medicine in britain, c1250-present. revision...

1

Medicine in Britain, c1250-present. Revision Pack

2

Overview of Exam Papers

You will sit three History exams at the end of your GCSE course. Below is an overview of what the three papers will

focus on.

Year 10

In term one of Year 10 you will study Medicine in Britain, c 1250-Present (Paper 1 Section B), in term two you will study

Early Elizabethan England 1558-1588 (Paper 2 Section A). In term three you will study Spain and the ‘New World’

c1490-1555 (Paper 2 Section B).

Year 11

In the term one of Year 11 you will study The British sector of the Western Front 1914-1918 (Paper 1 Section A). In term

two you will study Weimar and Nazi Germany 1918-1939 (Paper 3 Section A and B). In term three you will be revising

and preparing for your final GCSE exams.

Paper 1 Paper 2 Paper 3 Weighting 30% Total Mark: 52

Exam time: 1h 15

Section A Historic Environment: “The

British sector of the Western Front, 1914-18: injuries,

treatment and the trenches. 16 marks

3 questions. Question 1: AO1 Question 2a: AO3 Question 2b:AO3

Section B

Thematic Study: Medicine in Britain, c1250-Present

32 marks & 4SPaG marks 3 questions.

Question 4: AO1/AO2 Question 5: AO1/AO2 Question 6: AO1/AO2

Weighting 40% Total Marks: 64

Exam time: 1h 45

Section A British Depth Study: Early

Elizabethan England 1558-1588

32 marks 3 questions.

Question 1: AO1/AO2 Question 2: AO1/AO2 Question 3: AO1/AO2

Section B Period Study: Superpower relations and the Cold War,

1941-91 32 marks

3 questions. Question 4/5a Question 4/5b Question 4/5c

Weighting 30% Total Marks: 52

Exam time: 1h 20

Section A Modern Depth Study: Weimar & Nazi Germany 1918-1939

16 marks 2 questions.

Question 1: AO3 Question 2: AO1/AO2

Section B Modern Depth Study: Weimar & Nazi Germany 1918-1939

Case Study 32 marks & 4SPaG marks.

4 questions. Question 3a: AO3 Question 3b: AO4 Question 3c: AO4 Question 3d: AO4

Assessment Objectives

AO1: Knowledge

AO2: Analysis

AO3: Sources

AO4: Interpretation

3

Example Exam Questions

Practice makes perfect! One of the most effective ways to revise is to practice answering exam style questions. There

are stimulus points for each question. These are there to help you answer the question, try to include these points in

your answer. On top of the stimulus points, you need to include information of your own in your answer.

4 mark questions

1. Explain one way in which ideas about the cause of disease and illness were similar in the 14th and 17th Century.

2. Explain one way in which ideas about the treatment of disease were different in the 17th century from ideas in

the 13th century.

3. Explain one way in which ideas about preventing the plague were different in the 14th and 17th centuries.

4. Explain one way in which understanding of the causes of disease and illness was different in c1750 from the

present day.

12 mark questions

5. Explain why there was continuity in ideas about the cause of disease during the period c1250-c1500. You may

use the following information in your answer.

a. The Church

b. Galen

6. Explain why there was little change in the care provided by hospitals in the period c1250-c1500. You may use

the following information in your answer.

a. Ideas in the church

b. Herbal remedies

7. Explain why there were changes in the way ideas about the causes of disease and illness were communicated in

the period c1500-1700. You may use the following information in your answer.

a. The printing press

b. The Royal Society

8. Explain why there was continuity in the way disease was treated in the period c1500-c1700. You may use the

following information in your answer.

a. The Great Plague

b. Attitudes in society

9. Explain why there was rapid change in surgical treatments in the period c1700-c1900. You may use the

following in your answer.

a. Chloroform

b. Joseph Lister

10. Explain why there was rapid change in the prevention of smallpox after 1798. You may use the following

information in your answer.

a. Inoculation

b. The government

11. Explain why there was rapid progress in disease prevention after c1900. You may use the following information

in your answer.

a. Government intervention

4

b. vaccinations

16 mark + 4 mark (Spelling, Punctuation and Grammar) questions

12. ‘Hospital treatment in England in the period from 1250 to 1500 was very rare’. How far do you agree with this

statement? You may use the following information in your answer.

a. Charity hospital

b. Care in the home

13. ‘Individuals had the biggest impact on medical training in the 16th and 17th centuries’. How far do you agree

with this statement? You may use the following information in your answer.

a. Vesalius

b. The printing press

14. ‘There was rapid change in ideas about the causes of illness and disease in the period c1700-c1900’. How far

do you agree with this statement? You may use the following information in your answer.

a. Spontaneous generation

b. Louis Pasteur

15. ‘Louis Pasteur’s publication of the Germ Theory was the biggest turning point in medicine in the period c1700-

c1900.’ How far do you agree with this statement? You may use the following information in your answer.

a. Edward Jenner

b. Robert Koch

16. ‘Treatment of diseases and care of the sick completely changed after 1800’. How far do you agree with this

statement? You may use the following information in your answer.

o Magic bullets

o The NHS

5

How can I improve my written answer? The language you use to express your ideas is very important. One of the ways to get better at history is to be more precise with your use of language. For example, rather than simply saying that you agree or disagree with a statement you can use language that shows whether you agree to a large extent or only to some extent. Below is grid with useful phrases to vary your language in your answers.

...to show how far you agree with a statement:

...to show how important a factor/cause is:

I totally/ entirely/ absolutely agree with…

I substantially/fundamentally/ strongly agree with…

I agree to a large extent with…

I mainly /mostly agree with…

I agree to some extent with…

I partially agree/partly agree with

I only agree with… to a limited /slight extent

…was by far the most important reasons why…

The key/crucial/essential factor was…

…was the main cause of…

The most influential cause was…

…played a significant/important/major role

in…

…was of some importance in…

...to show significance of an individual, discovery, event or development:

...to show the extent of change:

…made the most important/significant contribution to…

…had a crucial/major/highly significant

impact on…

had an important influential impact on…

…was of some importance/significance

…only made a limited/partial/slight/minimal contribution to…

…was revolutionised in…

…totally changed during…

…was transformed during…

…there was fundamental change in…

The period saw significant/important progress in…

…saw some changes in…

…saw some progress in…

6

…saw limited/slight/minimal progress in…

Our understanding of medicine can be broken down into the three key areas shown below.

Task: Give at least three examples for

I. ideas about the cause of disease

II. ideas about the prevention of disease

7

III. Ideas about the treatment of disease

This unit focuses on change over time. You need to be able to explain which

factors are accelerating (enabling) change and which factors are inhibiting (stopping)

change from happening

Factors affecting the rate of change

Task: Draw an image to symbolise each factor. Using images in your revision will help you to remember information.

8

For example:

War=

The Church= The government= Individuals=

9

Chance/Luck= Teamwork= Education= Science and technology= Communication=

10

Respect for tradition= Seeking improvements=

What do I know already? Before you start reading through this pack, complete the following 4 knowledge planners on each time period. This will give you a good idea of just how much you already know. Don’t worry if it is incomplete, you can extra information from the pack later on.

The Middle Ages

c.1250 – c.1500

This was period of...

Key Words

Factors

11

Individuals

Medical Renaissance

C1500-c1700


Factors

Key Words

Individuals

12


Medicine in 18th and

19th Century Britain Factors

Key Words

13

Medicine in modern

Britain c1900-present


Factors

Key Words

Individuals

14

Topic 1: Medieval Medicine c1250-c1500

Background Information

Wars destroyed the Roman public health systems and medical libraries. The rulers of the small kingdoms built up armies rather than improving medical skills or public health. War disrupted trade so countries became poorer. Travel became more dangerous, reducing the communication between doctors. Training of doctors was abandoned. Copies of Galen’s books were either lost, or hidden away for safety.

HOWEVER, LATER…

The church had set up universities where doctors could be trained. Armies took trained doctors to war with them where they gained experience as surgeons. Rulers were taken to clean up towns. Merchants and scholars were once again travelling around Europe, sharing ideas

Influence of the Christian Church

The Christian Church grew stronger in the Middle Ages. Monasteries controlled education, priests and monks were the only people who could read. The

Church opened medical schools where the ideas of Galen were taught. The only libraries were in monasteries, church sometimes banned books they did not want people to

read. Monasteries made an effort to provide clean running water and toilets.

Medieval Hospitals

Medical care for the poor came from hospitals set up by monasteries, and run by monks and nuns. They provided “hospitality” for visitors. Genuinely ill people were often turned away due to fear of disease spreading.

The Return of Hippocrates and Galen

Individuals

15

Galen’s ideas were rediscovered. Church leaders looked carefully at Galen’s works and decided that they fitted in with Christian ideas because he referred to “the creator” in his works.

Doctors in the believed his ideas were correct and it was nearly impossible to improve his work. Galen had great influence on the doctors in the Arabic world and in medieval Christian Europe Medical schools began to appear in Western Europe, starting with the one in Salerno, Italy. Translations

of Galen’s and Hippocrates’ work were accepted as absolute truth in medical schools.

The Four Humours Theory

Medieval doctors believed illness was caused by an imbalance of the four humours. The theory developed into a more complex system, based on the position of the stars. Although human dissection was carried out in medical schools, findings were interpreted as the theory

of the four humours – although some later doctors began to challenge traditional understandings. New Developments in Medieval Medicine

More schools sprang up and human dissection was allowed. There were some doubts about classical texts.

New techniques included diagnosis by urine sample. This is a good aid to diagnosis, which is done today! Doctors also believed the stars caused disease and relied on astrology when deciding on treatments Trained doctors were very expensive. Medicine practised amongst the most was provided by

monasteries and housewife-physicians, using traditional cures and their experience.

Supernatural Beliefs and Treatments

The church believed that illness was a punishment for sins – they prayed to god if they became ill. Some believed that pilgrimages to holy shrines could cure illness. Doctors had superstitious beliefs, saying magical words when treating patients and consulting stars.

Developments in Surgery

In the Middle Ages, there was great demand for surgery because of warfare. Surgery was held in such low regard that many procedures were often left to untrained barber-surgeons. Wine was first used as an antiseptic. Surgical treatments were still simple, as major surgery was risky.

Public Health Measures

Towns lacked the public health schemes of the Romans. People relied on cesspits and wells. Waste was frequently disposed of into the street. People found it healthier to drink beer, than to drink water.

The Black Death – 1348

Spread by coughs and sneezes or by black rat flea bites – black rats were carried overseas by ships. Arrived in Britain in 1348. Its victims were struck down suddenly and most died.

16

Symptoms included exhaustion, high temperatures, swellings and difficulty breathing. Ships were made to wait 40 days before landing – they were quarantined.

What did people think caused the plague and how did they treat it?

Miasma – carried sweet smelling herbs, sat between two large fires. God – tried to appease god by praying, or becoming flagellants (whipping themselves as a punishment). Humours out of balance – use of opposites, purging, vomiting and bloodletting. Poisoned water – blamed the Jews.

Quick Summary of Medieval Medicine.

Doctors followed the ideas of Galen. They believed illness was caused by an imbalance in humours. Believed that God and the Devil influenced health. Disease was seen as God’s punishment for sins. Astrology became important. Doctors studied star charts because they believed that the movement of the

planets affected people’s health.

Task: Complete the hexagon (draw a picture in each hexagon and add an explanation around the

outside) to show the key features of medicine in medieval England.

17

Medieval Medicine Section One – Knowledge and Understanding

1. Who created the 4 Humours theory? [1]

__________________________________________________________________________________

2. Who was Claudius Galen and what did he discover? [2]

__________________________________________________________________________________

3. Explain the Opposites Theory: [3]

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

______________________

4. True or False - write a T or F in the box to show if this is something they believed in the medieval times or not:

[4]

Statement: True or False?

Elf shot could cause headaches and illness.

Chickens were evil and lead to illness.

If you offend God he will make you ill.

Monks and Nuns provide care in hospitals.

5. Describe the process and logic behind blood-letting: [3 + 1 SPaG]

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

__________________________________________________________________________

6. Explain the differences between a Physician, an Apothecary and a Barber Surgeon: [3]

_________________________________________________________________________________________________

_________________________________________________________________________________________________

18

_________________________________________________________________________________________________

_________________________________________________________________________________________________

______________________

7. What are the main differences and similarities between modern and medieval hospitals? [2]

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

______________________

8. What year did the Black death hit Europe? [1]

__________________________________________________________________________________

9. Describe the symptoms of the Black Death? [3]

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

______________________

10. What were the potential treatments for the Black Death? Choose 1 to describe in detail. [3]

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

______________________

11. Choose one factor that was at play in medieval medicine and describe how it both helped and hindered

medicine at this time. [3 + 1 SPaG]

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

____________________________________________

19

What tasks could I do to revise medicine in medieval England (c1250-c1500)?

1. Draw a rough outline of a church building. Inside it, list at least 3 reasons why many people in the Middle Ages believed that the main cause of illness and disease was punishment from God.

2. Write a leaflet in the style of a medieval manuscript, offering advice on how to avoid disease and illness.

3. If people believed that God sent disease, what sort of treatments do you think they tried? Make a list of possible treatments.

4. Create an advice poster to explain how the Four Humours led to illness. Make sure you give examples of different illnesses caused by different imbalances.

5. Hippocrates and Galen were both physicians who had a huge impact on medieval medicine. Write a short paragraph to summarise their ideas and explain how Galen built on the work of Hippocrates.

6. This activity will help you decide the importance of each key idea abou the cause of illness in the years c1250-c1500.

a. On a slip of paper, write down the key ideas about the causes of illness at this time: God; imbalanced humours; miasma; alignment of the planets/stars.

b. Now put these into a hierarchy (order of importance). Which do you think is most important? Least important? Do we still believe any of them today? Were some of these ideas more important to particular groups of people, or at different times?

20

7. Draw a cartoon stick figure to represent each different medical professional. Add labels to explain what sort of treatment each person carried out. Add an explanation of how each person was trained to do their job.

Topic 2: the Medical Renaissance in England, c1500-c1700.

Background to the Renaissance

Renaissance means rebirth. It began with close study of classic texts and was critical of old translations There was a greater interest in how the human body worked based on observation and dissection. Artists attended dissections of human corpses and did wonderful illustrations for medical books. Return of classical texts led to a renewed faith in the four humours theory and treatment by opposites.

Andreas Vesalius – Anatomy

Studied anatomy, became professor of surgery and anatomy at Padua. He was allowed to do dissections. Did his own dissections and wrote books based on his observations using accurate diagrams to illustrate

his work. His most famous book was ‘On The Fabric of the Human Body’ written in 1543. He was able to point out some of Galen’s mistakes. Vesalius said there were no holes in the septum of the

heart and that the jaw bone is not made up of two bones. Vesalius encouraged doctors to dissect and look for themselves.

Ambroise Paré – Surgery

Paré was a battlefield surgeon; this was still a low status profession. In battle, he ran out of boiling oil which was used for treating gunshot wounds. Paré made an old

Roman ointment of roses, turpentine and egg yolk. Paré develops ligatures to seal wounds instead of using a cauterising iron. Carried out an experiment to disprove Galen by proving the bezoar stone isn’t a treatment for position. Writes ‘Notes on Surgery’ and becomes the King’s surgeon.

William Harvey – Circulation of the Blood

Discovers the circulation of the blood, disproving Galen’s ideas. Identifies the difference between arteries and veins.

21

Becomes doctor the King, his ideas are very influential. To spread his ideas he writes “An Anatomical Account of the Motion of the Heart and Blood”. However, bleeding operations still continue after Harvey as people are unsure of what else to do. Blood groups are discovered in 1901, which makes blood transfusions successful.

22

The Great Plague of 1665

This was the worst of the reappearances of the Black Death. The death toll in London was about 100 000. Efforts were made to control the spread of disease. Households were locked in and red crosses were

painted on their doors with the words, “Lord have mercy upon us.” Carts organised by the authorities roamed the city to the now infamous cry of “Bring out your dead!”

collecting corpses for mass burial in “plague pits”. People realised disease was contagious, but they still didn’t understand about germs causing disease. The Great Fire of London in 1666 effectively sterilised large parts of London, killing the plague bacteria.

Public Health

There were many wars during the renaissance. Warfare gobbled up resources. Populations were beginning to increase in the towns and cities, placing more strain on the available clean

water supplies and sewage disposal systems.

What factors affected progress in medicine during the renaissance?

The Printing Press – new ideas could spread more easily and rapidly now that books could be printed. The Weakening Power of the Church – people did not have religious beliefs about the causes of diseases,

meaning that people started to look for natural causes. Doctors could now dissect. Artists Drawing from Life – medical drawings could be drawn and shared among doctors through medical

books, new anatomy books were produced. Renewed Interest in Ancient Learning – people wanted to learn how to read, they began to challenge old

medical ideas (e.g. Galen holes in the septum).

23


outside) to show the key features of the medical Renaissance in England.

24

Renaissance Medicine – Knowledge and Understanding

1. What is the Royal Society of Medicine? [1]

__________________________________________________________________________________

2. Who was Vesalius and in what field of medicine was his main contribution? [2]

__________________________________________________________________________________

3. Explain the impact of Thomas Sydenham – make 3 separate points: [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

4. True or False - write a T or F in the box to show if this is something they believed in the Renaissance or not: [4]


Some hospitals were now run by trained

physicians.

Sydenham wrote ‘On the Fabric of the Human

Body.’

Galen’s work was fully discredited.

The Royal Society was founded in 1660.

5. Describe the process and benefit of the Printing Press: [3 + 1 SPaG]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

____________________________________________________________________

6. Explain William Harvey’s medical contribution – make 3 separate points: [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

7. What are the main differences and similarities between the Black Death and The Great Plague? One of each. [2]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

25

8. What year did the Great Plague hit London? [1]

__________________________________________________________________________________

9. Describe the symptoms of the Great Plague? [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

10. What was the thinking behind ‘locking in’ as a plague treatment? Describe and explain the process in detail. [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

11. Choose one factor that was at play in renaissance medicine and describe how it both helped and hindered

medicine at this time. [3 + 1 SPaG]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

____________________________________

26

What tasks could I do to revise medicine in the ‘Medical Renaissance’ in England (c1500-c1700)?

1. Draw two columns and label the first one ‘Old ideas’, and the second one ‘New ideas’. Make brief notes on ideas about the causes of illness and disease in the years c1500-1700 that were the same as c1250-c1500, and the ideas that were different.

2. List the effects humanism had on medicine during the medical Renaissance.

3. Draw a stick figure of Thomas Sydenham. Ad thought bubbles to detail his ideas about medicine.

4. Investigating the causes of disease and isolating different types was very important in the fight against disease. Imagine you are a doctor in the 17th Century. Write a proposal or letter addressing other doctors, explaining how you think Sydenham’s ideas could be used to improve medical treatments.

5. There are lots of unusual new words in this time period, like iatrochemistry. Create a glossary for at least five words. Write the words and their definition. You could also do this on flash cards.

6. Make a list of all the new treatments described that appear between 1500 and 1700. How many of them are newer versions of old treatments and many of them are completely new?

7. Draw a table to show changes and continuities in medical training during the ‘Medical Renaissance’. How much do you think medical training had changed by 1700 – a little bit, some or a lot? Explain why you think this.

8. Vesalius is a key individual in the development of anatomy. Can you explain why he had an impact?

9. Draw an outline of a person. Label it with the different discoveries that Harvey made about the human body and blood.

10. Like Vesalius, Harvey is a key individual who had an impact on medicine. Create a fact file about him to use in revision. You should include: details of his background, his experiments and his impact on medicine.

11. Write a short paragraph to explain why Harvey’s work did not have much impact when it was first published.

27

Name: Andreas Vesalius Discovery: Career:

Before this breakthrough What kinds of ideas or methods did doctors have before this breakthrough?

What was the breakthrough? Explain the key aspects of this breakthrough

Short-term impact What was the immediate impact on medical ideas or treatments? Did this discovery improve health in the short-term? Did other discoveries need to be made to make full use of this breakthrough?

Long-term impact Why did this breakthrough lead to others? How did this change thinking about medicine? What other aspects of medicine changed as a result?

Why did this breakthrough happen?

28

Name: William Harvey (1578-1657) Discovery: Circulation of the blood Career: studied medicine in Cambridge and Padua in Italy and worked as a doctor in London.

Before this breakthrough What kinds of ideas or methods did doctors have before this breakthough?





29

TOPIC 3 – Medicine in the 18th and 19th Century (c1700-c1900)

Background Information

Why Had They Stopped Reading Galen in the Nineteenth Century?

New understanding of the body and Galen’s descriptions were incomplete and sometimes wrong. The invention of the proved that Harvey’s ideas were right. Theory of the four humours no longer accepted. People initially thought that miasma, caused disease. Doctors carried out dissections and used microscopes. Galen’s books were no longer important.

Smallpox and Edward Jenner

Inoculation

In the 18th

century, smallpox was a big killer. Lady Mary Wortley Montagu brought inoculation to Britain. She discovered that a health person could be immunised against smallpox using pus from the sores of a

sufferer with a mild form of the disease. However, inoculation sometimes led to smallpox and death.

Edward Jenner

Jenner was a country doctor. He heard that milkmaids didn’t get smallpox, but instead a milder cowpox. Jenner investigated and discovered people who had already had cowpox didn’t get smallpox. In 1796 he took a small boy and injected him with pus from the sores of a milkmaid with cowpox. Jenner

then injected James with smallpox. James didn’t catch the disease!

Opposition to the Smallpox Vaccination

Jenner could not scientifically explain how it worked. Inoculators were afraid of losing money. Many were worried about side effects; they worried about giving themselves a disease that from cows. Some members of the Church believed that vaccination was not natural. Developments in Nursing

Florence Nightingale

Nightingale brought discipline and professionalism to a job that had a bad reputation at the time. From a wealthy background, she became a nurse despite the opposition of her family. Went out to the Crimean War to sort out nursing care in the English camp. She made huge improvements in the death rate, due to improvements in ward hygiene. When she returns home, she writes a book ‘Notes on Nursing’ and sets up a hospital in London.

30

Mary Seacole

From a poor background in Jamaica. Seacole volunteers to help as a nurse in the Crimean War, she is rejected, but goes anyway self-financing her journey.

She nursed soldiers on the battlefields and built the ‘British Hotel’. Goes bankrupt when she returns to England – but receives support due to the press interest in her story

and she writes an autobiography. How Did Scientists Discover the Causes of Disease?

Louis Pasteur’s Germ Theory – 1857

Scientists thought microbes were caused by disease and appeared because of illness. This was the theory of spontaneous generation. Instead of blaming microbes, people looked for miasmas.

Louis Pasteur was employed in 1857 to find the explanation for the souring of sugar beet used in

fermenting industrial alcohol. His answer was to blame germs in the air. He proved there are germs in the air by sterilising water and keeping it in a flask that didn’t allow airborne

particles to enter. This stayed sterile – but sterilised water kept in an open flask bred microbes again. Robert Koch

German scientist. He began linking diseases to the microbe that caused that specific disease. Koch developed a solid medium to grow cultures, and dyeing techniques to colour microbes, which

he viewed through high-powered microscopes. He identified anthrax spores and the bacteria that cause septicaemia, tuberculosis and cholera.

Louis Pasteur – Chicken Cholera Vaccine

Hearing of Koch’s, Pasteur came out of retirement and competed to find new microbes and combat them. Pasteur looked for cures to anthrax and chicken cholera. Both he and Koch worked with large teams of

scientists. Charles Chamberland was in Pasteur’s team. Chamberland was told to inject chickens with chicken cholera, but it was the day before his holiday and he

forgot. He left the germs on his desk and injected the chickens when he returned from his holiday. The chickens survived, Pasteur and Chamberlain tried again with new germs, but the chickens survived. The cholera had been weakened by being left out, and the weakened cholera made the chickens immune.

Chamberland’s error had produced a chance discovery.

Louis Pasteur – Anthrax Vaccine

Pasteur’s team managed to produce a weakened version of the anthrax spore that would make sheep immune to the disease. They demonstrated this in a public experiment.

Overcoming the Problems of Surgery

Surgery in the early 1800s was dangerous and painful. Infection was the greatest danger to patients.

31

What problems faced surgeons in 1800?

1. Pain – patients can die of clinical shock during surgery. 2. Infection – people were unaware of microbes that cause infection. Surgeons would wear the same dirty

apron for every surgical procedure they carried out, passing on infection between patients. 3. Bleeding – patients can die if they lose too much blood during surgery.

How was the problem of pain overcome?

In 1800, surgeons tried various ways to ease suffering of patients – e.g. getting them drunk, knocking them out and giving them opium.

Nitrous Oxide or ‘laughing gas’ was discovered by Sir Humphry Davy. It was never really widely used as Davy’s findings were published in a book that was not well known, the book was given an obscure name.

Ether used by J.R. Liston during a leg amputation. However, it had very unpleasant side effects.

Chloroform used by James Simpson and some friends at his home. They realised that it could be used as during surgery. However, it led to unexplained deaths. The dose given could not be measured or controlled.

Reasons for opposition to anaesthetics:

They were uncomfortable for patients. Some doctors believed that pain was good for healing. People didn’t understand how they worked. Didn’t understand the side effects that new substances could have on the body.

The final acceptance of anaesthetics:

The final breakthrough came when Queen Victoria accepted the use of chloroform as an anaesthetic during the delivery of her eighth child.

How was the problem of infection overcome?

Until germ theory in the 1850s, surgeons didn’t take precautions to protect open wounds. They reused bandages, didn’t wash their hands before operations and didn’t sterilise surgical equipment.

Joseph Lister and the discovery of antiseptics:

Heard that carbolic spray was used on sewage. He knew sewage had a similar smell to gangrene. He had read the work of Pasteur on his germ theory. He was prepared to take risks.

Reasons for opposition to Lister:

Lister’s methods slowed down surgery. The spray was uncomfortable for doctors to use, it affected their skin. Pasteur’s germ theory was not widely accepted in 1857. Surgeons did not copy his methods correctly and were therefore disappointed with their results.

32

The final development of aseptic surgery: By the late 1890s Lister’s antiseptic methods led to aseptic surgery. This is the removal of all possible germs from theatres to ensure absolute cleanliness. The following methods were introduced…

Operating theatres and hospitals were rigorously cleaned. All surgical instruments were steam sterilised. Sterilised rubber gloves were first used and surgeon’s hands were scrubbed.

How was the problem of bleeding in surgery overcome?

Once William Harvey had discovered the circulation of the blood, the first blood transfusions were attempted.

Early blood transfusions often ended disastrously because…

Blood groups had not been discovered. They could not prevent the blood from clotting. Infection could be passed on.

33

Developments in Public Health

Public Health Problems in the Early 1800s

During the late 1700s and the first half of C19th, conditions in British towns became worse than ever. Houses were built as close together as possible as more people crowded into factory towns to work. Towns could not cope with the need to provide people with water and sewage disposal facilities. In these squalid conditions, diseases spread easily and rapidly. The conditions were so bad that many people’s health may have even become worse than ever before.

The Battle to Improving Public Health

Some thought that the government should force local councils to clean up their towns. However, many believed that the government shouldn’t interfere – this attitude is called laissez-faire. They believed the government should allow each local area to control its own affairs. This meant that local ratepayers made all the decisions. Local ratepayers didn’t want the government to

force them to pay for improvements to their towns.

Edwin Chadwick

In 1842 he was asked by the government to report on the living conditions and health of the poor. Chadwick concluded that poverty was caused by ill health which was caused by the terrible conditions in

which people lived. He said that ratepayers can cut their taxes and save money in the long-term by looking after the poor and

to spend money improving their health. In his “Report on the Sanitary Conditions of the Labouring Population” he said industrial towns should:

o Organise drainage and refuse collection o Provide a pure water supply o Appoint a Medical Officer of Health

For over 30 years an argument went on about the need for town councils or the government to take action. Towns such as Liverpool and Manchester did start to build sewage and water-supply systems.

1848 Public Health Act

The government did nothing at first about Chadwick’s recommendations. However, in 1848 there was another outbreak of cholera, this put pressure on the government to

do something. Parliament reluctantly agreed to pass Public Health Act. Although it was not compulsory. The government set up a Board of Health to encourage, but not to force,

local authorities to improve conditions. They gave local authorities money to make improvements in their areas if they wanted to and had

the support of local ratepayers. Only a few local authorities took any new measures. By 1872 only 50 Medical Officers of Health had been appointed. The Board of Health was abandoned in 1854.

34

1853 John Snow

In 1854 John Snow proved that there was a link between cholera and water supply. He used research, observation and door-to-door interviews to build a detailed map of a cholera epidemic in Broad Street.

Nearly all the deaths had taken place within a short distance of the water pump. Near to the pump, there was a brewery and none of the people there had cholera. The brewery had its

own water pump, and the men had been given free beer. They didn’t use the Broad Street Pump at all. After collecting evidence, John Snow removed the handle from the Broad Street pump.

There were no more deaths. It later came to light that a cesspool near to the pump had a cracked

lining which allowed the contents to contaminate the drinking water. Snow put pressure on water companies to clean up their water supplies.

1858 Great Stink

For years human waste made its way from the latrines in London into the River Thames. In 1858 the hot weather caused a ‘great stink’. The putrid smell was right under Parliament’s nose. Parliament considered moving and had to coat their curtains with a deodorant to get rid of the smell.

The Great Stink prompted Parliament to sort out London’s sewage and drainage system and to clean

up the River Thames. Within a year Sir Joseph Bazalgette had begun to build an extensive system of sewers and drains that

are still in operation today.

1867 Second Reform Act

Working class men were given the right to vote. For the first time, it wasn’t just the ratepayers who got a say in improving public health. MPs were forced to improve the living conditions of the poor.

1875 Second Public Health Act

Unlike the 1848 Public Health Act, the 1975 Public Health Act actually forced local authorities to introduce the following measures:

Provision of clean water Proper drainage and sewage The appointment of a Medical Officer of Health

35

But why was the act introduced?

Factor

Explanation

Scientific

In 1861 Louis Pasteur published his germ theory which proved the link between dirt

and disease. With scientific proof, people were more willing to pay taxes to cover the

Developments

costs of public health reforms.

New Voters

Working-class men were given the vote in 1867. MPs were more likely to take notice

of the victims of poor public health.

Statistics The government published statistics of where death rates were highest and what

people died of. The statistics shamed some unhealthy towns into action.

Cholera When cholera returned in 1865 and the link between disease and dirty water had

Outbreaks been proven by John Snow, ratepayers were finally prepared to take action.

Weakening of The government saw it could no longer leave public health measures to individuals or

Laissez Faire councils, and realised that they had to take action.

The Public Health Act of 1875 was very effective. By 1900 most British towns had built effective hygiene and water systems.

Result of the Public Health Act of 1875

Improved the standards of housing Stopped the pollution of rivers from which people got water Shortened working hours in factories for women and children Made it illegal to add ingredients that made food unhealthy Made education compulsory

Public Health – 1800 to Present Day

Limited – 1830s Optional – 1848 Compulsory – 1875 Comprehensive – 1948

A few towns introduced 1848 Public Health Act, 1875 Public Health Act, From cradle to grave,

sewers, refuse disposal towns could set up councils forced to Pensions, National

and clean water. Boards of Health if 10% provide basic sanitation Insurance, Welfare State

voted for it. and medical officers and the NHS.

36


outside) to show the key features of the medicine during the Industrial Revolution.

37

18th and 19th Century Medicine – Knowledge and Understanding

1. What is Spontaneous Generation? [1]

____________________________

2. Who was Jenner and in what field of medicine was his main contribution? [2]

__________________________________________________________________________________

3. Explain the impact of Louis Pasteur – make 3 separate points: [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________



Edward Jenner’s vaccination was based on cows.

Koch and Pasteur worked together on their

theory.

Florence Nightingale funded her own trip to the

Crimea.

James Simpson discovered Chloroform.

5. Describe the process of John Snow’s cholera investigation: [3 + 1 SPaG]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

____________________________________________________________________

6. Explain Joseph Lister’s medical contribution – make 3 separate points: [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

7. What are the main differences and similarities between antiseptics and anaesthetics? One of each. [2]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

38

8. What was the name of the pump causing cholera in John Snow’s investigation? [1]

__________________________________________________________________________________

9. Describe how Jenner discovered vaccinations? [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

10. What was the thinking behind using cowpox to cure smallpox? Describe and explain the process in detail. [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

11. Choose one factor that was at play in 18th and 19th Century medicine and describe how it both helped and

hindered medicine at this time. [3 + 1 SPaG]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

____________________________________

39

What tasks could I do to revise medicine in the Industrial Revolution (c1700-c1900)?

1. Create a timeline to show the development of Germ theory. Include

events from the work of both Pasteur and Koch. 2. Create flash cards to help you revise the new theories. Create one

card each for Pasteur and Koch, showing the impact they had in Britain.

3. Did Pasteur or Koch do more to improve understanding of disease? Write a persuasive speech arguing that Pasteur or Koch are most important.

4. Create a spider diagram to show changes and continuities in treatments by c1900. Next to each label on your spider diagram, write a sentence to expain why this change/continuity occurred.

5. How much had treatment changed by c1900? Write a paragraph to explain the extent of change that occurred by this point.

6. List the changes that had occurred in hospitals by c1900. 7. Explain the impact of more people attending hospitals. 8. Write an obituary for Florence Nightingale, explaining the impact

she had on nursing and hospital design. 9. Create an annotated timeline to show the changes that took place in

the field of surgery during the 19th Century. 10. Make flashcards for Simpson and Lister, explaining what they

did and what impact this had on surgical techniques. 11. Create a 6 picture storyboard to show how Edward Jenner

developed the smallpox vaccine. 12. As a method of prevention, vaccines were more effective than

anything that had been tried in previous centuries. What factors made the developments of new vaccinations possible?

40

Name: Edward Jenner Discovery: the development of vaccinations Career:



In 1798 Edward Jenner proved that vaccination prevented people catching smallpox, one of the great killer diseases. Jenner’s work was based on observation and scientific experiment. However, he did not understand what caused smallpox or exactly how vaccination worked.


At first there was opposition to making vaccination compulsory by law.


Over time Jenner’s discovery saved many thousands of lives in Britain and millions worldwide as vaccination eventually wiped out smallpox.


Belief in observation and scientific experiment

41

Name: Louis Pasteur Discovery: Germ theory Career:


Belief that bad air caused disease


Louis Pasteur published his germ theory in 1861, suggesting that bacteria (also called microbes or germs) cause human diseases.


In 1864 more experiments convinced many doctors that this theory was correct, though it took time to convince everyone. Some still insisted that bad air caused disease. Later Pasteur developed the first vaccines to prevent disease since Jenner’s vaccination for smallpox.


1875 Public Health Act The Public Health Act was a major change in the attitudes of governments to improving people’s health. This law was the first to say that it was compulsory for local councils to improve sewers and drainage, provide fresh, clean water supplies and appoint medical officers and sanitary inspectors to inspect public health facilities.

Why did this breakthrough happen? He based his theory on experiments which proved that germs make milk go bad and cause diseases in animals.

42

Name: Robert Koch Discovery: identified bacteria that cause diseases Career:



Robert Koch and his research team used Pasteur’s work to discover the bacteria that cause individual diseases, such as tuberculosis (TB) and typhoid, which killed many thousands of people.


Long-term impact Why did this breakthrough lead to others? How did this change thinking about medicine? What other aspects of medicine changed as a result? Koch’s methods were copied by other scientists, who discovered the bacteria that cause other diseased. Once they identified the bacteria they could develop vaccines to prevent people getting diseases.

Why did this breakthrough happen? Based upon Pasteur’s germ theory Scientific experimentation

43

Name: James Simpson Discovery: the first effective anaesthetic Career:



James Simpson showed that chloroform could be used as an effective anaesthetic during surgery in 1847. He used it to help women in childbirth and patients undergoing operations and wrote articles which led to other surgeons using it.


Chloroform was not problem-free. Sometimes patients died because too much chloroform was used or because they developed infections which could not be cured. Deaths during surgery actually increased for a time after Simpson’s discovery.



44

Name: Joseph Lister Discovery: effective antiseptics against infection Career:



After reading Pasteur’s germ theory, Joseph Lister, a Scottish surgeon, experimented with carbolic acid to produce the first antiseptic in 1867.


At first there was still opposition because some surgeons refused to accept Pasteur’s theory and did not believe bacteria existed.

Long-term impact Why did this breakthrough lead to others? How did this change thinking about medicine? What other aspects of medicine changed as a result? This greatly reduced the chance of patients dying form infection developed during an operation and made longer, more complex operations possible.

Why did this breakthrough happen? Building upon Pasteur’s germ theory. Scientific experimentation

45

Name: Florence Nightingale Discovery: Hospital and nursing Career:



Florence Nightingale was a great organiser, working to improve conditions in hospitals and the training of nurses. During the Crimean War (1854-56) she improved hygiene and cleanliness for wounded soldiers.


Long-term impact Why did this breakthrough lead to others? How did this change thinking about medicine? What other aspects of medicine changed as a result? Her nursing schools trained nurses to keep wards totally clean, provide fresh air and keep patients clean and well fed. Her work improved hospitals a great deal. Pasteur’s discoveries later provided more evidence to show why hospitals and patients had to be as clean as possible.


46

Name: John Snow Discovery: Preventing cholera Career:


Belief that disease was caused by ‘bad air’


Snow proved that clean water prevented cholera in 1854 In 1854 cholera killed over 500 people around Broad Street in London, near Dr Snow’s surgery. Snow mapped out the deaths, showing that people had caught cholera from the water they used for washing and drinking.


Although Snow proved that clean water prevented cholera but the government still did not make laws forcing towns to provide clean water and improve living conditions. Many scientists continued to believe that diseases were spread by ‘bad air’


1875 Public Health Act

The Public Health Act was a major change in

the attitudes of governments to

improving people’s health. This law was the

first to say that it was compulsory for local councils to improve

sewers and drainage, provide fresh, clean water supplies and

appoint medical officers and sanitary inspectors to inspect public health

facilities.

Why did this breakthrough happen? Mapping out of deaths (observation and scientific experiment)

47

TOPIC 4 – Medicine in modern Britain (c1900-present)

What Medical Progress Did the First World War Bring About?

Surgeons had the opportunity to experiment with new techniques. Surgeons developed techniques to repair broken bones, and perform skin grafts – plastic surgery.

Soldiers promised good housing when they returned. This helped to get rid of unhealthy slum housing. Surgery of the eye, ear, nose and throat all improved rapidly. Brain surgery also advanced.

The Development of X-rays

X-rays were first discovered 20 years before the war. Hospitals installed X-ray machines, but it was the First World War which confirmed their importance. More were manufactured to meet demand and they were installed in hospitals along the Western Front.

X-rays immediately improved the success rate of surgeons in removing deeply lodged bullets and

shrapnel which would otherwise have caused fatal infections.

Blood Transfusions

In the renaissance, Harvey proved blood circulates and this encouraged experiment with transfusions. It sometimes worked and sometimes failed. Scientists didn’t know about different blood groups. Blood groups were discovered in 1901 by Karl Landsteiner. The discovery made transfusions successful. During the First World War vast amounts of blood was needed. On-the-spot donors were impractical.

Many soldiers bled to death in the trenches before blood could get to them. The search began for a better method of storage and transfusion. Doctors discovered how blood can be

bottled, packed in ice and stored where it was needed. This discovery helped to save many lives.

48

The Discovery and Development of Penicillin

1 Fleming discovered mould killed germs. Writes articles but publishes them in book with an obscure name. 2 Chain and Florey begin research in Oxford after reading an article by Fleming. They experiment with mice. 3 Penicillin is first tested on a human being in Oxford. 4 U.S. and Britain fund production of penicillin. 5 Enough penicillin is produced to treat all the allied forces wounded in the D-Day invasion of Europe.

How Was Penicillin Discovered?

The discovery of penicillin is a great example of a chance finding helping science. One day in 1928 Fleming came to clean up some old culture dishes he had been growing bacteria for his

experiments on. By chance, a fungal spore had landed and grown on one of the dishes. He noticed that colonies of bacteria around the mould had stopped growing. The fungus was identified

and the substance given the name penicillin. It produced a substance that killed bacteria. Fleming was unable to take his work further. The industrial production of penicillin still needed work.

How Was Penicillin Developed?

In the 1930s two Oxford scientists, Florey and Chain, became interested in Fleming’s 1929 paper. In 1939 they gathered a skilled research team and three days after the outbreak of the Second World War

Florey asked the British Government to fund the team’s research into penicillin. British chemical firms were too busy making explosives to start mass production – so Florey went to US. America helped to mass produce penicillin, the casualties of the Second World War added to the urgency. By 1944 mass production was sufficient for the needs of the military medics. Fleming, Florey and Chain

were awarded the Nobel Prize in 1945.

Factors Leading to the Development of Penicillin

Government – British government funded Florey’s research, U.S. government funded mass production. Technology – microscopes and bacteria growing mediums. Scientific experiment – testing on mice. Individuals – Florey and Chain were skilled scientists supported by a skilled team of researchers. War – the growing casualties of World War Two added to the urgency to mass produce penicillin. Chance – Alexander Fleming discovered penicillin by chance in 1928. Impact of the Second World War

Blood transfusion –blood could be stored for longer, civilians donated blood. Diet – rationing improved some people’s diet, government encouraged healthy eating. Drugs – penicillin was developed as the first antibiotic. Poverty – evacuation took children out of urban areas. Highlighted contrast between rich and poor. Surgery – developments in the use of skin grafts and treatment of burns. Hygiene – government posters education people about health and hygiene.

49

The National Health Service

Influence of WW2

WW2 broke down social distinctions and brought people together. The raising of armies made powerful people take notice of the health problems of the poor. Evacuation of children increased awareness of how disadvantaged many people were. After the Second World War people looked for improvements in society. Such feelings led to the

1945 victory for the Labour Party.

Introduction of the NHS

Sir William Beveridge published his famous Beveridge Report in 1942. In it he called for the state provision of social security “from the cradle to the grave”. The report became a bestseller.

Aneurin Bevan was the Labour Minister for Health who introduced the National Health Service. National Insurance was introduced to pay for the NHS. Doctors and dentists were wooed with a

fixed payment for each patient. They were also allowed to continue treating private fee-paying patients.

The NHS Still Has A Few Problems…

Governments have reduced how much of the NHS is free – charging for prescriptions and dental health.

Long waiting lists and doubts about the quality of treatment have led to paying for treatment outside NHS.

Longer life expectancies have meant more need for care of the elderly and increased costs for the NHS.

50


outside) to show the key features of the medicine the 20th

Century.

51

20th Century and Modern Medicine – Knowledge and Understanding

1. What is DNA? [1]

____________________________

2. Who was Alexander Fleming and in what field of medicine was his main contribution? [2]

__________________________________________________________________________________

3. Explain the impact of the NHS – make 3 separate points: [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________



Lung Cancer is now 100% curable.

A Magic Bullet is a drug treatment.

Blood tests are a diagnosis tool.

The government does not get involved in Public

Health nowadays.

5. Describe the process of mass vaccination: [3 + 1 SPaG]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

____________________________________________________________________

6. Explain Crick and Watson’s medical contribution – make 3 separate points: [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

7. What are the main differences and similarities between surgical and medical technologies? One of each. [2]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

What was the name of the drug discovered by Paul Ehrlich? [1]

52

__________________________________________________________________________________

8. Describe how Florey and Chain developed Penicillin? [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

9. How has Lung Cancer treatments been developed? Describe and explain the process in detail. [3]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________

10. Choose one factor that was at play in 20th Century and modern medicine and describe how it both helped and

hindered medicine at this time. [3 + 1 SPaG]

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

____________________________________

53

What tasks could I do to revise medicine in the 20th Century (c1900-present day)?

1. Create a chain of paper people. Each person should be a different figure that was important in the discovery of DNA. How many people can you make in your chain?

2. Explain why the discovery of the shape of DNA was so important for scientists.

3. Which factor was more important in the development of our understanding of genetics: science or technology? Write a short paragraph explaining your opinion.

4. Create flashcards to show different lifestyle factors and the disease that they may cause. Write a factor on one side and the associated illnesses on the other.

a. Using our flashcards, write an advice leaflet to explain threats to health.

b. How is your leaflet different from a leaflet that might have been made for people in the 15th Century

5. Draw a timeline to show when different drugs that were developed in the 20th Century. Label each one with details, such as who was responsible for its development and which disease the drug fights.

6. Describe how science and technology assisted in the development of new chemical treatments.

7. Individuals like Ehrlich and Domagk inspired British scientists to look for new treatments, while science and technology made them possible. Which factor do you think has been the most important in the development of treatments post-1900?

8. Draw a table to show the change and continuity in care and treatment from earlier periods to end of the 19th Century.

9. Explain the most common causes of lung cancer. 10. Explain why lung cancer is difficult to treat. 11. How has science and technology helped in the diagnosis of lung cancer. 12. Draw a timeline from 1250 to 2000. Add onto it key information about the

ideas about the causes of disease and illness, methods of treatment and attempts at prevention. You could colour code these. Can you identify any turning points.

54

Name: Alexander Fleming Discovery: Career:






55

Name: Howard Florence and Florence Chain Discovery: Career:






56

Name: Aneurin Bevin Discovery: Career:






57

Name: Francis Crick Discovery: Career:






58

Specification content Medicine in medieval England

Key examples

Ideas about the cause of disease and illness

Supernatural and religious explanations of the cause of disease. Rational explanations: the Theory of the Four Humours and the miasma theory; the continuing influence in England of Hippocrates and Galen

Causes Supernatural – God, to punish sin, or to test your faith – leprosy especially seen as punishment. Also astrology – movement of the planets Rational – humours being unbalanced. Miasma (plural = miasmata) – bad air – swamps, corpses etc could transmit disease. Bad smell suggested sin

Approaches to prevention and treatment

Approaches to prevention and treatment and their connection with ideas about disease and illness; religious actions, bloodletting and purging, purifying the air, and the use of remedies. New and traditional approaches to hospital care in the 13

th century. The role of the physician,

apothecary and barber surgeon in treatment and care provided within the community and in hospitals

Treatment Always links to ideas about causes Supernatural – prayer, fasting, touching relics, going on pilgrimages, checking horoscope before treatment. Rational – bloodletting (could use leeches or cupping), purging, warm baths, herbal remedies

Case study

Dealing with the Black Death, 1348-49; approaches to treatment and attempts to prevent its spread

Prevention Prayer. The regimen sanitas (instructions on how to stay health, started with Hippocrates – eg stay clean, clean home etc), diet, herbs to make air smell

Key people Test yourself:

This knowledge should be in your head all year!

Hippocrates

‘Father of Medicine’ – 4 humours, clinical observation (watch and record details, use this to help with future cases), importance of exercise, Hippocratic Oath for doctors (to preserve life)

Doctors Physicians – trained at university by watching dissection and listening to Galen’s description. Diagnosed through urine etc sample+astrology.

Galen (129-200)

Built on Hippocrates’ ideas – theory of opposites (if cold, give something hot), also dissected animals to find out about anatomy (structure of body). Proved brain, not the heart, controls the body

Caring for sick

Number of hospitals increased – 1,100 by 1500. Mostly cared for poor and old. 30% of them owned by Church, rest by an endowment (money left in will). Most sick people cared for at home, mostly by women. Leper hospitals built outside cities.

Roger Bacon

Put in prison around 1270 for suggesting doctors should do their own research, not just follow Galen

Dick Whittington

Lord Mayor of London around 1400, set up an 8 bed hospital for unmarried mothers

Do you know these words?

Diagnosis – pilgrimage – rational – quarantine – supernatural – add some more of your own… Physicians,

apothecaries and surgeons

Physicians – diagnosed+recommended treatment, trained at university. Apothecaries – mixed herbal remedies (joined a guild, worked for master to train). Surgeons – least qualified, also cut hair

Case study Big question-

Why did so little change in medieval times?

Dealing with the Black Death

Bubonic plague – outbreak in 1348-9 – 1/3rd to 1 / 2 of the population died. Causes – miasma, Jews, sin, positions of planets. Treatments – confuses sins and pray, bleeding and purging (but seemed to make worse), sweet herbs or fire to clean air. Prevention – pray and fast, leave the area, carry sweet herbs, quarantine (new people stay away for 40 days), clean streets (or don’t, maybe bad smell will drive out miasma)

1. Power of Church – if you questioned it, you would go to Hell, and they supported Galen’s ideas (as he believed in one god)

2. Church controlled education 3. 4 humours ideas seemed to

work 4. Government was more

interested in defending the county and keeping it peaceful than improving health

59

GCSE Medicine in Britain – c1500-c1700 – The Medical Renaissance in England

Specification content Key examples


Continuity and change in explanations of the cause of disease and illness. A scientific approach, including the work of Thomas Sydenham in improving diagnosis. The influence of the printing press and the work of the Royal Society on the transmission of ideas.

Causes

Still God, miasmata, 4 humours (but rejected by some, disease seen as separate to body – eg work of Paracelsus), animalcules were a new idea (tiny animals – ie bacteria – seen under microscope)


Continuity in approaches to prevention, treatment and care in the community and in hospitals. Change in care and treatment: improvements in medical training and the influence in England of the work of Vesalius

Treatment

Not much change – still bloodletting+purging (4 humours), praying, herbal remedies (but new ingredients – eg tobacco from America). But some – eg herbal remedies chosen for colour/shape (eg jaundice treated by yellow things). Also idea of ‘transference’ – a disease could be transferred by touching (it would leave the first person). Start of looking for chemical cures – known as iatochemistry – eg using antimony to encourage vomiting

Case studies

1. Key individual: Harvey and the circulation of the blood. 2. Dealing with the Great Plague in London, 1665: approaches to treatment and attempts to prevent its spread

Prevention

Not much changed, though in towns you could be fined for not cleaning the street in front of your house. Barometers+thermometers used to check link between weather and disease

Key people This knowledge should be in your head all year!

Vesalius Learnt about anatomy from dissections. 1543 – ‘Fabric of the Human Body’ – proved Galen wrong in more than 200 ways, eg proved jaw only had 1 bone.

Doctors

Apothecaries and surgeons had more education through iatrochemistry and through practising in wars. Both needed licenses. Physicians still at university – not much practical training in England, but more access to textbooks. ‘Fugitive sheets’ = individual copies of pictures Copernicus

and Galileo Challenging the authority of the Church in astronomy – suggested the Sun, not the Earth, at universe centre

Thomas Sydenham

Nicknamed ‘the English Hippocrates’ – in London in 1660s and 1670s – emphasised careful observation. Said diseases could be organised into different groups (rather than personal to the patience) – saw measles and scarlet fever were different

Hospitals

Early 1600s, more people with illnesses coming in – stayed for short time which suggests cured. 1536 monasteries dissolved – fewer hospitals. New ‘pest houses’ for those suffering from plague.

Gutenburg+ Leeuwenhoek

Gutenburg (1450s) – first printing press Leeuwenhoek (mid 1600s) – first microscope

Royal Society

Set up in 1660, supported by Charles II. Provided laboratory and equipment so scientists could experiment, discuss and publish new ideas. These attitudes part of the ‘Scientific Revolution’

Chamberlen 1620 – invented forceps – fewer female midwives

Case studies Harvey and the discovery of the circulation of the blood

Studied at Padua where he was taught Vesalius’ theory that veins contained valves – Harvey tried to pump liquid away from the heart in dissected bodies but it didn’t work – contradicted Galen’s idea that blood flowed around the body from the liver. Harvey then disproved Galen’s idea that blood was burned up – in fact same blood circulated. He dissected humans and did vivisection on animals, proving heart like pump, suggesting capillaries linked arteries and veins. Published 1628, but people slow to accept

Dealing with the Great Plague in London, 1665

Treatment – not many records as people shut up in homes. Wrap patient in thick cloth to sweat out the disease. Transference (chicken on buboes). Prevention – pray, quarantine those who has plague for 28 days in house, plague doctors with special costume, more action from government than 1348 (dogs and cats killed, tar burnt on streets)

60

GCSE Medicine in Britain – c1700-c1900 – Medicine in eighteenth- and nineteenth-century Britain Specification content Key

examples


Continuity and change in explanations of the cause of disease and illness. The influence in Britain of Pasteur’s Germ Theory and Koch’s work on microbes.

Public Health Act

Previous laissez-faire attitude, then 1848 Public Health Act made action on clean water and sewage voluntary. 1875 Public Health Act made it compulsory for towns to take action. Change mostly because of (1) Snow (2) working men getting the vote in 1867 (3) Great Stink 1858.


The extent of change in care and treatment: improvements in hospital care and the influence of Nightingale. The impact of anaesthetics and antiseptics on surgery. New approaches to prevention: the development and use of vaccinations and the Public Health Act 1875

Causes Miasma until 1861, and afterwards – people slow to change. Spontaneous generation was a popular theory – rotting matter created microbes, which caused the miasmata.

Case studies

1. Key individual: Jenner and the development of vaccination 2. Fighting Cholera in London, 1854; attempts to prevent its spread; the significance of Snow and the Broad Street pump

Pasteur+ Koch’s influence

Pasteur – Britain slow to listen, followed Bastian’s spontaneous generation ideas. Lister did follow Pasteur. John Tyndall, a physicist, similarly linked dirt and disease, but people found ideas hard to accept. Koch made it easier for other doctors to study microbes+inspired them to

Key people This knowledge should be in your head all year!

Florence Nightingale

Nursed in the Crimean War in the 1850s, cut death rates from 42% to 2%. Then wrote 200 books about hospitals, including Notes on Nursing and Notes on Hospitals, and set up a training school for nurses in the 1860s at St Thomas’. [still believed in miasma] Made nursing respectable

Treatment

Not much change – still miasma belief so (eg) cholera still dealt with by burning tar, burning dead people’s clothes. Inoculation used for smallpox but dangerous. 2nd half od 19th century – patent medicines (‘cure-alls’)sold millions but had dangerous ingredients.

Edward Jenner

1796 – used cowpox germs to protect against smallpox – the first vaccination. Tested it on 23 people. Lots of opposition, including from Christians and from people who had done inoculation.

Louis Pasteur

Published germ theory in 1861 – germs cause disease. Then 1879 chicken cholera vaccine discovered by chance (injected old germs) – first vaccine since Jenner. Developed more, as did Koch

Hospitals

1859 – first cottage hospital (small hospital provided nursing care, with medical treatment from local GP) – 300 by 1900. Also voluntary hospitals in London. Most rich treated at home. Those who couldn’t support themselves treated in workhouses 1867 new infirmaries instead of this, paid for by rate-payers. Antiseptics used

Robert Koch

1875 – found the germ that caused anthrax – which proved germ theory was true and meant vaccines could be developed. Also stained microbes.

Simpson+Lister

Key developers of chloroform (1847), the first successful anaesthetic and carbolic acid (1865), the first antiseptic

Anaesthetics and antiseptics

Anaesthetics stopped pain (previously just opium or alcohol). Laughing gas from 1795 didn’t knock patient out. Ether from 1846 was flammable+caused vomiting. Opposition from Christians and because of Hannah Greener. Black Period – more deaths. Then antiseptic and aseptic surgery, though doctors didn’t like carbolic acid or Lister

Joseph Bazalgette

Responsible for ambitious London sewers, created after Great Stink in 1858, finished 1875

John Snow

1854 – proved that cholera was spread through water

Changes in society Jenner and vaccination

See above. Smallpox very serious – 11 epidemics in London in 18

th century. Inoculation = deliberately

giving someone the disease, to protect them later. Jenner published in 1798 and government then funded vaccine. Hostility because strange idea, and Jenner couldn’t explain how it worked. 1852 smallpox vaccination compulsory, enforced from 1872.

Fighting Cholera in London, 1854

First came to Britain 1831 – epidemics every decade to 1860s. Killed people in a week. Tar barrels burnt, but it didn’t help. In 1848-9 epidemic Snow suggested cholera was being transmitted by dirty water (not miasmata). He proved this in 1854 epidemic – mapped deaths in Soho and linked them to contaminated Broad Street pump

61

GCSE Medicine in Britain – c1900 to present – Medicine in modern Britain Specification content Case studies Ideas about the cause of disease and illness

Advances in understanding the causes of illness and disease: the influence of genetic and lifestyle factors on health. Improvements in diagnosis: the impact of the availability of blood tests, scans and monitors

Crick+ Watson Fleming, Florey and Chain

1928 – Fleming noticed unexpected mould growing in his experiment – penicillin, the first antibiotic. He published but didn’t get funding. 1939 – Florey and Chain researched, produced penicillin but couldn’t make enough – 1941 US govt agreed funding when they entered WW2. Later (after Hodgkin identified its chemical structure in 1945) synthetic versions could be produced, although some bacteria also became resistant to it.


The extent of change in care and treatment. The impact of the NHS and science and technology: improved access to care; advances in medicines, including magic bullets and antibiotics; high-tech medical and surgical treatment in hospitals. New approaches to prevention: mass vaccinations and government lifestyle campaigns

Fight against lung cancer

Very little lung cancer in 19th century. 85%

cases are smokers. Diagnosis issues – no national screening programme as diagnosis is tricky – X-rays not detailed enough – but CT scans, followed by PET-CT, or bronchoscopy, are better. Treatment – transplants, radiotherapy, chemotherapy, genetic research (some chemo drugs work better in patients with certain genes). Prevention – tobacco advertising banned on TV in 1965 and completely in 2005. 2007 – no smoking in public places and have to be 18 to buy tobacco. Adverts, tax on cigarettes, also (2015) illegal to smoke in a car with someone under 18

Case studies

1. Fleming, Florey and Chain’s development of penicillin 2. The fight against lung cancer in the 21st century: the use of science and technology in diagnosis and treatment; government action

Key examples Causes - genetic

Genetic understanding improved by 1900 through Mendel (genes come in pairs, one from each parent). Then 1953 Crick and Watson identified the structure of DNA, using photography from Franklin. Led to Human Genome Project, finished 2000 – identified complete set on DNA. From that, can identify genes that cause diseases – eg BRCA1 for some breast cancer (Angelina Jolie)

Causes - lifestyle

Smoking – popular from 1920s – biggest cause of preventable disease in world. Diet – too much sugar (leads to diabetes) and fat (heart disease). Also alcohol, tanning and STIs.

Treatment

Huge changes: 1. Magic bullets – specific cure for specific disease, first one 1909 Salvarsan 606 (Paul Ehrlich) for syphilis. 2. Penicillin – first antibiotic, could cure more than one infection. Lots of technology for treatment now (chemotherapy for cancer, kidney dialysis machines to do the work of kidneys if they fail). Better sci+tech includes mass production of pills, insulin pumps and hypodermic needles (which measure precise doses).

Improvements in diagnosis

X-rays from 1890s – can see inside human body without cutting into it. Later (1940s) ultrasound and then (1970s) CT and MRI scans – MRI can see tissue. Blood tests from the 1930s onwards and ECGs from 1900s onwards. Blood pressure monitors from 1880s onwards. Endoscopes from 1900 (camera to see inside body)

Treatment in hospitals and influence of NHS

1. Previously – some help through 1911 National Insurance Act, but only for workers, not for wives/families 2. NHS launched 1948 – government now responsible for GPs and for about 3000 hospitals. 3. High-tech surgery now includes transplants (eg hearts from 1967), microsurgery (reattaching tiny blood vessels), keyhole surgery (tiny incisions). More and better prosthetic limbs – for increased soldiers surviving attacks in Iraq and Afghanistan 4. Prevention has improved – mass vaccination for babies and young people (eg polio developed 1954, HPV 2008), Clean Air Acts in 1960s. Lifestyle campaigns against binge drinking or unprotected sex, and for healthy eating eg 5 a day

medicine in britain, c1250-present. revision...

Documents