cholera, which had already claimed around 500 lives within a month, were vomiting and diarrhoea. he concluded that the source of contamination must be through ingestion, rather than inhalation as was previously thought. it was this insight that resulted in the removal of the pump on broad street, after which deaths from cholera plummeted. english nurse florence nightingale pioneered analysis of large amounts of statistical data, using graphs and tables, regarding the condition of thousands of patients in the crimean war to evaluate the efficacy of hospital services. her methods proved convincing and led to reforms in military and civilian hospitals, usually with the full support of the government.> by the late 19th and early 20th century english statisticians led by francis galton, karl pearson and ronald fisher developed the mathematical tools such as correlations and hypothesis tests that made possible much more sophisticated analysis of statistical data. during the u.s. civil war the sanitary commission collected enormous amounts of statistical data, and opened up the problems of storing information for fast access and mechanically searching for data patterns. the pioneer was john shaw billings (1838–1913). a senior surgeon in the war, billings built the library of the surgeon general's office (now the national library of medicine), the centerpiece of modern medical information systems. billings figured out how to mechanically analyze medical and demographic data by turning facts into numbers and punching the numbers onto cardboard cards that could be sorted and counted by machine. the applications were developed by his assistant herman hollerith; hollerith invented the punch card and counter-sorter system that dominated statistical data manipulation until the 1970s. hollerith's company became international business machines (ibm) in 1911. psychiatry further information: history of psychiatry the quaker-run york retreat,