History Paper 1 — 16 markers

'There was little progress in understanding the cause of disease in the years C1250-C1700.’

How far do you agree? Explain your answer.

P: (for) unchallenged authority of church + ancient theories

E: most physicians remained strictly loyal to the Theory of 4 Humours created by H + C; King Charles II diagnosed using them in 1685

E: Belief in miasma + divine punishment persisted throughout the 1348 Black Death and 1665 Great Plague; plague doctors wore bird-like masks containing sweet-smelling herb at hawk to ward off harmful fumes

P: Rise of humanism + experimentation

E: Andres Vesalius, a doctor who studied medicine at Paris and Padua universities published OtFotHB (1543) which included detailed drawings to prove Galen wrong on >300 anatomical errors using dissections on executed criminals

E: William Harvey, a royal doctor for King James I and his son Charles I, published AAAotMotHaBiA (1628) proving that blood was not produced in the liver and consumed by the body but flowed in a continuous one way system pumped by the heart. Used ligature experiments on cold-blooded animals

P: Birth of modern diagnosis

E: Thomas Sydenhamm a well-respected doctor in 1660s-70s treated patients based on physical observations of their symptoms rather than old ideas. Observationes Medicae (1676) suggested that diseases could be grouped like plants and animals can

E: Royal Society (info abt that) helped spread new medical ideas e.g Antonie van Leeuwenhoek’s discovery of tiny organisms called ‘animalcules’ using early microscopes in 1676

'In the years c1800-present, the work of Pasteur was the most significant development in understanding the causes of illness!

How far do you agree? Explain your answer.

(16)

You may use the following in your answer:

• Germ Theory

DNA

You must also use information of your own.

P1: (for)

E: LP published Germ Theory (1861) where he used microscopes, flasks and other instruments to prove that microbes in the air caused disease, not spon. gen.

E: developed by Robert Koch who developed a method to Identify and isolate specific microbes that caused disease using agar jelly and dyes e.g TB (1882), anthrax (1876), cholera (1883)

P: significance of DNA/genetic research

E: Watson and Crick (1953) using data from Rosalind Franklin discover the structure or DNA as a double helix, opening door for modern genetic research

E: led to Human Genome Project (completed 2003) which mapped every gene in the body and their purpose, allowing for the identification of genetic markers for conditions like cystic fibrosis and breast cancer

P: Lifestyle / preventative understanding

E: Doll and Hill (1950) proved the link between smoking and lung cancer using statistical evidence, leading to gov. Ban on smoking in enclosed public spaces in 2007

E: modern advanced diagnostic tech e.g MRI and CT scans (developed in 1970s) allowed doctors to see internal damage and warning signs caused by lifestyle factors (e.g obesity, CHD) before symptoms appeared, allowing for early intervention

'The work of Thomas Sydenham was the key turning point in medicine in the years c1500-c1700!

How far do you agree? Explain your answer.

(16)

You may use the following in your answer:

• Sydenham's Observationes Medicae (1676)

• the Four Humours

You must also use information of your own.

P: Thomas Sydenham and clinical observation

E: in Observationes Medicae (1676), S argued that doctors should treat patients based on the physical observations of their symptoms, regarding the disease as an entity entirely separate from the person

E: S advocated for humanism and independent research. He rejected Galen’s ToO ands instead insisted on recording clinical observations. Suggested diseases could be grouped like plants and animals, leading to him correctly identifying that scarlet fever and measles were two different diseases + variety of treatments like using cinchona bark from Peru for malaria

P:

'The advances in surgery made in the years c1700-c1900 were more significant than advances in surgery made in the period c1900-present.'

How far do you agree? Explain your answer.

P1: (for) solved two of three fundamental barriers of surgery

E: James Simpson (1847)

E: Joseph Lister (1665)

P: (disagree) advancements in blood and transplants

E: Karl Landsteiner different blood groups (1901) A, B and O and that blood transfusions would only work if the blood used was compatible

E: (1954) firstsuccessful organ transplant performed on kidney of identical twins. (1867) first heart transplant performed by surgeon Christiaan Barnard

P: High-tech surgery techniques

E: developmet of endoscopes and fiber optics led to laparoscopic (keyhole) surgey in 1980s, using small incnisons and cameras to reduce recovery times

E: computer-assisted tech such as Da Vinci robotic surgery provided surgeons with 3D maginification and mechsnical precison tools to operate on areas like the prostate or heart wiht minimal nlood loss

'The main reason why medical care and treatment was ineffective during the edieval period, (1250-c1500, was because medical knowledge was based on Galen's ideas!

How far do you agree? Explain your answer.

(16)

You may use the following in your answer:

• Theory of Opposites

• hospitals

You must also use information of your own.

P: (for) Galen’s Theory of Opposites

E: medical treatment based on ToO, aiming to correct and balance the four humours of the body, BB, YB, P, B. e.g a ‘cold’ illness caused by excess phlegm was treated with ‘hot’ substances like eating pepper or giniger. Did not adress viral / bacterial cause = clinically ineffective

E: G’s anatomical knowledge based on animal dissections e.g pigs and apes leading to errors such as belief human jaw = 2 bones not one. Meant physicians performed blood letting based on incorrect venous maps = weakening patients further e.g in Black Death (1348)

P: influence and monopoly of the Church

E: promoted idea that illness was a punishment from God / test of faith, leading to non-medical treatments like self-flagellation, prayer and pilgrimages to shines like St Thomas Becket’s in Canterbury. Took priority over physical medicine.

E: Church controlled universities and medical training. Physicians required to study for 7-10 years at universities where they were only allowed to read works of H + G. Independent research was forbidden; e.g Roger Bacon (1214-92) was imprisoned for encouraging physicians And scientists to carry out their own research

P: Purpose and scientific limitations of Medieval hospitals

E: Medieval hospitals e.g St Bartholomew’s in London focused on care rather than cure. Most run by monks and nuns who provided food, prayer and nursing. Only 10% of hospitals actually cared for the sick

E: zero knowledge of germ theory; without microscopes, physicians blamed miasma. (1348 Black Death) Lord Mayor of London ordered streets to be cleaned of “filth and excrement” to stop smell, but because they didn’t understand flea-rat-bacteria link, mortality rate remained at 30-50% of pop.

"Providing access to care and treatment has been the most important development in the role of government in medicine in the years c1800-present' How far do you agree? Explain your answer.

You may use the following in your answer:

• National Health Service (NHS), 1948

Public Health Act, 1875

You must also use information of your own.

P: NHS and removal of wealth barrier

E: pre 1948, National Insurance Act (1911) only covered workers, leaving women, children and the elderly without care. NHS Act (1948) provided care that was free at the point of use for all 45 mil. UK citizens regardless of income

E: led to immediate improvements in health. In NHS first year, it provided 8.5 mil pairs of glasses and >5.5 mil prescriptions per month

P: shift to prevention via public health

E: Great Stink (1858) caused by unusually hot summer exacerbated smell of human waste in the River Thames. Led to Joseph Bazalgette funding an 82-mile network of intercepting sewers, preventing waste from dumping into Thames near drinking water inlets

E: following 1848 PHA and Great Stink, 1875 PHA = first time gov took compulsory responsibility for env. Forced local authorities to provide clean water, sewage disposal, food quality checks, public parks, new houses

P: Mass vaccination and modern lifestyle campaigns

E: NHS introduce mass screenings for potential diseases e.g for breast and cervical cancer (1988). Gov also carry out national vacc. programmes dor diphtheria (1942) and polio (1950), essentially eradicating these diseases

E: initiatives like Change4Life (2009) and 5 A Day (2003) encouraged healthy diets to tackle obesity crisis. Following Doll and Hill’s discovery of link between smoking and lung cancer (1950), Stoptober, graphic health warnings on cig packs and 2007 smoking in enclosed public spaces ban ensue

'The printing press led to significant progress in medical knowledge and treatment in the years c1500-c1700!

How far do you agree? Explain your answer.

(16)

You may use the following in your answer:

Vesalius' book, The Fabric of the Human Body

• herbal remedies

You must also use information of your own.

P: Spread of knowledge

E: invented in c1440 by J Gutenberg, by 2500 there were hundreds in Europe. Allowed the quick reliable circulation, e.g allowing V too publish otFotHB which used incredibly intricate and detailed drawings. Before, medical books hand-copied by monks leading to errors and censorings

E: Royal Society (Knowledge dump) used the press to publish first scientific journal Philosphical Transactions in 1665; allowed discoveries like Antonie van Leeuwenhoek’s animalcules to be shared and peer-reviewed instantly

P: (gegen) printing press just a tool; Roel of individual genius

E: Andreas Vesalius (knowledge dump) carried out his own human dissections and proved Galen made >300 errors (e.g human jaw bone)

E: William Harvey (knowledge dump) published AAAotMotHaBiA (1628), using ligature experiments on cold-blooded animals to prove blood circulated through the body continuously and pumped by the heart

P: (gegen) continuity in treatment

E: most people still used herbal remedies and ‘the Great Herbal’ (1526); these were passed down through generations and focused primarily on Galen’s ToO

E: During Great Plague (1665), ppl used quack remedies by quack doctors, carried pomanders to ward off miasma and fasting. Plague doctors wore bird-like masks w sweet-smelling herbs in beak

'In the years c1250-C1500, the physician was the most important person providing care and treatment!

How far do you agree? Explain your answer.

(16)

X

You may use the following in your answer:

• 

• 
  medical training herbal remedies

You must also use information of your own.

P: highly important for elite

E: studied for 7-10 years at church-run universities like Oxford/Cambridge, where they mastered Galen’s texts + To4H

E: recommended treatments based on urine charts, zodiac charts and vade mecum books to calc. perfect time for treatments e.g bloodletting

P: Importance of women for 90% of pop.

E: women, often apothecaries, provided bulk of herbal remedies, using plants like honey for throat infections and willow bark for pain

E: unlike physicians, women were free, accessible and had centuries of practical knowledge from mothers that often worked better than physician’s blood-letting

P: Hospitals and the Church

E: by 1500, approximately 1,100 hospitals in England. Staffed by monks and nuns, who focused on care not cure and spiritual welfare of victims

E: patients given clean bedding, clothes changing, nutritious food and spiritual support through prayer. Physicians rarely found in these hospitals, as Church prioritised soul over body and physicians treatment was very limited