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Medicine Through Time
Examples of Factors
Green=Religion
Blue=Government
Purple=Chance
Pink: Trade and Communication
Brown=Science
Orange=Technology
Red=War
Bright Blue=Individual Genius
Grey=Attitudes
Date
c.3400BC – 30BC
c.700BC – 300BC
400-300BC
c.460BC-377BC
330BC
AD 129
C. AD910
AD 980-1037
1300-1368
1348
1493-1541
1510-1590
1514-1564
1552-1620
1578-1657
1665
1689-1762
1749-1823
1818-1865
1820-1910
1822-1895
1842
1846/7
1848
1854
1860s
1875
1895
1901
1909
1911
1928
1938-40
1942
1948
1953
1967
Event
Ancient Egypt
Ancient Greece
Cult of Asclepios
Hippocrates
Alexander the Great founds Alexandria
Birth of Galen
Rhazes
Avicenna
Guy de Chauliac
Black Death
Paracelsus
Ambroise Paré
Andreas Vesalius
Lady Grace Mildmay
William Harvey
Great Plague of London
Lady Mary Wortley Montagu
Edward Jenner
Ignaz Semmelweis
Florence Nightingale
Louis Pasteur
Chadwick ReporT
Ether & chloroform in use
1st Public Health Act
Cholera linked to contaminated water
Joseph Lister & Carbolic Spray
2nd Public Health Act
X-Rays discovered
Karl Landsteiner & blood groups
Salvarsan 606
National Insurance Act
Penicillin
Florey & Chain
Beveridge Report
NHS
Crick and Watson
Christian Barnard & 1st heart transplant
Useful Websites for Revision
http://www.schoolhistory.co.uk/revision/medicine.shtml
http://medicinethroughtime.co.uk
http://getrevising.co.uk
http://www.bbc.co.uk/schools/gcsebitesize/history/shp/
Section A: Public Health
1348
1665
1837
1842
1847
1848
1853
1854
1854
1858
1861
1865
1865
1867
1875
1875
1906-1914
1942
1948
Black Death
Great Plague
William Farr links dirt to
death rates
Edwin Chadwick produces
‘Report on the Sanitary
Conditions of the Labouring
Population’
Cholera outbreak
First Public Health Act
Government take tax off
soap.
John Snow discovers causes
of cholera.
Florence Nightingale begins
to improve hospitals
The Great Stink in London
Louis Pasteur published
Germ Theory
Octavia Hill improves
housing
Joseph Bazalgette develops
sewer system in London
Working class men given the
vote.
Artisans Dwelling Act
Second Public Health Act
Liberal Reforms
Beveridge Report
NHS set up
The Prehistoric and Ancient Periods
Prehistoric period (before writing)
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20,000 – 10,000 years ago - Lived a nomadic lifestyle which meant they were always on the move.
This meant they avoided some diseases and moved before water supplies became polluted or there
were piles of human excrement to attract disease.
However, because they kept moving they probably left sick to die and even killed young babies.
Suffered badly from organisms like worms and lice.
Often deformed and racked with arthritis. They had gangrene because bacteria had got into
wounds. Caught rabies from animals like wolves and got infections by eating raw animal flesh.
However some benefits as did not live close together to spread diseases, ate wild plants and food to
keep nutrients up and not keep cattle or poultry that spread diseases.
12,000 – 10,000 years ago - Farmers then began to settle down but this less to decrease in public
health as mice and rats lived with them, mosquito and blood-sucking injects settled to feed off them
spreading malaria and diseases spread quickly due to increase population. Kept animals so spread
diseases.
Life expectancy around 19-25 due to lack of medical treatments and problems during childbirth.
Hard to find about due to lack of modern sources – based on primitive modern tribes such as
aborigines of Australia or Azande of Africa.
Ancient Egypt 3000 BC300BC
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Pharoah and his government did nothing to protect the people from illnesses. (Government Hindering)
Egyptians took great care to clean, probably as part of their religion, to stay at peace with the gods.
People washed twice a day and every night and before meals. They used soda, scented oil and
ointments as soap. ( Religion - Helping)
Ladies shaved their bodies with bronze razors and used eye make-up that included powdered
emerald-green copper ore which may have reduced eye infections by chance. (Chance - Helping)
Richer homes contained a room for washing but did not have plumbing to bring water in and out
(Technology - Hindering). People bathed by having a servant pour water over them from a jug. The
waste water ran away through a hole in the wall or into a sunken vase in the floor.
Toilets for the poor were wooden stools with a hole above a cup half-filled with sand. Richer families
had a limestone seat over a bowl standing in a pit – but all toilets had to be emptied by hand.
Ancient Greek
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City governments left people to keep clean and prevent illnesses in their own ways. The streets
were filthy but city governments did not organise any cleaning. (Government - Hindering)
There were a few public lavatories and running water took the waste away.
The rich could afford their own baths and lavatories but most people lived in small dirty houses with
only basins to wash in.
People visited the Asclepion – a temple – for treatments by experienced and skilled priests. Some
were very large and had baths, gyms and an athletics stadium.(Religion - Helping)
People placed a great emphasis on fitness and diet. They developed fitness regimes.
Ancient Rome
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First civilization to introduce a public health system. They believed diseases had a natural cause
and that bad health could be caused by bad water and sewage. Therefore everyone in the empire
benefitted – not just the rich.
Roman rulers needed healthy soldiers to control the Empire. Healthy workers and merchants were
needed to keep the Empire fed and rich. (Government/War - Helping)
Therefore, they built their towns, villas and army forts in healthy places, away from marshland and
polluted water. They tried to keep army forts and cities clean and made sure people had fresh
water.
Their public health schemes used their great skills as builders and engineers. Engineers, often from
the army, kept everything running and dealt with repairs. (Technology - Helping).
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Aqueducts carried fresh water many miles to towns. 9 different aqueducts brought water into Rome.
(Technology - Helping)
Water pipes carried water around the towns made from lead or timber. The rich paid to attach their
houses to the pipes.(Technology - Helping)
Public fountains provided drinking water and water for washing. 1352 built in Rome.(Technology Helping)
Public toilets were flushed by water from public baths and drained into the sewers 144 built in
Rome(although there were often twenty in a room) (Technology - Helping).
Bath houses were places for washing, exercise, talk and business. Even small towns had a bathhouse which were cheap to enter. 5,000 people used the baths every week though the water was
only changed once. They had warm baths, cold baths, steam baths with central heating provided by
hot air circulating beneath the floor. (Technology - Helping)
Sewers carried away waste from houses, latrines and baths. They were built of stone and depended
on there being enough water in the system to flush them out. If there wasn’t enough rain the waste
built up in the sewers. The sewers emptied into rivers which were used to wash clothes and also for
washing and drinking water-causing problems. Connected to public bath and lavatories and rich
paid to have houses connected.(Technology - Helping)
Generally streets cleaned every night of rubbish. Officials appointed to check food sold for quality
and freshness and banned from burying dead inside city walls.
After a fire in AD 64 much of Rome was rebuilt and the Romans took care to build straight broad
streets and wide squares.
Officials were appointed to check food being sold for quality and freshness.
Burying the dead inside the city walls was banned and this made the much healthier method of
cremation popular.
Army forts had their own bath-house, water supply and latrines. Many also had hospitals for
soldiers.(War - Helping)
Some problems did remain and they could not stop plagues spreading. In the AD160s a plague
(known as Galen’s plague) killed 5 million people.
The army carried disease wherever they were sent to fight or defend the empire. (War - Hindering).
Sewers sometimes spread disease. In York the sewers were too large so water did not flow quickly
enough to clear sewage in the bottom of sewers.
Pipes were made from lead and though the Romans would not have known, - this must have led to
lead poisoning.
Towns could still be dirty places. People had to carry water upstairs and if they did not want to carry
it down they threw their waste out of the window.
In some parts of the countryside little changed and few facilities were built.
Also, some poor Romans lived in crowded housing blocks.
No hospitals for most people if not in army
Prehistoric and Ancient Revision Questions
Prehistoric Medicine
1. What was the name given to the lifestyle of prehistoric tribes where they regularly moved
around?
Nomadic
2. What would prehistoric tribes have been used to treat cuts?
Sphagnum Moss
3. What modern day tribe provide an insight into medicine in the prehistoric period?
Aboriginals.
4. Which two types of people were regularly involved in treating people?
Medicine men and women
5. Broken bones were covered with mud, clay or animal fat and then bound with what?
Feathers, animal skin or tree bark
6. What methods were used to remove evil spirits from the body?
Chanting, amulets and charms and trephining
7. What was the biggest killer amongst women in the period?
Childbirth
8. What problems were common amongst the population?
Osteoarthritis (severe pains in the knees, wrists and joints)
9. What is the difference between prehistory and history?
History is the start of the use of writing
Ancient Egypt
1. Why was Egypt a largely peaceful country?
Surrounded by desert, mountains and sea
2. What did the Egyptians record their treatments on?
A kind of paper from a plant called Papyrus
3. What was the name given to the Egyptian way of writing?
Hieroglyphics – so they were only understood in Egypt!
4. What did Ir-en-akhty, a Pharoah’s physician, specialise in?
Eye diseases and problems in the stomach and rectum.
5. What feature in Egypt did the idea of blocked channels, which were believed to cause disease
at the time, link to?
The Nile and its irrigation channels – when these became blocked the crops would die.
6. Which new ingredients for herbal remedies were brought from India, China and North Africa?
Cinnamon, pepper and malachite.
7. How did doctors learn about the main parts of the body’s anatomy?
Through the process of embalming
8. What were Egyptians forbidden from doing due to their religion?
Dissecting – believed body needed to be preserved for the afterlife
9. How often did the Egyptians wash due to their religion?
Twice a day and every night and before meals.
10. Why did surgical instruments improve?
Specialist craftsmen and metal workers – made fine instruments from bronze.
Ancient Greece
1. What group of people focused on investigating mathematics, science, astronomy and other
subjects as ‘lovers of knowledge?
Philosophers like Socrates, Plato and Aristotle
2. Which law was developed in the period which set high standards of treatment and behaviour
for doctors?
The Hippocratic Oath
3. What were the four humours which Hippocrates based his theory on?
Black bile, Yellow Bile, Blood and Phlegm
4. What other theory did these ideas develop from?
Theory of the four elements.
5. What large number of books contained the first detailed list of symptoms and treatments?
Hippocratic Collection
6. What were the name of Asclepius’ two daughters?
Panacea and Hygieia
7. What were the names dedicated to Asclepius, the Greek god of healing?
Asclepion
8. What was the name of the instrument the Greek’s used for purging?
Bleeding cup
9. Who suggested that the heart provides the body’s heat and the brain cools it down and that
the two work together to control the body?
Aristotle
10. What place became famous for its university and library which had a wide selection of
books?
Alexandria
11. Who discovered that the brain, not the heart, controls the working of the body?
Herophilus.
12. Who began to wonder if the heart may be a pump and dissected the brain?
Erasistratus
13. What four step method for treating illness was developed along the lines of clinical
observation?
Diagnosis, prognosis, observation, treatment
14. What did ‘A Regimen for Health’ from the Hippocratic collection recommend?
Healthy lifestyle through diet and exercise
Ancient Rome
1. What was the name of Galen’s book written in AD 190?
On Anatomy
2. Which process did Galen believe it was vital to carry out as much as possible?
Dissection
3. How many books did Galen write?
60
4. Where did he gain his experience?
In Alexandria and as a surgeon at a gladiators’ school
5. Which theory did Galen develop based on giving a patient something hot if they were cold
and something cold if they were hot?
The Theory of the Opposites
6. What did Galen have named after him having made detailed notes on its symptoms?
Galen’s Plague
7. What did Galen discover about anatomy?
The nervous system (demonstrated on a pig!), proved that the brain controlled speech, proved that
arteries, not just veins, carried blood.
8. Which organisation was vital in preserving Galen’s ideas as it agreed that the body had been
created by one god?
The church
9. Which areas did the Romans build their towns, villas and army forts away from?
Marshland and polluted water
10. Name three examples of Roman public health schemes?
Aqueducts, public toilets, sewers, bath houses, public fountains, sewers, water pipes
11. Which former army general wrote a huge book of 600 herbal remedies?
Dioscorides
12. Which books were doctors trained from?
Hippocratic collection
Middle Ages (1000-1500)
Why did problems develop?
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Without the Roman army there were no engineers with the technological knowledge to keep public
baths, sewers and aqueducts working effectively. (Technology- Hindering)
Wars destroyed the Roman public health systems. Goths invaded Roman Empire in 364 AD and
split it into two halves. Goths, Huns, Vandals and Vikings also took land for themselves. (War Hindering)
Kings spent their money on wars, not on sewers and baths. They did not think it was their
responsibility to care for their population. (Government - Hindering)
What problems existed?
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In 1348 Black Death was brought to England which killed 40% of the population of Britain – both the
rich and poor alike. There were two types of plague: bubonic in which painful buboes appeared and
they got a high fever and headache and pneumonic which attacked people’s lungs.
Drinking water was taken from dirty rivers.
Water was often stored next to cesspits people used as toilets.
Pigs and chickens roamed the streets. Rats, mice and hawks scavenged in streets full of rotting fish
bones, animal dung, foods waste and human waste.
There were open sewers carrying refuse to the rivers
People felt they did not need to worry about dirt as they felt God sent diseases.(Religion Hindering)
What was done to solve them?
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From 1343 butchers were ordered to use a segregated area for butchering animals.
By the 1380s there were at least thirteen public toilets – however they were built over rivers.
Butchers were punished for selling bad quality food.
People were fined for throwing litter in the street.
During the plague some towns developed laws to board up the house of infected people.
By the 1370s there were at least twelve teams of rakers with horses and carts, removing dung from
the streets.
Some people did focus on washing (the rich washed twice a year) and Guy de Chauliac realised the
importance of a good diet.
Over time Public Health did start to improve compared to start of Middle Ages – particularly as
became more stable from 1200 onwards. King Edward III ordered people to start cleaning the
streets during Black Death (Government-Helping)
However, not enough people were employed by the government to enforce the laws and clean the
streets as it wasn’t seen to be that important. (Government/Attitudes - Hindering)
Were conditions in monasteries any better?
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Many monasteries were wealthy and had the money to make sure they stayed healthy.
They could build water pipes, drains and wash houses. They had fresh running water, toilets and a
compulsory bath 4 times a year.
What were hospitals like?
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Most people would never have set foot inside one. Being born, dying and medical care mostly took
place at home. However, first ones built during Middle Ages such as St Bartholomew in London in
1123.
Mostly run by Christians trying to carry out the teachings of Jesus – to help the sick and the poor.
Many were built and paid for by the Church. Normal people donated money to the church to help
build these in order to cleanse themselves of their sins. (Religion - Helping)
31% were Leper houses which were set up outside of towns to keep lepers separated from the rest
of the population. They provided accommodation and food but no treatment. Many people believed
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lepers were being punished by God for the sins and were not allowed to marry, they had to dress in
special clothes and ring a warning bell as they approached.
59% were Almshouses that took care of people too weak to look after themselves, the elderly
needing long-term care, widows with young children or single pregnant women. They provided
shelter but no real medical treatment.
10% were hospitals that concentrated on looking after the sick. They varied in size enormously with
those in big cities having hundreds of beds with others having 5 or 6. The elderly, poor widows with
young children, orphans, the blind, cripples and the poor who were sick were allowed in. People
who were seriously ill were often not allowed in as there was no hope for them and they would need
too much care.
Hospitals were houses of religion and were called Houses of God rather than hospitals. Their main
job was not to care for patients physically but to look after them spiritually. The inmates spent much
of the day praying and confessing to help get rid of their sins. Christians thought soul more
important than body and disease was punishment from God so people had to suffer. However, most
followed Jesus’ example and showed compassion and care. Sometimes the monks carried out
some basic treatment but they mainly got regular meals, rest, clean linen, baths, warmth and
shelter.
Islamic cities like Cairo and Baghdad no cleaner but Islam taught people should keep themselves
clean and should look after each other. Hospitals built in every city and focused on medical
treatment to rich and poor. Developed hospitals with libraries, pharmacy and lecture rooms.
(Religion-Helping)
Revision Cards
Public health in the Middle Ages & the Black Death
1. What evidence is there that public health in cities like Canterbury improved in the Middle
Ages?
Maps show that Canterbury Cathedral monastery had a sophisticated water system, with fresh
running water and latrines for the monks
2. What is a cesspit?
A place where people poured human waster
3. What was a major problem with cesspits?
They weren’t emptied regularly and sewage often seeped into the water supply
4. When did the Black Death first strike Britain?
1348
5. What are the symptoms of the Black Death?
Fever, buboes and vomiting
6. What is pneumonic plague?
A more severe form of the plague, spread by particles in the air
7. What did people think caused the Black Death?
Punishment from god; planetary movements; bad smells; certain communities, such as the Jews;
imbalances in the humours
8. Who were the flagellants?
People who whipped themselves as a way of atoning for their sins and saving themselves from the
plague
9. How did some people, especially doctors, try to protect themselves from the plague?
By holding strong smelling herbs close to their noses
10. How did the people of Barcelona try to protect themselves from the plague?
By building a 7 km candle!
11. Which English King wrote to the mayor of London, ordering him to clean up the city streets?
Edward III in 1349
Renaissance (1500-1750)
Had Public Health improved since the Middle Ages?
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Still outbreaks of plagues e.g. 1604 30% people in York died from plague.
Towns were still over-crowded and full of dirty.
Government did not think it was their job to provide clean water and did not have skills or money to
do this. Government did issue some orders (plague sufferers should have bundles of straw outside
home to warn people and carry a white stick) but little done to enforce regulations because
government did not want to pay to employ them. (Government-Hindering)
How did the Great Plague (1665) chance Public Health?
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Another outbreak of plague killed 100,000 people in London and thousands more over Britain.
Government were forced to act to try and reduce death rates. Signs of a more scientific approach as
compiled Bills of Mortality which showed what people were dying of. Showed highest numbers of
death were in poorest and dirtiest areas. (Government-Helping)
Victims were shut up in their homes and government employed watchmen stood guard to stop
anyone going in or out. Houses marked with a red cross. Had searchers to check causes of death.
Bedding had to be hung in smoke of fires before used again. Fires lit in streets to kill poison.
Householders ordered to sweep outside their door. Stray animals removed from city or killed.
Entertainment venues (plays, bear-baiting, game venues) banned to stop crowds gathering.
Ensured bodies buried 6 feet deep.
However, still lack of understanding as people still believed that God had sent plague and
government ordered days of public prayer and fasting to people could ask God to be merciful.
Others believed it was miasma. (Religion/Attitudes-Hindering)
Government only acted when there was an emergency and did little after the Great Plague. Places
still remained dirty and overcrowded.
1666 Great Fire of London destroyed London and was rebuilt with wider, better-paved streets and
improved buildings. (Chance-Helping)
Revision Cards
Renaissance Public Health
1. When did the ‘Great Plague’ of London occur?
1665
2. How many died in London alone?
65,000 out of a population of 400,000
3. Which famous author, who also wrote ‘Robinson Cruse’, wrote about the impact of the
plague?
Daniel Defoe
4. What was it called?
A Journal of the Plague Year
5. What type of amulet did some people wear to ward off the plague?
Abracadabra amulet
6. What did people chew as a defence against the plague?
Tobacco
7. Every parish was ordered to have 2 or 3 examiners. What was their job?
To find out who was ill in each household and what their symptoms were
8. What did the constable do, if someone was found to be suffering from the plague in a
particular house?
Board it up, and paint a red cross with the words ‘Lord have mercy’ on the front
9. Who would stand outside the house?
Two watchmen – one for the day and one for the night to make sure no one left
10. What was the job of the searcher?
To find any bodies they think may have died from the plague and report them to the authorities
11. When did burials take place?
Before sun-rise or after sunset to avoid crowds gathering near the infected bodies
12. What measures were recommended for the bedding of infected houses?
Washed and aired and perfumes used
13. What was the job of a raker?
To ensure the streets were kept clean
14. What new regulations were issued governing animals?
Cats and dogs were slaughtered; pigs were forbidden to be left to roam the streets
15. How were beggars treated?
They were forbidden to roam the streets, begging for money on pain of execution
16. What happened to public entertainment?
Theatres, bear-baiting pits and places where people gathered in large numbers were closed down
17. How were the dead buried?
At least six feet deep and covered with quicklime
18. What event stopped the Great Plague spreading any further?
The Great Fire of London,1666
Industrial Period (1750-1900)/Nineteenth Century (1800-1900)
What problems existed?
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Regular outbreaks of cholera which was a high killer.
Life expectancy amongst poor in overcrowded towns was much higher than rich in countryside.
Poor public health in streets with mud and animals throughout. Open drains ran through streets.
Animals in streets and particularly in poor areas of housing or ‘courts’ where were dung-heap to
feed animals.
Poor quality water taken from dirty rivers and streams.
Poor conditions in factories with long working hours and hot and dirty conditions with dangerous
machinery. Swallowing coal and textile dust led do lung disease. Chimney sweeps also dangerous
job.
Doctors could charge fees so poor could not afford to go.
Poor quality food as difficult to bring into towns and expensive. Also, other items mixed into food
(chalk, sand, sawdust) to increase its weight so they got more money for it.
Overcrowding due to high increase in population. Railways and other transport not available to take
people to work so had to live in the towns and cities.
Poor quality housing in towns and back to back housing. Built in a rush.
No understanding of disease until 1861 and Germ Theory. Continued to believe in miasma.
(Science-Hindering)
No laws forcing local councils to provide sewers, fresh water or toilets in homes. Water came from
pipes in the streets.
Large number of diseases – cholera spread in drinking water or contaminated food, diphtheria
spread by coughing, typhus spread by lice, smallpox, typhoid spread by food and water, scarlet
fever and measles by coughing and tuberculosis through coughing and sneezing. Easy to spread.
Government not expected to play a major party in improving living and working conditions. No
pensions or help for sick and unemployed. (Government-Hindering)
Pasteur’s Germ Theory was not published until 1861 and was not accepted until much later on.
People refused to pasteurise (boil) milk as believed it would kill the goodness. (Attitudes-Hindering)
People did not want to give their money to the government to improve things. They felt people
should look after themselves. They did not want government interference. This was called a laissezfaire attitude. Also, the rich did not want to give up their money to help the poor. (AttitudesHindering)
What improvements occurred?
Date
1837
1842
Event
William Farr used information
about births, deaths and
marriages to identify for the
government where death rates
was highest and what people
died of (Individual GeniusHelping)
Edwin Chadwick, working for
the Poor Law Commission,
worked hard to produce a
‘Report on the Sanitary
Conditions of the Labouring
Population’. (Individual Genius
– Helping)
Successes
Showed link between high death
rate and unhealthy living
conditions. Shamed some towns
into improving public health and
increased pressure for change.
Failures
Proved poor live in dirty,
overcrowded conditions and this
caused disease. This made them
too ill to work and made them even
poorer. This meant higher taxes
had to be made to look after the
poor.
Argumentative, arrogant
and rude so people did not
listen.
Recommended improving drainage
and sewers, removing dirt from
streets and houses, providing clean
water supplies and appointing
medical officers to check these
changes carried out.
Government were reluctant
to interfere with local
councils (GovernmentHindering)
People refused to pay for
improvements initially.
(Attitudes-Hindering)
1847
1848
Cholera outbreak
First Public Health Act
In long term produced mass of
evidence to show government and
people needed reforms and led to
1st Public Health Act.
Raised fear and concerns that
deaths would happen.
Increased pressure on government
to follow Chadwick’s
recommendations and led to Public
Health Act.
Set up a national Board of Health.
In towns with high death rate
government could force local
council to make improvements to
water supply, sewerage and
appoint a Medical Officer of Health.
Local councils encouraged to make
public health improvements. Could
collect taxes to pay for this.
1853
Government take tax off soap.
(Government-Helping)
1854
John Snow discovers causes
of cholera. He wanted to
improve medical methods and
challenge old ideas (Individual
Genius-Helping)
1858
The Great Stink in London
when summer was very hot.
1861
Louis Pasteur published Germ
Theory and proved it by 1864.
(Individual Genius - Helping)
1865
Octavia Hill bought three slum
homes in 1865 and cleaned
them up to show how
Councils allowed to appoint
Medical Officers of Health and local
boards of health to oversees Public
Health.
More people were able to afford it
and it killed germs – even though
people did not understand why.
In 1849 published book saying
cholera spread through water but
laughed at. Proved it in 1854 when
500 people died over cholera in
Broad Street in ten days. Snow
mapped out deaths in detail and
proved that coming from a water
pump. This pump was taken away
and Snow published book ‘On the
Mode of Communication of
Cholera’.
Smell from the Thames grew worse
due to heart and was called the
‘Great Stink’. Chance that near to
Houses of Parliament so
government took more notice.
Added to evidence that more
improvements needed. (ChanceHelping)
Provided clear proof that dirt
caused disease. People more
willing to pay taxes to cover costs
of public health reforms and more
towns took actions. Change in
attitudes away from laissez-fair.
(Attitudes-Helping)
Led to similar schemes elsewhere
and campaigned for laws for
councils to improve housing.
Government did not make
act compulsory and only
encouraged changed. Only
103 towns set up local
boards of health.
(Government/Attitudes Hidnering)
National Board of Health
was abolished after six
years in 1854 as people
had ignored it.
People reluctant to accept
new ideas and did not lead
to Public Health Act. Germ
Theory not published yet so
people continued to believe
in miasma. (AttitudesHindering)
1865
important healthy homes were
for working people and to stop
overcrowding. Overall she
improved 2000 homes.
(Individual Genius-Helping)
Joseph Bazalgette develops
sewer system in London
(Individual Genius-Helping)
1867
Working class men given the
vote. Previously only the rich
had been able to vote who had
little interest in improving
public health for the poor.
1875
Artisans Dwelling Act
(Government-Helping)
1875
Second Public Health Act
(Government-Helping)
Technology and media
Helped to lead to 1875 Artisans
Dwelling Act.
Planned and organised building of
London’s sewer system. Included
83 miles of main brick sewers,
1100 miles of sewers for each
street and pumping stations to
drive the flow of sewage.
Government worried more about
the needs of working class men.
More desire to provide improved
conditions for them. Even more
working class men could vote from
1884.
Government gave council powers
to knock down slums on health
grounds.
Passed compulsory laws that
councils had to provide clean
water, public toilets and proper
sewers and drains. Also councils
had to appoint a Medical Officer of
Health and sanitary inspectors to
inspect public health facilities. Also
laws to improve standards of
housing (Artisans Dwelling Act
above), stopped pollution of rivers
(River Pollutions Act), shortened
working hours in factories (Factory
Act), made it illegal to provide poor
quality food (Sale of Food and
Drugs Act) and made education
compulsory.
People far more willing to accept
ideas. Reflect changes in attitudes.
(Attitudes-Helping)
Great improvements in engineering
during Industrial Revolution and
building of railways. Improved
machinery and methods of
building. Also invented first flushing
toilets which went into sewers.
(Technology-Helping)
Newspapers and magazines (such
as Punch) raised awareness of the
problems by publishing cartoons
and stories about the poor
conditions. (CommunicationHelping)
How did Florence Nightingale and Mary Seacole improve Public Health? (Individual Genius-Helping)
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In early 1800s problems with hospitals – cramped, stuffy, high chances of infection, poor training for
nurses.
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Florence Nightingale horrified her wealthy family by wanting to be a nurse (said God wanted her to
become one – Religion – Helping) but eventually trained in Germany and returned to London where
she was Superintendent of Nurses in a hospital.
When Crimean War broke out in 1854 she heard reports of terrible conditions and so arranged with
Minister for War, Sidney Herbert (also a family friend), to take 38 nurses to the Crimea. (WarHelping)
Whilst at Scutari in the Crimea she concentrated on cleaning hospital and patients. Focused on
washing of linen and bed sheets. Also cleaned the wards, repaired the way they were built. Death
rate from 40% of wounded to 2%.
Returned to Britain a heroine and raised money (£44,000) to set up first training school in 1860 for
nurses – Nightingale Training School. Great organiser and focused training nurses for good of
patient.
Wrote a 800 page to government saying to improve sanitation in hospitals (clean water, good
drains, toilet facilities, cleanliness), good ventilation and good food supplies, clothing and washing
facilities.
1859 wrote a book ‘Notes on Nursing’ which helped training and ‘Notes on Hospitals’ were
recommendations on how hospitals should be laid out. (Communication-Helping).
Improvements in technology allowed new hospitals to be built (Technology-helping)
However, paid little notice to Pasteur’s Germ Theory and instead just focused that dirt caused
disease. Focused on cleanliness.
Mary Seacole also influential nurse in Crimean War. Knowledgeable healer and midwife.
Volunteered to go and help but paid her own way to get there. (War-Helping)
Set up ‘British Hotel’ providing food and drinks to soldiers. Treated sickness and went to battlefields
to help soldiers which showed her bravery. Very popular amongst soldiers.
When returned she was largely ignored in Britain. Nobody tried to learn from her medical skills due
to her race and lack of money. (Attitudes-Hindering)
Revision Cards
Public health in the nineteenth century
1. What diseases were common in nineteenth century cities?
Cholera, typhus, smallpox, dysentery & rickets
2. When did the first cholera epidemic strike Britain?
1832
3. How does cholera spread?
When infected sewage gets into drinking water
4. What are the symptoms of cholera?
Diarrhoea leading to dehydration and organ failure
5. There were further outbreaks of cholera. When did they occur?
1848, 1854 & 1866
6. Who published the ‘Report on the Sanitary Condition of the Labouring Population of Great
Britain’?
Edwin Chadwick
7. When was the first Public Health Act passed?
1848
8. Why was it unsuccessful?
The recommendations were not compulsory. Some towns set up Local Health Boards but others
ignored the suggestions
9. What is the idea of ‘laissez faire’
Literally to let people do what they want – in the early nineteenth century people thought it wasn’t
the role of government to interfere in health provision
10. Who first made the link between contaminated water and the spread of cholera?
Dr John Snow
11. Where did he conduct his investigations?
Broad Street, London
12. When was the second Public Health Act passed?
1875
13. What was different this time?
Recommendations were compulsory – towns had to set up a board of health and provide better
sanitation
14. Which female reformer campaigned to have the ‘Artisans’ Dwellings Act’ passed which
forced local authorities to pull down slums and rebuild healthier houses?
Octavia Hill
15. Which famous reformer surveyed living conditions in London’s East End and produced a
map of his findings?
Charles Booth
16. Who produced a similar survey for York?
Seebohm Rowntree
Developments in nursing
1. What was the name of the war which Florence Nightingale and her nurses helped in?
Crimean
2. What were Florence Nightingale’s dates?
1820-1910
3. What was the name of the hospital that she worked in during the Crimean War?
Scutari
4. What was the name of the Secretary of War who helped Florence organise a party of nurses
to visit the battlefront in the Crimean War?
Sidney Herbert
5. What was the reaction of Florence’s family to her desire to help soldiers?
They opposed it – it wasn’t a respectable activity for a woman of her status
6. The death rate stood at approximately 40% in the hospital she first served in. By the end of
the War (1856) what was the percentages of deaths?
2%
7. What was the name of the book Florence wrote about nursing?
Notes on Nursing
8. How much money did the public raise to help her train nurses?
£44,000
9. In which hospital did she set up her first Nightingale School of Nursing?
St Thomas
10. How many trained nurses were there in the UK by 1900?
64,000
11. What did the 1919 Registration of Nurses Act introduce?
Compulsory training for nurses
12. When were men first admitted into the Royal College of Nursing?
1960
13. What was the name of the contemporary of Florence Nightingale who arguable did as much
for nursing during the Crimean War?
Mary Seacole
14. Who helped to finance Mary Seacole’s work?
No one, she had to fund herself
15. What was the name given to the hostel she set up where she nursed soldiers and served
them hot drinks and food?
British Hotel
16. What was the name of the book Mary Seacole wrote about her life?
“The Wonderful Adventures of Mary Seacole in Many Lands”
Twentieth Century (1900-2000)
Why was there pressure for improvements in the 1900’s?
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During 19th century life expectancy had started to rise: had reached 46 for men and 50 for women.
Death rates of children before the age of one had risen between 1880 and 1900 to over 140 out of
1000. Many still suffered from major health problems because of dirt and poverty. Not enough
trained midwives to help and advise new mothers. Many parents could not afford medical cures and
diseases spread rapidly.
Many still lived in poor conditions and died from diseases. Poor did not have decent housing,
enough food or medical help.
The government gave no help to the sick, unemployed and elderly. Those who could not get help
from relatives, friends or charities had to go into workhouses. (Government-Hindering)
During the Boer War (1899-1902) 38% of recruits were rejected because they were not fit enough
for the army because of health problems. This helped to raise awareness. (War-Helping)
Seebohm Rowntree investigated poverty and living conditions in York where had business for many
years. In 1901 published ‘Poverty: A Study of Town Life’ which gave evidence that more than 25%
people in York in poverty and was damaging their health. Raised awareness and he increased own
workers’ wages and conditions in factories. In 1941 published ‘Progress and Poverty’ which showed
50% reduction in poverty and poverty now caused by unemployment. (Individual Genius-Helping)
Charles Booth, a Liverpool businessman, was a friend of Octavia Hill and others trying to improve
living conditions for poor. Aware of poverty in Liverpool and in 1896 looked into conditions in
London. Paid for research into East End of London and produced a detailed report on living
conditions and poverty. Discovered 35% people living in poverty. Realised 85% of those in poverty
was because were unemployed or low wages – not their fault. Produced book ‘Life and Labour of
the London Poor’ and continued to build up evidence of poverty and ill-health and told government
to take responsibility. Suggested old age pension. (Individual Genius – Helping)
How did the Liberal Party improve Pubic Health?
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In 1906 a new Liberal government was elected who had promised to pass reforms (changes) to
improve everyday life for the poor. (Government-Helping)
Passed by David Lloyd George who was a Liberal MP and Chancellor-of-the-Exchequer (controlling
money). He was an inspiring speaker and friend of Rowntree. He insisted on taxing the rich to pay
for the reforms. (Individual Genius-Helping)
Reforms (Laws) passed were:
1902 – Compulsory training for midwives
1906 – Meals provided free for schoolchildren in need.
1907 – All births told to Medical Officer of Health and health visitor would check on mothers after
this to ensure knew what to do.
1907 – Schools for mothers opened focusing on hygiene and how to be a good mother.
1908 – Old Age pensions paid to people over 70 who had little money.
1909 – Back-to-back housing banned. New regulations to enforce higher standards of buildings.
1911 – National Insurance Act provides help for the sick. Government, employers and workers all
paid into scheme and if worked fell ill he was given ten shillings a week for 26 weeks and free
medical care.
1912 – Clinics held in schools to give children free medical treatment.
However, some councils refused to bring in changes and give up their money and people could still
not afford treatments and initial medical checks did not help children. Furthermore, not everyone
was covered by National Insurance Act (Workers families, unemployed, disabled were all not) and
others could not afford the payments. It also only covered workers for 26 weeks and not long term.
Also, hard to register to be given a pension as only the very poor who met certain criteria and given
very little money as part of pension. Reforms mainly focused on the poor children and mothers.
Why did progress slow between 1914-1939

Due to World War I government focused their time and money on fighting and building weapons.
Left government in debt after the war. (Government/ War – Hindering)
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However, after war David Lloyd George promised ‘Homes Fit for Heroes’ for the returning soldiers
and said local councils provided good homes for returning soldiers to rent. (Government/ WarHelping)
Also, the Great Depression which spread throughout Europe in 1929 meant that British businesses
suffered. Unemployment rose to over 3 million and the government had less money to spend on
people’s public health.
Also, unemployed not covered by National Insurance Act and those who did have jobs were paid
less so struggled to afford to pay into National Insurance Scheme.
Death rates increased amongst children under the age of one and in towns with unemployed.
Still some attempts to improve public health with old unhealthy slum houses knocked down and
700,000 new homes rebuilt. 80% slum dwellers supposedly rehoused but some remained.
Why was there pressure for further improvements?
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World War II changed people’s attitudes. Everyone risking their lives so ‘all in it together. Growing
feeling everyone should have access to good healthcare. Also, soldiers and civilians given free
healthcare during war. (Attitudes/War – Helping)
Also, children evacuated from towns and cities to countryside. Raised awareness amongst middleclass and rich about how dirty, unhealthy and underfed poor children were.(Attitudes-Helping)
After sacrifices of war people wanted a better future and healthcare part of this. Also good excuse to
rebuild old facilities. (War – Helping)
Rationing introduced to enjoy people’s diets. Government posters encouraged healthy eating.
How did the Beveridge Report help?
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Government asked a leading civil servant, Sir William Beveridge, to write a report on how to improve
people’s lives. He had been important in organising the National Insurance Act of 1911.
(Government/Individual Genius – Helping)
He ‘declared war on poverty and disease’ and recommended setting up National Health Service
free for everyone, that everyone would paid National Insurance to pay for it, that medical staff would
be paid by the government rather than charging patients for treatment, benefits for the sick, old,
unemployed, disabled and mentally ill. Great enthusiasm to the report with people queuing to buy it
and 600,000 sold.
Also other improvements as government ran national campaigns to make sure all children
vaccinated. E.g. compulsory vaccination against diphtheria in 1940 reduced deaths from 300 per
million to less than 10 per million. (Government-Helping)
Why was the NHS created?
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Recommended by Beveridge report and general enthusiasm for National Health Service. Proposed
by government in 1944 by Labour Party – one of main reasons they were elected into power.
However, opposition from doctors who were afraid would lose freedom and be unable to charge
private patients money. (Attitude - Hindering)
Opposition from people who believed poor and sick were like this because of laziness and should
not be helped. If were helped would be getting ‘something for nothing’ and would get even lazier.
(Attitude- Hindering)
Opposition from councils and charities as objected to government taking over control of hospitals
from them. (Attitude - Hindering)
Opposition ended when Aneurin Bevan, Minister of Health agreed doctors could continue to treat
patients privately whilst working for NHS. Originally 54% members of BMA (British Medical
Association) said against NHS and this had gone up to 90% but Bevan convinced them and by time
NHS opened 90% supported it.He was an inspiring speaker and was determined to make life better
for working people. (Individual Genius - Helping)
National Health Service Act passed 1946. In July 1948 NHS government officially introduced NHS.
Everyone could now get free treatment (before this 8 million could not afford to) (Government Helping)
Range of services offered: Hospitals, specialists, blood transfusion, dentists, medicines and
appliances, family doctors, ambulances, vaccination, health centres, health visiting, home nursing,
after-care of sick, maternity and child welfare and NHS led medical training and research.
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Also, hospitals rebuilt, health centres created, new equipment, better distribution of doctors
Successes: Increase in life expectancy (particularly women in childbirth)
Problems: Government could not afford to keep running it for free to introduced charges for dentistry
and prescription charges
Changes to the NHS: 1960s – New building programme to replace old hospitals, 1970s – Single
issue campaigns about smoking, healthy diet 1989 – ‘Working for Patients’ scheme promotes
competition between hospitals to improve standards, 1990 – Hospitals allowed to become Trusts
with GPs buying services from them, 1992 ‘Health of the Nation’ initiative by government sets five
targets for NHS to reduce death in heart disease, cancer, mental illness, HIV/AIDS,1998 NHS Direct
begins with telephone service offering 24 hour advice, 1999 NICE begins with focus on medical
excellence.
How has public health changed?
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Most people do now have better quality housing and everyone has free healthcare. Vaccinations for
a large number of diseases and treatments available. The largest killers in the past (TB, Cholera,
dysentery) can now be dealt with. Improvements in nutrition.
New killer diseases replaced old ones due to increases in smoking and obesity. Led to rise in lung
cancer and heart disease. Government taking some measures against smoking and fatty foods but
challenging task.
Still some problems in hospitals (legionnaire’s disease can spread) with spread of infections and
epidemics can break out (swine flu, SARS)
Greater focus on personal health – NHS launched campaigns to reduce obesity, binge drinking and
smoking.
Also spread of pollution to beaches and toxic accidents can happen. Car exhaust fumes causing
polluted air. Still dangers in workplace and unemployed suffer poor public health.
What is the World Health Organisation?
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Still lower life expectancy and high levels of infant mortality in third world and developing countries.
More diseases, poor diet, often devastated by war with government not helping people, few trained
doctors or health workers, poor communication and transport, lack of education, poor quality drugs
and treatments and other problems.
World Health Organisation (WHO) set up in 1948 by United Nations to help people throughout world
to achieve highest possible level of health.
Greatest success was wiping out smallpox. In 1967 WHO began campaign and by 1980 declared
that it had been wiped out. Spent £313 million on vaccines, treatments and to inspect different
countries.
1987 Who launched campaign to fight HIV/AIDS. In 2007 33.2 million people still living with HIV.
Many in Africa. Rapid spread partly due to modern travel as much cheaper, faster and causes
spread. (Communication-Hindering)
WHO focus on educating people and providing treatments but is no cure.
Revision Cards
Twentieth Century Public Health
1. What organisations were important in pressuring the government to do something about the
problems in public health?
Religious organisations such as the Salvation Army who provided food for the poor
2. Name two individuals who carried out reports into the remaining problems in Public Health?
Seebohm Rowntree (Poverty: A Study of Town Life in 1901 of York) and Charles Booth (Life and
Labour of the London Poor 1886 – studied East End London)
3. What changes for childbirth and children did the Liberal Reforms bring?
Compulsory training for midwives (1902), Meals for school children (1906), All births to be notified to
health visitor (1907), Schools to provide medical care and checks (1907) Local Authorities to
provide health visitors and clinics for pregnant women and infants (1918)
4. What type of housing did the 1909 Liberal Reform ban?
Back to back housing (Slum clearance programme later began in 1930 – 70,000 new homes built)
5. How did World War I have an impact on housing?
Government promised ‘Homes for Heroes’ after victory – pledged in 1919 Housing Act to build and
good quality housing.
6. Which key act was introduced in 1911?
National Health Insurance Act (workers and their employer made contributions to a fund which was
then used to give the workers sickness benefit and free medical care if they were ill)
7. What were the problems with this Act?
Limited to those who were employed and did not apply for their families. Also, many struggled to
keep up with the payments – especially during the depression which led to widespread
unemployment.
8. What vaccination campaign was launched in 1940?
Diphtheria vaccination
9. In the 1930s who did most people rely on their treatments from?
Family members and local pharmacy (could not afford to go to doctors)
10. Why did World War II increase pressure for changes in Public Health?
As everyone suffered in war – feeling all should have free health care available, evacuated children
raised awareness of problems of poverty, people wanted a better future (and healthcare was part of
this)
11. Which leading civil servant member put forward his ideas about a free national health
service, where all hospitals were controlled by government, in 1942?
William Beveridge in the Beveridge Report
12. What groups were angered at the proposal?
Local authorities who currently ran the hospitals, those who were worried about the cost of the NHS,
the British Medical Association and doctors who didn’t want to be told where to work and how much
to be paid.
13. Which politician was influential in changing the attitudes of opponents and reaching
compromises with them?
Aneurin Bevan (90% doctors supported NHS by time of its set up)
14. When was the first day of the NHS?
5 July 1948
15. What improvements did the NHS make?
Free treatment for all, creation of health centres, better distribution of doctors around the country.
16. In what period was there a new building programme to replace out of date hospitals?
1960s
17. What Act was introduced in 1956 to try to reduce the problems with smog in London?
Clean Air Act
18. What problems emerged with the NHS?
Became more expensive to run as cost of care increased – had to introduce prescription charges to
counter act this and certain treatments now had to be paid for.
19. What are the biggest killer diseases today?
Cancer and heart disease
20. What is the name of the organisation set up in 1948 to help all people throughout the world
to reach the highest possible level of health?
The World Health Organisation (WHO) – declared smallpox extinct from world in 1980.
21. Which campaign did the group launch in 1987?
To fight AIDS/HIV – but by 2007 33.2 million people still had it (mainly in Africa)
Section B: Understanding and Treatment of
Disease
c.460BC-377BC
AD 129
1493-1541
1721
1798
1861
1882
1885
1909
1928
1932
1941
1953
Hippocrates
Birth of Galen
Paracelsus
Lady Montagu bring
back inoculation from
Turkey
Smallpox vaccination
Germ Theory
Koch discovers TB
bacteria
Rabies vaccine by
Pasteur
Discovery of Salvarsan
606
Discovery of Penicillin
Discovery of Prontosil
Mass production of
Penicillin
Watson and Crick
discover DNA
Prehistoric
Understanding of disease
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Anything which could not be explained by natural injuries was blamed on evil spirits.
Believed illnesses could be caused by an enemy who made evil spirits enter victims body using pointing
bone and chanting a curse.
Treatment of disease
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Charms warn to ward off evil spirits
Cuts covered with mud and bound with strips of tree bark.
Broken bones covered with mud, clay or animal fat and tied up with feathers, animal skin or tree bark.
Fevers, pain and swellings, chest and lung complaints all treated by steam.
Chants sung to keep away evil spirits
Herbal remedies – such as sphagnum moss - some worked as included chemicals which acted as
antiseptics or anaesthetics. (Chance-Helping)
Trephining to release evil spirits
Healers
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Medicine man – trained to communicate with gods and spirits.
Women
Ancient Egypt – 3000 BC  300BC
Understanding of disease
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Continued to believe that illnesses were caused by the gods and evil spirits.(Religion-Hindering)
Developed first natural theory. Said illnesses caused when channels in the body became blocked. Idea
came from farming and the Nile. When the irrigation channels leading to the fields from the Nile became
blocked, the crops died. Egyptian doctors thought that people stayed healthy as long as blood, air and
water flowed through the channels around the body but if they became blocked (for example by rotting
food) then people fell ill. (Chance-Helping)
Lacked spread of ideas from other civilisations as Egypt isolated. Led to long-term stability but little
development between 3000 BC to 30BC
Treatment of disease
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Praying and chanting to Gods (Religion-Hindering)
Herbal remedies – getting new ingredients from trade. (e.g. Cinnamon and pepper from India and China
and Malachite from North Africa). Some were effective – malachite helped to stop bacteria growing in
wounds and honey was a natural antiseptic. (Trade and Communication-Helping)
Recorded treatments using hieroglyphs on papyrus. E.g. Ebers Papyrus Recorded examination,
diagnosis and treatments. However, this could not be understood by non-Egyptians. (Trade and
Communication – Helping)
Developed purging or bleeding to unblock blocked channels. Made patients vomit or empty their
bowels. Used laxatives like castor oil or blood let by using leeches or puncturing skin.
Recorded treatments show focus on examination, diagnosis, prognosis and treatment. Shows careful
methods.
Used combination of supernatural (praying to Gods) and natural (herbal remedy) treatments at temples
or wore amulets and chrms to Gods.
Healers
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Women
Very few women were doctors – only one Peseshet – out of 129 known Egyptian doctors.
Egyptian doctors mixture of doctor and priest. Carefully trained, studying medical papyrus recording
treatments and cases.
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Some were general doctors but specialist doctors employed by Pharoah’s e.g. Ir-en-akhty specialised
eye diseases, stomach and rectum. Carried out herbal remedies, simple surgery, prayers and chants
Many temples had schools attached to them where doctors trained and gave free treatments (paid for
by Pharoah’s). Other doctors were paid in goods or services.
Ancient Greek
Understanding of disease
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Wealthy classes (rich from farming and trade) spent their time being educated whilst slaves and poor
did their work. Small number of educated Greeks became interested in finding more logical, natural
explanations for the world around them. Many famous philosophers – ‘lovers of knowledge’ such as
Socrates, Plato and Aristotle (Attitudes-Helping)
Vast majority continued to believe that illnesses were caused by the gods and evil spirits. This was why
meant went to Asclepia/Asclepion to pray to Asclepius – the Greek God of healing. Believed Gods
responsible for everything that happened. (Religion-Hindering)
Hippocrates born 460 B.C. in Cos where was a doctor. Developed Theory of the 4 Humours saying
body contains four humours – blood, phlegm, yellow bile and black bile. When they are balanced
people are healthy but when they become unbalanced people became ill. Believe linked to seasons –
cold weather linked to an excess of phlegm, summer meant too much yellow bile and fever and
vomiting and autumn meant too much black bile, spring and hot weather linked to an excess of blood.
Linked this idea that universe made up of four basic elements (earth, air, water and fire) and these
linked to different seasons. (Individual Genius-Helping)
Treatment of disease
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Use of purging to clear four humours – bleeding cups to purge blood as believed opening veins with
knife because too much interference.
600 BC – focus on supernatural. Praying at Asclepia. When first arrived would sacrifice animal at statue
of Asclepios and then washed in baths. Took part religious ceremonies. Believed God visited them with
his daughters, Panacea and Hygieia and his snake. Harmless snakes were left in the abaton overnight
where patients slept to help set scene. Every large town had an Asclepeion – built on sites of great
beauty with spring water and refreshing breezes. Mixture of supernatural and natural treatments. Many
got better as believed in Gods or because more relaxed and healthier. (Religion-Helping)
From 430 BC – begin focus on natural. Hippocrates encouraged doctors to look for natural treatments
for illnesses rather than praying to Gods. Big focus on diet and exercise. Seen at Asclepia where focus
on exercise, cleansing, regular food and rest. (Individual Genius-Helping)
Hippocrates showed that it was important to observe and record symptoms and development of
disease. Helped to choose correct treatment and aid future patients (Individual Genius-Helping)
Hippocrates wrote some of the first books called the Hippocratic Corpus or Collection. First detailed list
of symptoms and treatments. Other doctors also wrote books (Individual Genius/Trade and
Communication – Helping)
However, Hippocrates works say nothing about surgery and anatomy and many ideas could only be
followed if you were rich.
Healers
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Women
Ancient Greeks had no female midwives as decided no women should learn the science of medicine.
Improved standards for Doctors due to Hippocrates. Hippocratic Oath created to give people confidence
in doctors. Had to keep high standards of treatment and behaviour and work for benefits of patients and
not the wealthy. (Individual Genius-Helping)
Priests carried out treatments at Asclepia, as well as simple surgery. Treatments they gave would have
been effective as included herbal ingredients. (Religion-Helping)
Ancient Roman
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Took ideas from Greeks as fell under control of Roman Empire from 250 BC. Allowed Greek doctors,
ideas and gods to make their way into Rome and the Roman Empire. (War-Helping)
Understanding of disease
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Gods – continued to believe supernatural causes. Took many ideas from Greeks when conquered
them. Believed in importance of Asclepius. (Religion-Hindering)
Believed Greek understanding of diseases correct that illnesses caused by imbalance of humours.
Was a period where ideas of Hippocrates ignored as Asclepiades, a Greek Doctor, who said doctors
should do more to help patients, dismissed theory of four humours and claimed human body made of
atoms moving through pores and channels of the body and liquids. Health depended on atom and
liquids moving smoothly due to diet, exercise and relaxation.
Treatment of disease
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Very similar to Greek as used Greek doctors and used books and ideas of Hippocrates
Continue to pray to the god Asclepius – took many of their ideas when they conquered Greece.
(Religion-Hindering)
Continued use of herbal remedies which would have been effective as included ingredients such as
honey and garlic. More ingredients as Romans invaded more countries and traded more. (War/Trade
and Communication-Helping)
Continued use of purging to remove four humours.
Focus on diet and exercise – supported by Galen.
Galen promoted interfering more with patients. Developed the theory of the ‘opposites’ to balance the
humours. If you were too cold then give someone heat using hot ingredients or if they were too hot give
them cool ingredients. (Individual Genius – Helping)
Continued focus on observation – taking notes on pulse and symptoms. E.g. Galen made detailed
notes of plague.
Further books produced to record treatments and share ideas. (Trade and Communication – Helping)
Galen wrote new books combining Greek ideas with what he had learned from his own work. Used for
the next 1500 years. (Individual Genius)
Healers
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Women looked after family and friends
Women could also become midwives.
Doctors were looked down on by the rich. Anyone could become a doctor initially in Ancient Rome.
Many believed were strong, fit and healthy and did not need doctors like weak Greeks did. Mainly
Greek doctors who worked in Rome who became more popular but mistrusted as foreigners. (AttitudesHindering)
Middle Ages (1000-1500)
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Described as ‘thousand years of darkness’ but no an entirely fair name.
Understanding of disease
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Continued to believe in Theory of 4 Humours as Galen promoted these ideas. People believed Galen
had covered everything so his books had all the answers. Used for medical training.
Also, Galen ideas fitted in with Christian church which controlled education in Europe in Middle Ages.
Galen said body created by one god, who had made all parts of the body fit together perfectly. This
matched Christian ideas. (Religion-Hindering)
Continued to believe that Gods caused disease – as seen with Black Death in 1348 as felt was a
punishment from God.
Monasteries preserved old writings by Roman and Greeks so could be studied again later after wars.
Islam also preserved old ideas too. However, both of these stopped new ideas (ReligionHelping/Hindering)
Believed Black Death caused by position of planets (doctors believed stars and planets affected
people’s bodies as many from same elements of air, earth, fire and water)
Others blamed on bad digestion, weakness and blockage.
Some minority groups such as the Jews blamed in countries.
Some even thought illnesses caused by arrows fired by elves! E.g. chicken-pox
Some linked it to toilets, standing water or rotting items. First suggestions of miasma theory.
Had no idea that Black Death of 1348 carried by rats and spread by fleas due to lack of scientific
understanding. Led to bubonic and pneumonic plague – blisters, high fever, severe headaches,
unconsciousness and death common symptoms.
Treatment of disease
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Continued to purge as believed in 4 humours – used bleeding charts to show where to take blood from.
People bled regularly to avoid illness – monks bled between seven and twelve times a year. Some used
leeches to suck out blood. Also did enema (mixture of water and other items) squirted into anus through
a pipe attached to pig’s bladder.
Prayed to God for forgiveness. During Black Death King Edward III ordered services and processions. 6
foot candles lit as offerings to God. (Religion-Hindering)
People prayed to God to merciful and went on pilgrimages to locations such as Canterbury Cathedral
(Religion-Hindering)
Flagellants whipped themselves to get forgiveness for their sins from God (Religion-Hindering)
Church helped to preserve a great deal of knowledge from the Greeks and Romans. Monks in
monasteries copied out the Bible, histories and other Ancient books. These would have been lost
otherwise due to the destruction. (Religion – Helping)
Focus on studying pulse and observing still.
Focus on diet and exercise.
Urology took place with study of urine common. Physician matched patient’s urine against the colours,
smell and density on chart.
Use of herbal remedies – new books developed such as Bald’s Leechbook which was a collection of
treatments. Honey and plantain common ingredients.
Decided on best time to carry out treatments using Zodiac man. Believed parts of body linked to signs
of Zodiac and planets. Showed doctor when to avoid treating each party of the body.
Arab rulers believed it was important to develop education. Many Greek medical books were translated
into Arabic which helped treatments to spread. Baghdad was the main centre for collecting and
translating books.
Al-Razi (860-925) or Rhazes wrote over 200 books, including his own ideas about the differences
between measles and smallpox. Ibn Sina or Avicenna wrote a medical encyclopaedia called The Canon
which was used to teach European doctors until the 1600s. (Individual Genius-Helping)
Many Muslim medical ideas and books reached Europe via the Muslim rulers of southern Spain. These
ideas were also spread during the crusades and conflicts between the Christian and Islamic countries.
(War-Helping)
Healers
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Doctors trained by reading books by Hippocrates and Galen but also new ideas of Arab doctors such as
Ibn Sina and al-Rhazes. (Individual Genius-Helping)
However, fewer than 100 physicians in England.
At start of Middle Ages was a downturn as libraries destroyed to prevent learning and wars made travel
more dangerous so doctors travelled much less to gain experience and education. (War-Hindering)
Women could be midwives but had to have licences after qualifying through an apprenticeship.
However, women could not be doctors because they were not allowed to go to university to study
medicine. Women could also do simple surgery because surgery was learned through practice, not
from books of theory.
Mothers and family members treated most illnesses. Grew herbs for medicine.
Armies took trained doctors to war with them where they gained experience as surgeons on battlefield.
(War-Helping)
Priests said prayers to help sick and protect from illness. They ran the hospitals and religion focused on
caring for sick. Islamic religion taught people to care for the sick – had a hospital in every large
town(Religion-Helping)
Revision Card
Medieval Europe
1. Why was the Church so important in the development of medicine in the Middle Ages?
The Church was closely involved in education, for example it founded university colleges and
schools; the Church paid for foundations like hospitals and infirmaries that cared for the sick
2. How did the Church’s influence hinder the development of medicine?
Superstitious explanations for the causes of disease were often looked for; the Church didn’t want
to challenge established texts like Galen which supported the idea of a ‘divine creator’
3. Medieval doctors continued to use the ideas of which two famous ancient writers?
Hippocrates & Galen
4. Name a famous medieval medical school
Montpellier, Padua, Bologna, Paris, Salerno
5. What is the use of urine to diagnose disease called?
Uroscopy
6. Apart from religion and the 4 humours, what else did medieval doctors think would influence
a patient’s health?
Astrology – the position of planets and stars
7. When was the College of Physicians founded?
In 1518, by Henry VIII
8. What did it do?
Licensed doctors
9. What did you have to do to become a doctor?
Pass an oral exam
10. If you couldn’t afford a doctor, who or what could you turn to for help?
Apothecary, monks in an infirmary, family cures
11. What is a quack doctor?
One who sold remedies without any medical benefits in order to make money
12. By 1500 how many hospitals were there in Engalnd?
Over 500
13. What was unusual about St Leonard’s in York?
It had over 200 beds
14. Who founded a hospital for unmarried, pregnant women in London in the 1400s?
Richard Whittington, Mayor of London
15. How were lepers normally looked after?
In special leper hospitals built outside the city walls
Arab medicine
1. Why is Arab medicine so important in the study of the development of medicine?
2.
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4.
5.
6.
7.
8.
9.
During the Middle Ages, a lot of medical knowledge was lost due to the collapse of the Roman
Empire and the wars that followed. The Arab world was relatively peaceful and cultured and
preserved a lot of medical knowledge, especially by collecting and translating ancient texts like
Hippocrates & Galen
What was the Arab doctor, Rhazes most important contribution to the development of
medicine?
Distinguished smallpox and measles as separate diseases
Who wrote the ‘Canon of Medicine’?
Avicenna
What did it do?
Brought together the ideas of Hippocrates, Aristotle & Galen
What important, but forgotten discovery did Ibn al-Nafis make in the 13th century?
That blood flowed from one side of the body to the other via the lungs and did not cross the septum
Were dissections allowed in the Arab world?
No. They were also tightly controlled in the Christian world
How good was public health in Arab cities?
Cities like Baghdad had had hospitals since 805 AD. Public baths were popular in Arab cities like
Cairo and Damascus.
How well trained were Arab doctors?
There were many medical schools and exams for doctors are recorded in Baghdad in AD 931
How did war help the development of medicine in the Arab world?
The Crusades – wars fought between Christians and Muslims over who controlled Jerusalem – led
to mew developments in surgery and exchanges of ideas and treatments
The Renaissance (1500-1750)
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During Renaissance, due to large number of people dead during Black Death, people demanded
higher wages and more spent on education.
Renaissance means ‘rebirth’ or ‘revival of learning’. Focused on ideas of Greek and Romans again
and wanted to learn. (Attitudes-Helping)
Looked carefully of ideas of Galen as worried that Middle Ages may have translated them wrong as
thought people Middle Ages ignorant. Published new editions of Galen’s books.
Based themselves on the Greeks who loved enquiry and began challenging old ideas. Began to
realise Galen had made mistakes. (Attitudes-Helping)
However, not everyone agreed with these new ideas and continued to believe the old ones.
(Attitudes-Hindering)
Understanding of disease
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Most continued to believe that Gods caused illness (Religion-Hindering)
Most continued to believe in theory of 4 humours.
Some began to link the fact that dirty places led to more deaths. They believed illness was caused by
bad or dirty air – called miasma. (Attitudes-Helping)
Paracelsus (he changed his name to mean ‘better than Celsus’ – Celsus was a famous Roman doctor –
this began to challenge the ideas of Galen and ancient doctors. Was willing to speak out at a time
when could have been killed for it. Said Theory of Four humours wrong and illnesses caused by
chemicals and should be treated with chemicals. Still believed religion had an impact and said God had
sent secret messages about how world works – believed the shapes of plants resembled illnesses they
should be used to treat e.g. plant ‘eyebright’ used to treat eye problems. However most people though
he was mad and universities did not teach his ideas. (Individual Genius – Helping/Attitudes-Hindering)
Treatments
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Continued to focus on good diet and exercise.
Bleeding and purging to balance humours.
Bezoar stone (stone from stomach of goat like animal) was used by some to cure poisons. One was
given to King Charles of France but Ambroise Pare, his surgeon, proved by testing it on a patient that it
didn’t.
Still study of urine.
Still prayed and wore charms. Many wore Abracadabra charms during Great Plague. (ReligionHindering)
Some believed that ‘King’s touch’ would cure them of scrofula or the King’s Evil. Between 1660 and
1682 92,000 people visited the King’s court.
Inoculation began to be used to prevent against certain diseases – such as smallpox
Herbal remedies with many written down e.g. Culpeper’s The Complete Herbal was a famous book.
New ingredients used as European travels to America and Asia. Rhubarb from Asia used to purge
bowels and make people vomit. Opium imported from Turkey and used as an anaesthetic. Tobacco
used for a range of problems. (Trade and Communication-Helping)
Healers
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University trained physicians still accept ideas of Hippocrates, Galen and Arab doctors. Reluctant to
accept Galen could have been wrong. (Attitudes- Hindering)
Becoming fashionable for wealthy to go to physicians rather than women. Charger large fees.
Most could not afford physicians and went to women in family or local wisewomen. Wealthy ladies often
provided local care for families e.g. Lady Grace Mildmay kept records of her patients and treatments.
Apothecary sold and mixed medicines prescribed by physicians.
Surgeons trained by watching other surgeons and given licenses to do so but still looked down on as
not university trained. Some women became surgeons – however became less common as surgeons
were more likely to be made to attend University and women banned from them. (Attitudes-Hindering)
‘Quack doctors’ made their living through going around towns selling treatments.
Women worked as midwives although first guides written by men who had little experience. First one by
a woman was The Midwives Book by Mrs Jane Sharp in 1671.
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Women less important from 1620 as Peter Chamberlen invented forceps – used to free baby from
womb during a difficult birth. After this male physicians said only men should use forceps as only they
had been to university to gain anatomical knowledge.
Revision Cards
Renaissance Treatments
1. Which type of ideas were seen to become more important that supernatural?
Scientific (seen in the setting up of the Royal Society in 1660 – Britain’s most prestigious
scientific body).
2. What happened to the ideas promoted by the Catholic Church in this period?
Challenged during the religious change during the Reformation – Protestant Churches were
developed by Martin Luther.
3. Whose books did physicians training at university read?
Classical texts which were translated. Hippocrates, Galen and Arab doctors such as Ibn Sina.
Began to read work of Vesalius, Pare and Harvey but reluctant to accept that Galen was wrong.
4. Who tended to treat the poor who could not afford to go to doctors?
Women in the family or local wisewomen, skilled in the use of herbal remedies.
5. Why was it impossible for women to become doctors?
Not allowed to go to university.
6. Which technological discovery by Peter Chamberlen in 1620 downgraded women’s role in
childbirth and midwifery?
Forceps.
7. Which individual called Galen a ‘liar and fake’ and Avicenna a ‘kitchen master’?
Paracelsus (he instead believed that illnesses were caused by chemicals in the body and that
treatments should be based on chemicals and minerals)
8. Which treatments continued to be used which had existed since the Ancient period?
Purging and herbal remedies.
9. Where were new ingredients for herbal remedies being discovered?
America and Asia as these continents were explored. Rhubarb from Asia was used to purge the
bowels and Ipecacuanha from Brazil was used to make people vomit. Opium was also brought
in from Turkey and used as an anaesthetic.
10. What was the name of the stone which Pare proved was not able to absorb poisons like people
had believed?
Bezoar stone
11. Which illness were King’s such as Charles II believed to be able to cure if they touched
someone?
The skin condition scrofula, otherwise known as the King’s Evil
Industrial Period (1750-1900)/Nineteenth Century (1800-1900)
Understanding of disease
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Belief in Gods and 4 Humours fading.
In early 1800s believed that bad air causes diseases.
Anthony van Leeuwenhoek made a microscope in 1600 and this was improved by Joseph Lister
senior who developed a microscope that could magnify things 1000 times. (Science and
Technology-Helping)
Theory of spontaneous generation developed by Felix Pouchet – scientists used new microscopes
to study germs on rotting food and decided that bacteria was created by decay.
Pasteur and Koch
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Louis Pasteur (1822-1895) was a French university scientist, not a doctor. He loved to demonstrate
his experiments in public and was a determined man. (Individual Genius-Helping)
Pasteur worked in alcohol industry in Lille. Realised that bacteria made alcohol sour. Suggested
that heating liquids (pasteurisation) would kill bacteria and make them safe to drink.
Pasteur was convinced that germs caused disease. Mocked by those who believed in spontaneous
generation. Emperor of France and government supported Pasteur and paid for his research
assistants and a new laboratory to carry out his experiments with specially designed equipment
(e.g. swan neck flasks. (Government/Technology-Helping)
In 1864 carried out experiments that proved germ theory correct. Showed bacteria caused decay,
were not evenly distributed in air. Took sterile flasks into streets of Paris and sealed them – bacteria
grew. Bacteria varied depending on location. Stale air included no bacteria and showed heating air
made it sterile.
In 1865 called to help silk industry because disease killing silkworms. Proved disease being spread
in air and causing disease in animals. Then began to research human diseases but couldn’t identify
specific bacteria.
Robert Koch, a doctor from Germany, began to study bacteria himself. He was ambitious, focus on
detail, worked painstakingly. Increased rivalry between France and Germany in 1870-1871 due to
Franco-Prussian War. Wanted to be successful to glorify countries. (Individual Genius/War –
Helping)
Koch investigated anthrax and discovered specific bacterium that caused anthrax. First time specific
germ that caused an individual disease been discovered. Proved germ theory.
He then developed a method of proving which bacteria caused disease. He improved methods of
studying bacteria. He developed ways of staining bacteria so they could be photographed using a
new high-quality photographic lens. He discovered how to grow bacteria on potatoes which made
them easier to study. (Science and Technology-Helping)
Revolution in communications in nineteenth century helped spread of ideas. Quickly reported in
newspapers and fast boat and train travel allowed doctors to meet at conferences and learn from
each others’ ideas (Communication-Helping)
Treatment of disease
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Still use of purging, praying, herbal remedies as past.
Inoculations
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Smallpox killed more children they any other disease and survivors left scarred.
To stop people catching it inoculation used in China and other parts of Asia. This involved spreading
pus from a smallpox pustule into a cut in the skin of a healthy person. Lady Mary Wortley Montague
brought this idea back from Turkey in 1721 where her husband was British ambassador.
Inoculation became big business in Britain with doctors charging up to £20 per patient for thousands
of inoculations. Robert and Daniel Sutton made a fortune from it – inoculated people then kept them
in ‘airing houses’ to stop them spreading infection. Inoculated over 14,000 people.
However, very risky as if got too strong a dose they could die. (2/3 out of every 100 died) Could also
be spread by inoculated person. People could not afford them.
Vaccinations
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Some people thought milder disease of cowpox seemed to give protection but no doctor had written
about it or tested it.
Edward Jenner decided to observe patients carefully and experiment to test his ideas. He followed
the advice of surgeon John Hunter who told him to challenge ideas. He had realised that milkmaids
who caught coxpox never seemed to get smallpox. He realised that vaccinations might work –
putting a weaker form of a disease into a patient to build up resistance.
Carried out experiments in the 1790s. He took a sample of cowpox from an infected milkmaid,
Sarah Nelmes, an tried it on a healthy 8 year old boy, James Phipps. Boy developed cowpox but
not smallpox and was vaccinated against it when tried to give him smallpox.
In 1798 published book, An Enquiry into the Causes and Effects of Variola Vaccinae, known by the
Name of Cowpox, describing vaccination and proved evidence it worked. By 1803 vaccination was
being used in the USA and in 1805 Napoleon had the whole French army vaccinated (Trade and
Communication/Individual Genius-Helping)
Government helped to spread his ideas – in 1802 and 1807 Parliament gave Jenner £30,000 to
develop his work. In 1852 vaccinations were made compulsory in Britain and were strictly enforced
until 1887. Led to drop in deaths from smallpox. (Government-Helping)
Jenner was an excellent example of how experimenting and enquiry could defeat a killer disease –
encouraged doctors and scientists. Ideas spread worldwide and in 1980 smallpox declared
eradicated from the world.
However, many people did oppose vaccination. In 1866 an anti-vaccine league was formed. Some
believed it was unnatural to give diseases from animals and against God’s wishes. Inoculators were
angry that they would lose their jobs and profits. The Royal Society of Science refused to published
his book and said his ideas were too revolutionary. Other people had not heard of Jenner so
refused to believe him. Many turned against vaccination as untrained people did them and thought
they were rushed and clumsy. Others did not have the time to get their children vaccinated. Some
saw as dangerous as doctors mixed up vaccines and others used infected needles. Some did not
like the government telling them what to do in terms of vaccinations – laissez faire attitude.
(Attitudes-Hindering)
Also, government could not decide how much to force people and from 1887 vaccinations were not
compulsory. (Government-Hindering)
Furthermore, Jenner did not know that germs cause disease and could not explain how the
vaccination worked. Science was not that developed. (Science-Hindering)
Technology helped use as developments in steel making helped to produce a thin syringe that did
not break which could be used for vaccinations (Technology-Helping)
Louis Pasteur & Robert Koch
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In 1879 Pasteur built up his research team to make faster progress. Started trying to help farming
industry to cure chicken cholera. He identified bacterium causing chicken cholera. Then found
vaccination for it in 1880 when one of his team, Chamberland, used an older batch of cholera to
inoculate some chickens and when he realised it was an old batch he understood that germs
weaken over time. (Chance-Helping).
Pasteur then developed a vaccine for animals against vaccine. He tested this in a public experiment
and the news spread.
Koch was angry when he heard of Pasteur’s anthrax vaccine – believing Pasteur had stolen his
research. He focused on identifying bacteria that cause a human disease. He found a way of
staining the tuberculosis bacterium in 1882. First human bacteria identified.
Showed possible to identify human bacteria -1882 identified typhoid, 1883 cholera, 1884 tetanus,
1886 pneumonia,1887 meningitis, 1894 plague, 1898 dysentery
Pasteur then began to focus on vaccines for human diseases. Investigated rabies, testing vaccine
on dogs, but did not know if would work on people. Tested them on Joseph Meister in 1885, who
had rabies, and the boy survived. Led to vaccinations for typhoid 1896, tuberculosis 1906,
diphtheria 1913 and tetanus 1927.
Revolution in communications in nineteenth century helped spread of ideas. Quickly reported in
newspapers and fast boat and train travel allowed doctors to meet at conferences and learn from
each others’ ideas (Communication-Helping)
Healers
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Ordinary people could call on local doctors – trained through apprenticeship and attending medical
lecturers. Were using new technology like stethoscope and used drugs and herbal remedies to
treat. Doctors also acted as ‘male midwives’. Usually had standard charges but did not charge if
patients too poor.
Dispensaries appearing to give medicines to doctors. Provide poor with cheap medicine. Many
people got treatments from here.
Many illnesses still treated at home – food, warmth and herbal remedies.
Some also visited ‘quack doctors’ or bought remedies that claimed to cure everything. Made little or
no contributed to improvement in health but were cheaper. Were not controlled by government and
although they did not work – people got rich from them.
From 1880s government introduced laws to control making of medicines and by 1900 harmful
ingredients removed. Chemical drugs starting to be developed such as aspirin. By 1900 companies
like Boots, Wellcome and Beecham set up.
What role did women play?
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Until 1700s women could qualify as surgeons and midwives. However, not allowed to become
physicians as needed university training and women not allowed. (Attitudes-Hindering)
In 1852 a law required doctors to belong to a College of Surgeons, Physicians or Apothecaries
(person who dispenses medicine) – all of which were closed to women.
Women allowed to be nurses as seen with Florence Nightingale and Mary Seacole in 1854.
Some women challenged the situation – Elizabeth Blackwell went to America to qualify as a doctor
in 1849 and worked in New York and then travelled back to Britain to encourage British women to
be doctors. (Individual Genius-Helping)
Elizabeth Garrett Anderson first woman to qualify as a doctor in Britain. During 1860s she worked
as a nurse and attended lectures at Middlesex Hospital. Male students at the Hospital protested
against her attending. Elizabeth Garrett passed all the exams to qualify as a doctor but the Colleges
of Surgeons and Physicians would not allow her to join. She took the College of Apothecaries to
Court which then accepted her as a member before it too banned female members. (Individual
Genius-Helping/ Attitudes-Hindering)
In 1874 six women, led by Sophie Jex-Blake, completed a medical course at Edinburgh University
but the University refused to give them their certificates so they instead qualified in Dublin or
Switzerland.
In 1876 law was passed opening all medical qualifications to women. However, up until 1881 the
Royal College of Surgeons refused to allow anyone to take exams in midwifery to stop women from
learning alongside men. (Attitudes-Hindering)
Revision Cards
The Fight against Germs
1. Who was the first person to suggest that microorganisms were the cause of disease?
Louis Pasteur
2. Before Pasteur, scientists thought that micro-organisms didn’t cause disease but appeared
because of death or disease. What was this theory called?
Spontaneous generation
3. What did people think caused diseases before Pasteur? ?
Noxious gases called miasmas
4. How did Pasteur prove the existence of germs?
Sterilising liquids and putting them in a sealed flask and comparing them to liquids in flasks which
had been left open to the air. The liquids in these flasks went bad, whilst the sealed ones stayed
fresh
5. Which scientist first linked diseases to the microbes that caused them?
Robert Koch
6. What were Koch’s most important technological contributions to germ research?
Using solid media to grow microbes, staining them to identify different microbes and photographing
them
7. Name 3 types of disease he identified in this way
Anthrax (1875), Tuberculosis (1882),Cholera (1883)
8. What was the first human disease identified by Koch?
Tuberculosis or TB
9. What factors spurred Pasteur and Koch on to develop the science of Germ Theory?
Personal rivalry; national rivalry – France & Germany had been at war (1870-1); government
funding
10. What was the vaccine that a member of Pasteur’s team discovered by chance?
Chicken cholera
11. How did Pasteur develop a cure for rabies?
Borrowed an idea of an earlier scientist who had used dried rabbit spines containing the rabies
bacteria, an injected this into the spine of an infected boy
12. Apart from war, what other factors helped Pasteur & Kocj develop germ theory?
Chance, government funding, teams of scientists, competition, new technologies
Twentieth Century (1900-2000)
Understanding of disease
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Understood germ theory and continued to identify specific bacteria.
Watson and Crick discovered DNA in 1953. This helped people to understand that some diseases
were genetic. (Down’s syndrome, Alzheimer’s disease, Parkinson’s disease, Cystic Fibrosis,
Cancer) (Individual Genius-Helping)
Treatment of disease
Magic bullets
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Developed first cures for people who have already become sick with diseases. Vaccines only
prevent people getting them. Magic bullets attacked the bacteria developing in the body – made
from chemicals and called sulphonamide drugs.
1909 Paul Ehrlich (who had been part of Koch’s research team) developed the first chemical
Salvarsan 606 which destroyed the harmful bacteria that caused syphilis. It took a number of
attempts to find the magic bullet (over 606) and in the end it was lucky it was retested by Dr Hata as
they hadn’t notice Salvarsan 606 worked the first time. (Individual Genius/Chance-Helping)
In 1932 Gerhard Domagk developed Prontosil, the second chemical ‘Magic Bullets’ to cure blood
poisoning or septicaemia. Scientists then discovered that the important chemicals in these cures
was sulphonamide and drug companies produced more magic bullets for diseases such as
pneumonia (Individual Genius-Helping)
Antibiotics (bacteria which kill other bacteria)
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Magic bullets could not kill staphyloccus germs which caused major infections and often killed the
victims. This became a cause for particular concern due to the number suffering from it in World
War I and World War II (War – Helping)
1872 Joseph Lister noticed mould of bacteria called penicillin killed other bacteria. Used this mould
to treat a nurse with an infected wound but did not use it again.
During World War I Alexander Fleming was sent to study soldiers’ wounds infected with streptococci
and staphylocci bacteria. Many soldiers died from them. Fleming worked on dealing with these
bacteria. (War-Helping)
In 1928 Fleming found what he’d been seeking whilst working at St Mary’s Hospital in London.
When he went on holiday he left Petri dishes containing bacteria on his bench. On his return he
noticed that on one dish the staphylococci bacteria had disappeared. He realised that penicillium
mould had blown in through Fleming’s window and landed on the dish. (Individual Genius/ChanceHelping)
Fleming carried out experiments with the penicillin mould on living cells. He discovered that if
penicillin was diluted it killed bacteria without harming the cells. He made a list of the germs it killed
and used it to treat another scientist’s eye infection. However, it did not work on deeper infections
and took too long to produce. He also mainly used it as an antiseptic and not as a main treatment.
In 1929 Fleming wrote about penicillin in a medical journal but nobody took any notice.
(Technology-Hindering)
In 1938 Florey and Chain were researching how germs could be killed. They read Fleming’s article
on penicillin and realised it could be effective. (Communication-Helping)
They tried to get funding from the government. They got £25 from the British government who were
spending money on a war. (Government-Hindering). They instead went to the American
government who gave enough for five years research. (Government-Helping)
Florey and Chain discovered that penicillin helped mice recover from infections but to treat one
person needed 3000 times as much. Could not afford to produce this much. (Technology-Hindering)
Florey and Chain began growing penicillin in whatever they could, using hundreds of hospital
bedpans – no major companies agreed to help them at this point. They used freeze drying to
produce the pure penicillin. By 1941 there was enough penicillin to test it on one person. The
volunteer was Albert Alexander, a policeman with septicaemia, who was dying. Florey and Chain
used penicillin and it worked but they ran out of penicillin after five days. They could not make
enough of it.
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
In 1941 America was attacked at Pearl Harbour and entered the war. American government
realised potential of penicillin for treating wounded soldiers and made interest-free loans to US
companies to buy expensive equipment needed for making penicillin. Soon began mass producing
and had 2.3 million doses by D-Day in 1944. By 1945 they were using 2 million doses a month –
saving 12-15% of soldiers’ lives. (Government-Helping)
After the war penicillin became available for civilian use. Used to cure meningitis, pneumonia, chest
infections, throat infections, abscesses, kidney infections, cuts and infections. Wonder drug of the
twentieth century. Antibiotics have saved an estimated 200 million lives in less than 70 years.
Recent treatments
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
Mass production of many drugs as treatments. (However, drugs have led to some problems such as
thalidomide which was given to reduce morning sickness during pregnancy – led to children being
born with severely deformed limbs)
Development of customised drugs to cure one person’s health problem
Gene therapy – using genes from healthy people to cure the sick.
Alternative therapies
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
Acupuncture – inserting fine needles at pressure points on the body to release blocked energy.
Homeopathy – Patients takes a very weak amount of a substance which would produce symptoms
similar to that patient has. Encourage body to heal itself.
Herbal remedies – Health shops sell remedies made from plants and animal substances.
Healers
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Over time has been breakdown on restrictions of women – greater opportunity to attend university
and taken on more work.
Nowadays many women can be doctors – around 50%.
People have NHS and GPs available but some continue to use cheap, easy-to find remedies
handed down through families or herbal remedies.
Revision Cards –
Twentieth Century Understanding of Disease
1. What did Francis Crick and James Watson discover in 1953?
The structure of DNA
2. What factors were important in their discovery?
Individual Genius (Crick and Watson great scientists), Technology (x-ray photographs and improved
microscopes) and Government (funded projects)
3. What is the name of the project which was completed in 2001 (15 years since starting) which
worked out exactly how each part of human DNA affects the body?
Human Genome Project
4. What types of diseases did this allow for greater understanding of?
Genetic diseases such as Diabetes, Down’s syndrome, Alzheimer’s, Parkinson’s, Cystic Fibrosis
5. What problems may emerge from genetic engineering?
Ethical/moral issues regarding choosing nature of a child and abortion of ill children. Growth of stem
cells from foetuses.
Twentieth Century Treatments
1. What vaccinations were developed during the early part of this period?
Tuberculosis (1906), Diphtheria (1913) and Tetanus (1927)
2. What is a ‘magic bullet’?
A chemical which is able to target and kill one specific bacteria.
3. What magic bullet was discovered in 1909 by Paul Ehrlich?
Salvarsan 606 – able to kill syphilis bacteria.
4. How did chance play a role in this discovery?
They nearly missed the discovery and it was only when it was being retested that another
assistant, Sahashiro Hata, realised that it killed syphilis bacteria.
5. What were the problems with early Magic Bullets?
Could kill people as well as the bacteria
6. Who discovered Prontosil which could kill the bacteria which caused blood poisoning
(septicaemia)
Gerhardt Domagk in 1932
7. Who did Domagk try the magic bullet out on?
His daughter after she got severe blood poisoning.
8. What was the key ingredient in Prontosil which was discovered through the use of electron
microscopes?
Sulphonamides
9. What was discovered at St Mary’s Hospital in 1928 and who by?
Penicillin by Alexander Fleming
10. Why was staphylococci such a problem in infection?
Very resistant to any magic bullets – unable to kill it and massive killer.
11. How did chance play a role in this discovery?
Penicillin got onto a dish through an open window and Fleming saw it was killing the
staphylococci bacteria
12. Why was Fleming not able to make more of this discovery?
Did not have facilities or the support to develop and test his ideas.
13. Which two people became interested in Fleming’s 1929 report about penicillin?
Florey and Chain
14. What did the two individuals use to grow penicillin in?
Milk bottles, milk churns, a dog bath and a hand pump (using new freeze-thaw technology)
15. Which animal did Florey and Chain carry out their first experiments on?
8 mice (those who were injected with penicillin survived the bacteria they were contaminated
with)
16. What significant development happened in the use of penicillin in 1941?
First human trial on Albert Alexander (showed that it worked – although they ran out of penicillin
so patient died)
17. Why was war significant in the development of penicillin?
When American entered the war they realised they would need penicillin to treat patients so
gave $80 million to four drug companies to find a way to mass produce it.
18. How many doses were the American army using in a month in 1945?
2 million
19. Which drug, produced between 1959 and 1962 led to severe abnormalities to foetuses?
Thalidomide
20. What type of treatment has become possible since the discovery of DNA?
Genetic engineering (e.g. DNA can be made to produce protein insulin)
21. What alternative modern treatments are often used today?
Acupuncture, homeopathy, hypnotherapy
Section C: Surgery and Anatomy
AD 129
1543
1575
1628
1799
1847
1847
1847
1853
1861
1867
1878
1880
1889
1895
1901
1932
1941
1967
Birth of Galen
Vesalius publishes book ‘The
Fabric of the Human Body’
Pare publishes ideas on
surgery
Harvey publishes book about
circulation of blood
Humphry Davy discovers
laughing gas
J.R. Liston discovers ether as
anaesthetic
Simpson discovers
chloroform as anaesthetic
Semmelweiss promotes
washing of hands
Victoria used chloroform
Germ Theory leads to focus
on germs in surgery
Lister develops use of
carbolic acid as antiseptic
Koch discovers septicaemia
bacteria.
Lister develops catgut
ligatures
William Halsted discovers
rubber gloves
Wilhelm Rontgen develops Xrays
Karl Landsteiner discovers
blood groups
Wesse develops saline
solution
Mass production of penicillin
Barnard first heart transplant
Prehistoric
Surgery
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Trephining to release evil spirits
No internal or external surgery as lacked technology or understanding (Technology/Science –
Hindering)
Anatomy

Only knew what they could see. No internal dissections.
Ancient Egypt
Surgery
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Carried out simple surgery on the outside of the body, cutting out swellings or sewing up wounds.
Carried out trephining to ease pains or swellings.
However, no internal surgery as lacked any understanding of body and wanted to preserve it for
afterlife.
Doctors had stronger, sharper bronze surgical instruments due to improved metal-working tools.
(Technology-Helping)
Anatomy
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Knew about major parts of body’s anatomy (heart, lungs, lived and brain) and about veins, muscles
and many bones but did not understand what they did. Learnt this by examining wounded soldiers
or workers injured on building projects or due to embalming, removing and preserving the body’s
organs after death. (War/Religion-Helping)
However, the knowledge may not have spread that far as embalmers were seen as ‘unclean’ and
did not have much contact with people.
Not allowed to carry out dissection (careful cutting and analysis of dead bodies) because their
religion said the body was needed in the after-life. (Religion-Hindering)
Thought air drawn in through nose, into the lungs and then to heart and then to rest of body. Said
heart could speak through the vessels to all limbs but not aware circulation of blood. Knew a little
about nervous system (importance of spinl cord for ftrasnferring information).
Ancient Greek
Surgery
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Less interest in this area compared to understanding and treatment of disease.
Carried out external surgery. Good at setting broken bones and could amputate limbs. Learned how
to drain lungs of people who had pneumonia.
Minimal internal surgery as lacked understanding, anaesthetics or interests in doing it – too
dangerous. Only cut out tumours and ulcers.
Began to use opium, alcohol, wine and vinegar during surgery which seemed to reduce death rates
but no understanding of why. Squeezed out pus because realised harmful.
Anatomy
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Dissection of bodies was illegal in Greece so doctors had not developed detailed knowledge of
anatomy and physiology. (Religion-Hindering)
However, human dissection allowed for a time in Alexandria. This was in Egypt but part of the Greek
Empire. At Alexandria the Greeks built a university and library which collected books from around
the world.
At Alexandria, Herophilus discovered the brain, not the heart, controlled the workings of the body.
He identified parts of the stomach. (Individual Genius-Helping)
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Erasistratus dissected the brain and began to understand that it sends messages to the rest of the
body through nerves. He also dissected hearts and wondered whether the heart was a pump but
could not prove it. (Individual Genius-Helping).
Aristotle had an interest in biology. Although he did not dissect bodies his studies led him to suggest
the heart and brain were the most important organs in the body – the heart providing heat and the
brain cooling it down with the two controlling the body together. (Individual Genius-Helping)
Ancient Roman
Surgery
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Continued to mainly carry out external operations like Greeks and amputations. Splints for broken
bones and trephining.
Some plastic surgery on nose lips and ears, cauterising vessels if bandage would not contain
bleeding and operations in abdomen, varicose veins and cutting away scrofula.
Continued improvement in equipment and technology. (Technology-Helping)
Gained more experience due to amount of wars as Romans expanded their empire. (War-Helping)
Continued to use opium, alcohol, wine and vinegar during surgery which seemed to reduce death
rates but no understanding of why. Opium dulled pain but no effective anaesthetics and wine,
vinegar of honey cleaned wounds but did not prevent infection. (Science-Hindering)
Anatomy
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
Cladius Galen was born in Greece and started studying medicine at 16 – going to Alexandria for a
time. He became a surgeon at a gladiator’s school which helped his knowledge of treating wounds
and anatomy. Aged 20 he moved to Rome and put on public displays of dissecting animals. He later
work for the emperors.
He placed a great focus on anatomy and wrote a book called ‘On Anatomy’ in AD 190. He said that
doctors should actively dissect bodies and get used to the structure of the bones and body. He
recommended going to Alexandria or digging up bodies. Or he said to use animals such as apes
that resembled humans most. (Individual Genius/Communication – Helping)
Galen demonstrates his discoveries about the workings of the nervous system on a pig – cutting
different nerves to show which ones controlled movement and vocal cords. He proved that the
brain, not the heart, controlled speech and that arteries, not just the veins, carried blood around the
body. However, he did make some mistakes. (Individual Genius- Helping/Hindering)
Middle Ages (1000-1500)
Surgery
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Three types of surgeons – barbers who cut hair and did minor surgery (pulling teeth, lancing boil,
leeching and cupping), surgeons (blood-letting and more major surgery outside the body) and
military surgeons who had to take more risks with victims of war and tried new methods. Surgeons
all looked down on as did not have to attend university and trained through apprenticeships.
Simple surgery on visible tumours and wounds, sewed up or cauterised large cuts, removed
cataracts from eyes with needles, dealt with dislocations and broken bones but only external. No
internal surgery as lacked understanding or equipment to do so. Continued to use opium as
anaesthetics and wine, vinegar or honey to clean wounds but still no understanding. Exactly same
as Ancient Rome.
Surgeons used Zodiac chart to identify best times for carrying out treatments and surgery based on
the planets.
Was continued improvements in techniques and instruments as gained more experience.
Some new equipment e.g. John Bradmore, the royal surgeon, designed a metal forcep to pull out
arrow wounds and smothered wounds with honey to keep them free of infection. (Individual GeniusHelping)
Some challenged Galen’s ideas. Galen had said pus was a good thing to leave on a wound and
tried to make it develop. However, Hugh and Theodric said this was wrong and wine should be used
to clear away the pus.
Henri de Mondeville, a military surgeon and teacher, told his students to bathe and cleanse wounds
and then seal them up quickly. He also wrote a surgical textbook who said that more could be learnt
about surgery and they should challenge old ideas. (Individual Genius-Helping)
Surgeons also began reading books. Roger of Salerno wrote first European textbook on surgery
and Guy de Chauliac wrote a seven-volume book called Great Surgery – using the ideas of Ibn
Sina, Hippocrates and Galen (Individual Genius/Communication – Helping)
Anatomy
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Doctors knew about Greek and Roman discoveries but did not try to learn any more. Dissection was
carried out to show what Galen had said but not make new discoveries.
Dissection remained banned by the church until 1482 when the Pope said executed criminals could
be dissected. However, church still not keen on them. The Arab religious law banned human
dissection throughout the whole period. (Religion-Hindering)
Dissection were an important, but small, part of medical education in Italy and Spain. Universities in
Spain copied this in the 1500s.
At University Physician told surgeon what parts of body to dissect and read Galen’s book to explain
what was happening. Students just watched.
Believed Galen was correct as Church promoted his ideas and refused to allow anyone to challenge
him. (Religion/Attitudes-Hindering)
However, regular dissections were a step forward as they made it more likely someone would
challenge Galen.
Were some new ideas among Arab doctors. Ibn al-Nafis investigated anatomy of the heart and
challenged Galen. Galen had said blood moves through invisible channels in the heart whereas alNafis said did not exist and said blood moves from heart to lungs and back so circulates. Idea was
correct but nobody built on it in Europe. (Individual Genius-Helping)
Revision Cards
Medieval surgery
1. Who would have conducted simple surgical operations in medieval Europe?
Barber-surgeons
2. Why was a surgeon considered to be lower in status than a physician?
You didn’t need to attend university or medical school and you often used tools like a craftsman
would
3. When did dissection of corpses begin in Europe?
In the 1300s
4. Who could conduct dissections?
Assistants – not the students in medical schools themselves
5. Why was surgery still rare?
Poor equipment, little pain relief, problems with infection & blood loss
6. What did John of Arderne recommend surgeons should use for pain reliefe in the fourteenth
century?
Opium and hemlock – a poison!
7. Who was the most famous author on medieval surgery?
Guy de Chauliac
8. What was the name of his book?
Chirugia Magna – the Great Book of Surgery
9. Who was the first documented woman surgeon in this country?
Katherine, a surgeon in London in 1250
10. How many physicians were there in England in the 1300s?
Fewer than 100
11. Why were there few advances in anatomy in this period?
People didn’t want to challenge Galen; the Church controlled access to training and knowledge in its
medical schools and libraries
12. What was the most common surgical procedure in the Middle Ages?
Bleeding using a bleeding cup
13. Who was John Bradmore
The king’s surgeon who removed an arrow from the face of Henry, Prince of Wales after the battle
of Shrewsbury (1403)
14. Why did surgeons challenge Galen about pus?
Galen thought pus was good because it carried away disease, but medieval surgeons thought it
was best to keep wounds clean
15. What did Hugh and Theodoric of Lucca suggest should be used to keep wounds clean?
Wine and honey
16. Where did they get many of their ideas?
Working as surgeons on Crusade
Renaissance (1500-1750)
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During Renaissance, due to large number of people dead during Black Death, people demanded
higher wages and more spent on education.
Renaissance means ‘rebirth’ or ‘revival of learning’. Focused on ideas of Greek and Romans again
and wanted to learn. (Attitudes-Helping)
Looked carefully of ideas of Galen as worried that Middle Ages may have translated them wrong as
thought people Middle Ages ignorant. Published new editions of Galen’s books.
Based themselves on the Greeks who loved enquiry and began challenging old ideas. Began to
realise Galen had made mistakes. (Attitudes-Helping)
However, not everyone agreed with these new ideas and continued to believe the old ones.
(Attitudes-Hindering)
Surgery
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
Development of canons and guns on battlefields meant there were new types of wound which
needed dealing with. (War-Helping)
Printing press invented by Johannes Gutenberg in 1450s. This helped the spread of high quality
books. (Technology/Communication-Helping)
Richard Wiseman was Surgeon to Charles Ii – published A Treatise on Wounds in 1672 and other
books. Used a mixture of old ideas of Hippocrates and Galen focusing on diet and herbal remedies
but also the new ideas of Pare and developed new treatments.
Ambroise Pare (1510-1590)
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Learned surgery as an apprentice to his brother, then worked at Royal Hospital in Paris. From 1536
spent 20 years as army surgeon and then became surgeon to French Kings.
Wrote ‘Ten Books on Surgery and Apology and Treatise’. The printing press spread Pare’s ideas
more quickly and widely than they would have been in the Middle Ages. (Individual
Genius/Communication-Helping)
Prior to Pare had been no major breakthroughs in surgery. Wounds treated by pouring boiling oil
onto them to kill the poison or ramming an oil-soaked cloth into the wound and binding it up. Both
very painful. Open wounds and amputations were closed by putting a red-hot iron called a cautery
onto the wound to seal the blood vessels – again very painful.
Pare was determined, intelligent and willing to try new ideas. He didn’t give in to critics who said
new ideas were mistaken. He was willing to learn for himself rather than just using old books – this
reflected Renaissance attitudes. (Individual Genius/Attitudes-Helping)
Pare changed the treatment of gunshot wounds. Replaced boiling oil with his own mixture of egg
yolks, oil of roses and turpentine. Pare only tried his new remedy for gunshot wounds when he ran
out of boiling oil so it was a bit of luck! (Individual Genius/Chance-Helping)
He used ligatures to stop bleeding – silk threads tied around individual blood vessels. He called
cauterising ‘old and too cruel’. He designed new technology called a ‘crows beak’ to clamp the
artery (Individual Genius-Helping)
He designed and arranged the making of false limbs for wounded soldiers and included drawings of
them in his books to spread ideas. (Individual Genius-Helping)
War helping him make these discoveries as he had plenty of practice and opportunities to try new
methods. (War-Helping)
Important for the future as his ideas were translated and became widely known, he encouraged
surgeons to think for themselves and try new methods, he showed improvements were possible and
ligatures did stop bleeding.
However, stopping bleeding with ligatures was slow and wasn’t quick enough in the chaos of war.
Ligatures were also dangerous as they could carry infection deeper into a wound (a better antiseptic
was needed to stop this) and there were still other major discoveries to make in surgery with
regards to antiseptics and anaesthetics.
Anatomy

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
Big focus on drawing and art in Renaissance by skilled artists such as Leonardo da Vinci. Focused
on understanding muscles, tendons, bones and movement of the body. Even artists were carrying
out dissections.
Also, first effective microscopes developed by Hooke and van Leeuwenhoek that allowed people to
study anatomy more carefully. (Technology-Helping)
Printing press invented by Johannes Gutenberg in 1450s. This helped the spread of high quality
books. (Technology/Communication-Helping)
Andreas Vesalius (1514-1564)
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Vesalius studied medicine in Paris and Italy and became Professor of Surgery in Padua, Italy.
Vesalius was inventive and determined and stole body’s to carry out his work. (Individual GeniusHelping)
Wrote ‘The Fabric of the Human Body’ in 1543 which was the first detailed and fully illustrated
description of human anatomy. This book spread around the world. The cover of the book showed
Vesalius carrying out a dissection himself – showing he felt doctors should do it rather than just
watching.(Individual Genius/Communication – Helping)
First person to challenge Galen’s description of anatomy – believed vital to ask questions. Proved
that human jaw bone made up from one bone, not two as Galen said. Said breastbone has three
parts, not seven as Galen said and that blood does not flow into the heart through invisible holes in
the septum. (Attitudes/Individual Genius-Helping)
Made great use of the printing press. Used best printer and supervised engraving of illustrations and
printing himself. Able to get same copies of book with no mistakes. Used all over Europe.
(Technology-Helping)
Important for future as focused on enquiry and change, showed more to be learnt, built up clear
picture of anatomy and his book and attitude spread.
However, many doctors refused to accept that Galen could be wrong. Vesalius heavily criticised
(Attitudes-Hindering)
Also, limited impact as nobody immediately healthier due to Vesalius’s work.
William Harvey (1578-1657)
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Studied medicine at Cambridge and Padua in Italy. Worked as a doctor in London. Became doctor
to King Charles I.
Published his book ‘An Anatomical Account of the Motion of the Heart and Blood’ in 1628 which
described how blood circulates around the body. (Individual Genius/Communication-Helping)
Challenged Galen’s idea that blood manufactured in liver to replace burned up blood and that blood
passed from one side of the heart to the other through invisible holes.
Built on the ideas of Realdo Columbo who in Renaissance said blood moved along veins and
arteries and Fabricus who was Harvey’s tutor at Padua and proved there were valves in the veins.
(Individual Genius-Helping)
Harvey proved the heart acts a pump, pumping blood around the body by:
1. dissecting live cold-blooded animals who hearts beat slowly so he could see the movement of
each muscle in the heart
2. dissecting human bodies to built up knowledge of the heart
3. proved the body was a one-way system by trying to pump liquid past valves and failing to do so
4. calculating that the amount of blood going into arteries each hour was three times a man’s
weight which showed it was being pumped around. (Individual Genius-Helping)
Helped by mechanical water pumps in London which may have given Harvey idea that heart is
pumping blood. (Technology-Helping)
Focused on careful dissection, observation and experiment. Spent hours repeating experiments and
going over details. Change of attitudes in Renaissance. (Individual Genius/Attitudes-Helping)
Big impact on future as laid groundwork for future investigations, improved a vital area and showed
the importance of carrying out dissection and challenging Galen.
However, could not explain everything about circulation of blood. Did not know about capillaries and
discovered in 1600s by Professor Marcello Malphigi.
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
Harvey’s ideas were only gradually accepted. Many thought he was mad and ignored his theory as
he challenge Galen (Attitudes-Hindering)
Also, was still a lot more to discover about the blood (e.g. blood groups) and his discovery did not
make anyone better.
Revision Cards
Surgery and Anatomy
1. What does Renaissance mean?
Revival of learning – focus on education and new ideas. Led to questioning of Galen’s ideas.
2. Which technological developments in this period were important in developing surgery?
Microscope (allowed greater investigation of anatomy), gunpowder (lead to new injuries for
surgeons to deal with), printing press invented by Johannes Gutenburg (allowed for the wider
and quicker distribution of ideas)
3. Where did Andreas Vesalius study and later become a Professor of Surgery?
Padua
4. How did Vesalius carry out his initial dissections and show his commitment?
Stole the body of a criminal from the gallows to dissect.
5. What was the name of his book which included the first detailed and fully illustrated
description of human anatomy?
Fabric of the Human Body (1543)
6. Which of Galen’s mistakes did he prove wrong?
Over 200 including that the human jaw bone had one bone, the breastbone has three parts not
seven and blood does not through holes in the septum.
7. Which group of people were very important in developing anatomy?
Artists who attended dissection and carried out detailed illustrations.
8. Who published ‘An anatomical account of the motion of the heart and blood’ in 1628?
William Harvey
9. Which idea did Harvey prove wrong?
That blood was constantly manufactured in the liver to replace blood burned up and that there
were holes in the Septum.
10. How did Harvey discover that the heart acted like a pump?
Dissected live cold-blooded animals whose hearts beat slowly, dissected human bodies, tried to
pump liquid past valves in veins and couldn’t do so – showed one way system.
11. What technological developments may Harvey have got his ideas from?
Mechanical water pumps.
12. Professor Marcello Malphigi discovered what which Harvey had failed to?
Capillaries and their role in transferring blood from veins to arteries.
13. Which individual was born in 1510 and died in 1590 and worked at the Royal Hospital in
Paris?
Ambroise Pare
14. What was the name of Pare’s books?
Ten Books on Surgery and Apology and Treatise
15. What method had previously been used to seal wounds?
Cauterisation
16. Gunshot wounds had previously been treated by pouring boiling oil onto them. How did
Pare change this?
Used a herbal remedy instead made of egg yolks, oil of roses and turpentine.
17. How did chance play a role in this discovery?
Only tried a new remedy because he ran out of boiling oil.
18. What were Pare’s other two key discoveries in this period?
Ligatures (silk threads to tie around individual blood vessels) and false limbs.
19. What was the problem with ligatures which meant they were often not used?
Dangerous as could spread infection and much slow than cauterisation – needed speed
particularly during battle.
20. Why did these individuals not have a significant impact in the short term?
21. Many people were very resistant to their new ideas
Industrial Period (1750-1900)/Nineteenth Century (1800-1900)
Surgery

In 1750-1800 poor conditions for surgery. No anaesthetics so patients held down – focus on speed in
surgery which led to accidents e.g. Napoleon’s surgeon amputated 200 limbs in 24 hours. No
knowledge of germs so dirty environments – surgeons wore own clothes and no antiseptics. Big
problems with infections – in hospitals death rates between 25% and 50% after amputations from
infections. Also, no way of stopping bleeding effectively as ligatures could spread infection and no blood
transfusions. Limited types of surgery could do – little internal surgery and mainly amputations.
Development of anaesthetics
What types of anaesthetics were there?
1. Laughing gas/nitrous oxide discovered by Humphry Davy 1799. Helped by improvements in chemistry –
realised chemicals had an effect on human body. This reduced pain but did not make patients
unconscious. (Science/Individual Genius-Helping)
2. Ether used from 1847 which was first used by J. R. Liston. However, ether irritated eyes and lungs –
causing coughing and sickness. It could also catch flame and smelt bad. It also came in a large heavy
battle that was hard to carry around. (Individual Genius-Helping)
3. Chloroform discovered by James Simpson of Edinburgh University in 1847. Experimented with different
chemicals to see effects as an anaesthetic – realised chloroform was very effective. Other surgeons
started to use it. However, did lead to sickness and bad taste. Could also result in death as could not
control dosage. (Individual Genius-Helping)
4. Controlling dosage of chloroform was helped by John Snow when he invented an inhaler to control the
dosage (Individual Genius-Helping)
Why was there opposition?
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Typical opposition to new ideas due to conservative attitudes and the following reasons (AttitudesHindering)
Chloroform was a new and untested gas – noone knew for sure if there would be long term effects on
bodies or minds. Not sure what dosage to give.
1848 Hannah Greener died while being given chloroform during operation to remove toenail. Scared
surgeons and gave opponents evidence of danger.
Anaesthetics did not necessarily make surgery saver – doctors attempted more complex operations
which carried infections deeper into the body and caused more loss of the blood. The number of people
dying from surgery increased known as the ‘Black Period’ (1 in 2500) which concerned some soldiers
who returned to using ether.
People were against pain relief and believe that pain was natural because God wanted it.
Some were opposed to easing the pain of childbirth – believing it was a natural part of life.
People in the army thought it was natural for soldiers to suffer pain.
Why was opposition overcome?
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Anaesthetics gradually accepted and James Simpson key role in this. He used chloroform regularly and
showed doctors how to use it safely. (Individual Genius-Helping)
Queen Victoria allowed John Snow to use chloroform during the delivery of her eighth child (1853), as
did Charles Dickens wife, so the most powerful woman in the world supported it – meaning opposition
to anaesthetics was doomed.
Use of anaesthetics improved as they found ways of relaxing muscles as well as putting patients to
sleep. New chemicals had fewer side-effects than chloroform. Local anaesthetics develop as well as
general anaesthetics but chloroform started the process. (Science and Technology/Helping)
Development of antiseptics
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Had previously used liquids such as wine and vinegar to keep wounds clean as before Germ Theory
had no idea what was causing infection in open wounds. Did not wash hands, reused bandages, did not
sterilise equipment and wore dirty clothes (Science-Hindering)
Ignaz Semmelweiss
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Semmelweiss was concerned about the deaths of healthy women after childbirth. Noticed that women
whose babies were delivered by midwives were much less likely to die that those delivered by medical
students. (Individual Genius-Helping)
He recommended washing their hands in a basin of chlorinated water to reduce risk of infection and
called doctors who did not wash it ‘murderers’.
However, he had little support and no-one built on his ideas. People thought he was a crank and a
fanatic (Attitudes-Hindering)
Joseph Lister
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Joseph Lister had researched gangrene and infection and had a keen interest in the application of
science in medicine. He used the ideas of Pasteur and Germ Theory which helped to spark his
discovery. (Individual Genius/Science – Helping)
Came up with idea by noticing that carbolic acid had an effect on sewage and prevented smells. He
experimented with using carbolic in treating people who had fractures where bone broken through skin.
Applied carbolic acid to the wound and used bandages soaked in carbolic to help the wounds heal.
Death rates dropped from 45.7% to 15%. (Individual Genius-Helping)
People began washing hands with carbolic acid and a carbolic spray to kill germs in the air was placed
around the operating table.
1880 he started the use of antiseptic ligatures in surgery made from catgut.
In long term other doctors built on ideas as hospitals became cleaner places and longer and more
complicated surgery.
Why was there opposition to antiseptics?
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Again, people’s conservative attitudes meant they were reluctant to accept new ideas. (AttitudesHindering)
Lister’s carbolic spray seemed very extreme as it cracked the surgeon’s skin and made everything
smell. Made operations more expensive and less pleasant for surgeons.
Surgeons were still convinced that speed was important because of the problem of bleeding and
antiseptic sprays slowed it down.
When surgeons copied Lister’s methods they did not achieve the same results as they were not as
careful.
Some argued that antiseptics slowed down the body’s own defence mechanisms.
Pasteur’s ideas spread very slowly and many did not accept the idea of germs.
For many centuries surgeons had lived with idea that patients would die and many felt defensive that
Lister had said they could have been saved.
Lister was not a showman like Pasteur and seemed cold, arrogant and aloof and sometimes criticised
other surgeons.
Lister was always changing his techniques because he wanted to find a substance as good as carbolic
spray but without the corrosion. People said that because he was changing his methods they did not
work.
What further improvements were there in preventing infection?
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1878 Koch discovered bacterium which caused bacterium or blood poisoning. Showed it was important
to kill the germs
By late 1890’s aseptic surgery had developed – meant removing all germs from the operating theatre
and hospitals, steam-sterilised instruments (from 1887), surgical gowns and face masks and from 1894
sterilised rubber gloves were used for the first time (William Halsted developed a skin infection from
chemicals used to disinfect hands so William Halsted, chief surgeon, arranged for Goodyear Rubber
Company to make a thin paid of rubber gloves).
Led to more ambitious operations – infected appendix removed in 1880s and first heart operation in
1896. Doing more complex and deeper surgery as less chance of infection.
Anatomy
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No further developments as aware of the ideas of Vesalius which summarised all knowledge about the
body and blood vessels and capillaries already discovered. Not good enough technology yet to discover
DNA.
Revision Cards - Antiseptics
1. What is the difference between an antiseptic and an anaesthetic?
One kills germs the other kills pain
2. What is asceptic surgery?
One in a sterile environment
3. What was the name of the Hungarian doctor who first urged midwives and nurses to keep
their hands clean?
Ignaz Semmelweiss
4. What were his dates?
1818-1865
5. What is the name of the infection that many women caught after giving birth?
Puerperal fever
6. Who urged the use of a special spray to keep operating spaces completely clean?
Sir Joseph Lister
7. What was the name of the spray he used?
Carbolic spray
8. Why did some doctors resist the use of carbolic sprays?
Messy, unpleasant to breathe, the acid caused skin to crack
9. How much did the use of carbolic spray reduce death rates by?
From about 50% to 15%
10. Who first suggested using sterile rubber gloves in surgery?
William Halsted
Anaesthetics
1. What was popularly used as an anaesthetic before the nineteenth century?
Opium, alcohol or mandrake
2. What did Humphry Davy use in 1799?
Laughing gas or nitrous oxide
3. Why was ether rejected as a form of anaesthetic?
Irritant and explosive
4. What alternative to ether did Dr James Simpson test out on himself?
Chloroform
5. What were the problems with choloform?
Difficult to get the dosages right, also caused liver damage
6. Which famous person used choloform in childbirth, making it popular with the British public
Queen Victoria for the birth of her eighth (out of nine) child, Prince Leopold
7. Why did some people object to the use of chloroform in childbirth?
They thought it unnatural and that women should suffer. They gave examples from the Bible to
illustrate the necessity of pain in childbirth
8. Why did deaths increase between 1846-1870 with the introduction of chloroform?
Surgeons attempted more complex surgery, which led to blood-loss and infection
9. What is this period often known as?
The ‘Black Period’
Twentieth Century (1900-2000)
Surgery
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More pressure due to World War 1 and World War II. Millions wounded, surgeons given opportunity to
experiment with new techniques (head wounds particularly common) and many surgeons who learned
their skill quickly in wartime worked as specialist surgeons after war. (War-Helping)
Date
1895
Development
Wilhelm Rontgen discovered x-rays which could pass through flesh. Within months x-ray
machines being made. (Science and Technology/Individual Genius-Helping)
World War I increased need for x-rays as needed to locate bullets and shrapnel lodged
deep within wounded men and x-rays helped this. (War-Helping)
Governments ordered the making of many more x-ray machines during the war for the
fronts (Government-Helping)
1901
1906
1932
1939-1941
Marie Curie persuaded the government to pay for mobile x-rays machines that could move
around the battlefronts called ‘petite Curies’. (Individual Genius-Helping)
Karl Landsteiner discovered the existence of blood groups which then made blood
transfusions possible. (Individual Genius-Helping)
Previously stored blood clotted and could not be used. During World War One there was a
huge need for blood. Sodium citrate began to be used in stored blood to prevent clotting
and scientists then discovered how to separate and store crucial blood cells. This allowed
the development of blood banks during World War II. (War/Science – Helping)
Radiation therapy (radiotherapy) discovered by Marie Curie. They noticed that skin on
hands burned by material handling when researched x-rays. Discovered radium which
used to diagnose cancers and in radiotherapy. (Individual Genius/Science– Helping)
Helmuth Wesse developed anaesthetics that could be injected into the blood stream,
allowing more precise control of doses and safer and longer operations. Local and general
anaesthetics could now be used depending on the need of the operation. (Individual
Genius/Science – Helping)
Surgeons learnt to cut away infected tissue and protect body with a saline solution as an
antiseptic.
Development of penicillin in World War II allowed to fight infection successfully.
World War I
and World
War II
World War I and II introduced need for new solutions to wounds. Wounds deep and bullets
carried infection further. (War – Helping)
Terrible injuries of World War I and World War II led to rapid improvements in plastic
surgery and skin grafts due to bullet and shell damage. Surgeons carried out 11,000
operations giving more experience and they learnt from each other(War-Helping)
Archibald McIndoe carried out 4,000 operations in World War II and had been inspired by
his cousin Harold Gillies who carried out plastic surgery in World War I. In 1938 he became
Consultant in Plastic Surgery to the Royal Air Force and he reconstructed faces and
hands. He also helped patients’ psychologically to deal with changes in appearance –
setting up The Guinea Pig Club to allow them to socialise with other burn victims.
(Individual Genius-Helping)
1967
Christiaan Barnard (1922-201) became famous for carrying out the world’s first heart
transplant in 1967 with his doctors, nurses and scientists. The patient died 18 days later
but a lot was learnt from it.
Other transplants carried out (kidneys in 1954, Liver in 1963, bone marrow 1980, heart and
lung 1982) used improved technology and scientific understanding. (Science and
Technology – Helping)
1980s/1990s
Drugs developed to stop body rejected organs and ‘tissue-typing’ used to match organs to
people (Science-Helping)
Improvements in technology has allowed key-hole surgery to take place which means a
small incision is made to do operations. Instruments such as endoscopes and fibre-optic
cables make this possible. (Technology-Helping)
Micro-surgery has developed because of technology with surgeons able to rejoin blood
vessels, nerves and reattach severed limbs. (Technology-Helping)
Anatomy
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Discovery of DNA took place. In 1800s scientists knew DNA existed and understood it influence what
we look like but did not know how (Science-Hindering)
In 1953 two scientists in Cambridge, Francis Crick and James Watson, discovered the structure of
DNA. They were great scientists and very adventurous in their ideas.They proved it was in every human
cell and that it passed on information from parents to children. Each gene controls a different function
and each human has slightly different instructions (Individual Genius-Helping)
They were helped by a team of scientists with skills and knowledge (Wilkins was an expert in X-Ray
photography and Franklin photographed a single strange of DNA). Also supported by government and
industries who helped pay for their research equipment and team. (Government-Helping)
Crick and Watson had the latest and best equipment, using new technologies such as X-ray
photography and improved microscopes. They used improvements in genetics and biochemistry to help
them. (Science and Technology-Helping)
The complete set of genes in a living creature is called a genome. In 1986 the Human Genome Project
set out to identify the exact purpose of each gene in the human body – completing a map of human
DNA. This was completed in 2001 and 18 countries had been involved.
Current stories about whether genetic engineering could take place to choose nature of a child by
choosing their DNA or whether genetic screening or testing should take place to identify illnesses
people could suffer from and prevent them before they happen.
Revision Cards
Twentieth Century Surgery
1. Why were the First and Second World War important in improving surgery?
More experience for surgeons, more severe wounds (including broken bones) including eye, ear,
nose and throat. Infections were carried deeper into wounds (and problems with dirty conditions)
and x-rays improved on and in greater demand to find bullets and shrapnel.
2. How did war hinder developments in the First World War?
Stopped medical research and 14,000 doctors taken away from normal work.
3. What did Wilhelm Rontgen discover in 1895?
X-rays
4. Who enhanced these discoveries and developed radiotherapy?
Marie Curie (used to treat cancer)
5. What was discovered in 1901?
Blood groups by Karl Landsteiner
6. How were transfusions improved during World War II?
Previously required on-the-spot donors. Now discovered way of separating blood plasma so it could
be used more effectively.
7. What new methods were used to deal with infection?
Cutting away infected tissue and use of saline solution
8. What techniques did McIndoe and Gillies focus on?
Plastic surgery and skin grafting (dealing with the number of burns caused during the war)
9. How did anaesthetics improve in the twentieth century?
Able to inject them directly into blood stream and further control dosage – developed by Helmuth
Wesse.
10. What were production during this period which helped to reduce chances of infection?
Antibiotics
11. What first transplants were carried out in 1954 and 1963?
Kidneys in 1954 and liver in 1963.
12. What did Dr Christiaan Barnard carry out in 1967?
The first heart transplant
13.
What key transplants have been carried
out since then?
Bone marrow (1980) heart and lung transplant (1982)
14.
What had initially hindered the use of
transplants?
Needed drugs to stop the body rejecting organs.
15. Which type of surgery meant that smaller incisions were required?
Keyhole surgery – using fibre optic cables and computers as technology improved.
16. What type of surgery has made it possible to rejoin nerves and small blood vessels?
Microsurgery
Individuals
Who was the Greek god of healing?
Asclepius
Who was Panacea?
The daughter of Asclepius, the Greek god of healing (it’s also the name for a drug which cures all illnesses
Who was born in Cos around 460BC?
Hippocrates
Who was the pioneer of the Theory of the Four Humours?
Hippocrates
Which Arab doctor of the Middle Ages wrote a million-word textbook covering all aspects of medicine?
Avicenna (also known as Ibn Sinna
Who wrote ‘The Fabric of the Human Body’?
Vesalius
Where was Andreas Vesalius born and where did he travel to?
He was born in Brussels, and travelled to Italy
What was the name of the famous Paris hospital, run by the Church where Ambroise Paré trained to be a
surgeon?
Hotel Dieu
Which famous local celebrity was born in 1578 in Folkestone
William Harvey
Which military surgeon treated wounds with turpentine and sealed amputations with silk ligatures?
Ambroise Paré
Who first thought that disease attacks the body from the outside rather than within?
Paracelsus
What was the name of Charles II’s surgeon?
Richard Wiseman
Who first developed a vaccine for smallpox using cowpow?
Edward Jenner
What was notable about Elizabeth Garret?
She was the first woman to qualify as a doctor in Britain
Who was the author of ‘Notes on Nursing’?
Florence Nightingale
When did Pasteur publish his ‘Germ Theory’?
1861
Who developed the carbolic spray for use in surgery?
Joseph Lister
Who described doctors that didn’t wash their hands as ‘murderers’?
Ignaz Semmelweiss
Which German scientist Identified different bacteria using stains and cultivating them on Petri dishes
Robert Koch
Who made a connection between cholera and a water pump in Broad Street, London seven years before
the publication of Germ Theory?
Dr John Snow
Whose laboratory can be found at St Mary’s hospital, London?
Alexander Fleming
Who wrote a report in 1942 proposing free national health care?
William Beveridge
Who pioneered the use of heart transplants in the twentieth century?
Christian Barnard
What was the name of Charles II’s surgeon?
Richard Wiseman
Who first developed a vaccine for smallpox using cowpow?
Edward Jenner
What was notable about Elizabeth Garret?
She was the first woman to qualify as a doctor in Britain
Who was the author of ‘Notes on Nursing’?
Florence Nightingale
When did Pasteur publish his ‘Germ Theory’?
1861
Who developed the carbolic spray for use in surgery?
Joseph Lister
Who described doctors that didn’t wash their hands as ‘murderers’?
Ignaz Semmelweiss
Which German scientist Identified different bacteria using stains and cultivating them on Petri dishes
Robert Koch
Who made a connection between cholera and a water pump in Broad Street, London seven years before
the publication of Germ Theory?
Dr John Snow
Whose laboratory can be found at St Mary’s hospital, London?
Alexander Fleming
Who wrote a report in 1942 proposing free national health care?
William Beveridge
Who pioneered the use of heart transplants in the twentieth century?
Christian Barnard
What was the name of Charles II’s surgeon?
Richard Wiseman
Who first developed a vaccine for smallpox using cowpow?
Edward Jenner
What was notable about Elizabeth Garret?
She was the first woman to qualify as a doctor in Britain
Who was the author of ‘Notes on Nursing’?
Florence Nightingale
When did Pasteur publish his ‘Germ Theory’?
1861
Who developed the carbolic spray for use in surgery?
Joseph Lister
Who described doctors that didn’t wash their hands as ‘murderers’?
Ignaz Semmelweiss
Which German scientist Identified different bacteria using stains and cultivating them on Petri dishes
Robert Koch
Who made a connection between cholera and a water pump in Broad Street, London seven years before
the publication of Germ Theory?
Dr John Snow
Whose laboratory can be found at St Mary’s hospital, London?
Alexander Fleming
Who wrote a report in 1942 proposing free national health care?
William Beveridge
Who pioneered the use of heart transplants in the twentieth century?
Christian Barnard
Which British Lady wrote about the use of inoculation as a result of a her travels through Turkey where the
practice was used?
Lady Mary Wortley Montague
Which Poor Law commissioner wrote a report linking poverty and ill health?
Edwin Chadwick
Which Victorian engineer saved London by building a new sewage system after the Great Stink of 1858?
Sir Joseph Bazalgette
Which Jamaican nurse set up a ‘British Hotel’ to provide food and shelter for troops during the Crimean
War?
Mary Seacole
Who was Paul Ehrlick?
The man who discovered the first magic bullet, Salverson 606
Why should we remember Florey and Chain?
They discovered ways of mass producing penicillin
Who first discovered X-Rays?
Wilhelm Röntgen
Who first discovered the element radium, which was later used to treat diseased cells?
Marie Curie
Who wrote ‘A Report on the Sanitary Conditions of the Labouring Population’?
Edwin Chadwick
What was William Farr’s contribution to better public health?
After 1837, data on births, deaths and marriages had to be recorded. He used this to work out where and
why people were dying.
Who made the link between cholera and infected water?
Dr John Snow
Who helped to persuade the government to pass the ‘Artisans Dwelling Act, 1875’ giving councils the
power to know down slum housing
Octavia Hill
Whose ‘Germ Theory’ published in 1861 gave scientific evidence of the dangers of poor sanitation?
Louis Pasteur
What did Sir Joseph Bazalgette do following the Great Stink of 1858?
Built a new sewage system for London
Who produced a detailed study of poverty in York at the turn of the twentieth century?
Seebohm Rowntree
What did Charles Booth produce in 1886, that helped tackle poverty?
A colour-coded map showing the poorest regions of East London
Which British PM introduced the National Insurance Act, 1911?
David Lloyd George
Who produced a report, selling 600,000 copies, on how to improve Britain’s health service when WWII was
over?
William Beveridge
Who was Nye Bevan?
Labour health minister who helped introduce the NHS in 1948