GCSE HISTORY - HEALTH AND THE PEOPLE (facts)

What did Hippocrates develop that is still used today?

The Hippocratic Oath
Doctors promise to do their best to treat the patient and keep all information confidential.

What theory did Hippocrates develop?

The Four Humours

What four substances made up the Four Humours?

- blood
- phlegm
- black bile
- yellow bile

What did Hippocrates do differently to doctors of his time?

He developed the idea of clinical observation of the patient, rather than just the illness, taking a more holistic approach.

What theory did Galen develop?

The theory of Opposites
It concerned how patients could be treated using the four humours.

How did Galen study anatomy?

By dissecting animals such as pigs and monkeys, since in Ancient Rome dissecting humans was illegal.

What developments to anatomy did Galen make?

- he discovered that the brain controls speech (true)
- he believed that blood passed from one side to the other through tiny holes in the septum (false)
- he said that the human jaw was made up of two bones (false, it is made up of one)

What are some examples of medieval treatment?

- prayer
- astrology
- trepanning

What treatments did Hippocrates and Galen encourage doctors to use?

- bloodletting
- purging
- herbal remedies

What is an example of a treatment using Galen's theory of opposites?

- If you had a cold, you had a runny nose
- You would need to get rid of excess phlegm

What sort of treatment was provided by monasteries in the medieval period?

- a focus on making the patient comfortable in infirmaries
- treated by monks and nuns
- provided care for those in the local area
- treatments were based on prayer and herbal remedies

What sort of treatment was available to wealthy medieval people?

- a private physician who had been trained at a university
- they practiced the ideas of Hippocrates and Galen

How did the Church help medical progress in the medieval period?

- The Church was the only source of help to many people because it was free
- Monks copied out the works of Hippocrates and Galen. This helped preserve their work so it could be developed and challenged.

How did the Church hinder medical progress in the Medieval period?

- It limited the ability to challenge the theories of Galen, since he believed in one God.
- Many treatments were based on the belief that disease was caused by God, so prayer could treat any illness.

How did Islamic ideas progress medicine in the Medieval period?

- The Qur'an tells people that they have a duty to help those who are sick.
- As a part of the faith, Muslims have a duty to give money to charity. This money was used to build hospitals
- The faith also encouraged doctors to develop new treatments, unlike the Christian Church.
- Due to the Crusades, many European doctors travelled to the Holy Lands, where they picked up Islamic ideas on medicine

What were the achievements of Al-Razi?

- a doctor in modern-day Iraq
- helped plan the building of the first hospital in AD805
- he hung meat in different parts of the city and built the hospital in the area where the meat rotted the slowest
- he was the first person to discover the difference between smallpox and measles
- he wrote over 200 books, which were then translated into Latin and used in Europe

What were the achievements of Ibn Sina?

- a doctor and astronomer
- he wrote many books, the most famous being 'The Canon of Medicine', completed in 1025, which explored human anatomy, human developments, and natural treatments
- he was known as the first doctor to build on the ideas of Galen, not just copying them

What was trepanning?

- a procedure where a hole was drilled in the top of the skull
- this was thought to allow 'bad spirits' to escape
- most people died

What was cauterisation?

- used to stop bleeding
- it involved heating a piece of iron in a fire and pressing it onto a wound
- this would seal the blood vessels
- there was risk of a severe burn that would cause a lot of pain to the patient
- it could cause infection or death

What was medieval anaesthetic like?

- herbal mixtures
- opium or hemlock

What were toilets in Medieval London like?

- public toilets were built on London Bridge so waste was taken away from the city
- some toilets just emptied into the street
- wealthier individuals sometimes paid for their own toilets these led to a pit that would be emptied by a gongfermer. the waste was supposed to be taken outside the town or city walls. however, gongfermers would sometimes empty the waste into the river or dispose of it in another part of the town.

How did butchers spread waste in Medieval towns?

-they would dump waste they could not sell in the streets or the river. -- open drains ran down the middle of streets which washed waste down into rivers.
- if there was a dry summer, this waste would be left in the streets.
- the poor conditions attracted rats, which eventually contributed to the spread of the Black Death in the 14th century

How did councils try and clear waste from Medieval towns?

- punishments
- new towns

What were the symptoms of the bubonic plague?

bubonic plague caused large swellings called buboes under the armpits, on the neck and in the groin

How did the plague spread?

- Bubonic Plague - fleas on rats (ships from China)
- Pneumonic Plague - coughing and sneezing

What did medieval people think spread the plague?

- miamsa
- imbalance of four humours
- witchcraft
- God

What did medieval people do to try and stop the plague?

- Flagellants whipped themselves, to show God they were punishing themselves for their sins
- People would pray
- Doctors would try to balance the four humours
- Miasma theory led people to carry herbs or flower petals, so they could avoid the smell of the streets.
- Physicians used a range of herbal remedies
- People strapped dead chickens or frogs to themselves on their buboes

What were the consequences of the Black Death?

- killed a third of the population between 1348 and 1350
- food was not harvested, so survivors of the plague faced starvation
- when peasants moved to work for a lord, they could not move back home. because of this, and the fact that there weren't many workers, they demanded higher pay. this led the government to make the 'Statute of Labourers' "No peasants could be paid more than the wages paid in 1346. No lord or master should offer more wages than paid in 1346. No peasants could leave the village they belonged to."

What book did Vesalius publish?

- his book 'On the Fabric of the Human Body', published in 1543
- an extremely detailed and accurate guide for doctors on how the human body worked
- it contained detailed and accurate drawings of the human body, which was helpful for doctors.

How did Vesalius improve on the work of Galen?

- some of Vesalius’ discoveries proved that Galen had made some mistakes
- Vesalius proved that the human jaw bone was made of one bone, not two
- he also proved that blood did not pass from one side of the heart to the other through the septum - a rubber-like tissue often referred to as cartilage

What discoveries did Pare make on the battlefield?

- when treating gunshot wounds, the traditional method was to use hot oil to cauterise wounds
- Paré used this method until, one day, he ran out of oil
- He remembered reading about an old remedy that used egg yolk, rose oil and turpentine.
- he found the patients who had been treated with the hot oil were in significant pain but those who had been treated with the ointment were sleeping and their wounds were healing

What improvements did Pare make to cauterisation?

- if patients had severe wounds or had a limb amputated, blood vessels were sealed by cauterising them - this sometimes caused patients to die from the pain or from infections in the wound cauterisation caused.
- Paré used ligatures to tie blood vessels and stop bleeding - this was effective in stopping blood loss but did not necessarily reduce the death rate.
- Paré did not know about germ theory, so surgeons’ hands and the ligatures were often unclean - this meant there was a high chance of infection and death.

What did Harvey discover?

- Galen had said that blood was burned up by the body, like fuel on a fire. He said new blood was made in the liver. These ideas were widely believed by doctors in the Middle Ages.
- Harvey dissected frogs, which have a slow pulse rate, and showed that blood was pumped around the body by the heart.
- He also discovered the role of valves in blood vessels, which make sure blood only flows in one direction.

What book did Harvey publish?

- Harvey published a book in 1628 called An Anatomical Account of the Motion of the Heart and Blood.
- His high profile as physician to the king helped Harvey’s work to be widely shared.
- The book included details and diagrams of experiments Harvey had carried out to support his findings.

How many people did the Great Plague kill?

100,000 people in London

What was the cause of the Great Plague?

- The cause of the spread was poor sanitation, which led to sewage and waste being discarded in the streets and river.
- This resulted in a significant increase in the population of black rats, which carried the bubonic plague bacteria.

What government action was taken against the Great Plague?

- There was a more organised and coordinated response to the Great Plague than the Black Death
- the government introduced a quarantine for all ships coming into London
- If a household contained someone infected with the plague, the people were locked inside and a red cross was painted on their door.
- Searchers were employed to walk the streets, enter plague houses and identify the cause of death.
- There was a belief that stray cats and dogs were spreading plague, so the mayor of London ordered that they should all be killed. This may have actually made the outbreak worse, as the cats would have caught some of the rats that were responsible for spreading the disease.
- Belief in miasma meant people were ordered to light fires in the streets to create smoke. This was thought to mask the bad air believed to be causing the plague.

What are some hospitals that opened in the 18th century?

1751 - St Luke's Hospital in London - mental illness
1746 - London's Lock Hospital - venereal disease
1747 - Middlesex Hospital - pregnant women
By 1800, London's hospital alone was handling 20,000 patients a year

What were Hunter's discoveries?

- He carried out an experiment to prove his belief that syphilis and gonorrhoea - infections caused by two different types of bacteria - were caused by the same disease.
- To do this, Hunter deliberately infected himself with pus from a gonorrhoea patient, but he ended up infecting himself with syphilis as well.
- Hunter believed that the most effective treatment for the diseases was to give the patient mercury - a chemical element that is highly poisonous.
- Many years later this theory was proved to be false and it is thought that the needle was already infected with syphilis from another source.
- Over his career, he amassed a huge collection of animal and human skeletons, bones and body parts. He had over 14,000 items from more than 500 different species.
- Hunter encouraged other doctors to learn and study the anatomy of humans and animals, to increase their understanding of how the body works.

Why was Hunter significant?

- As a prominent doctor and leading member of the Royal Society, Hunter was responsible for the training of other doctors. These included Edward Jenner.
- Hunter was keen to encourage other surgeons to follow careful scientific methods when developing their practice. He argued that this would help surgeons to improve their methods and lead to better outcomes for patients.
- Hunter wrote several books, including The Natural History of the Human Teeth, A Treatise on the Venereal Disease and A Treatise on the Blood, Inflammation, and Gunshot Wounds. These helped other doctors to learn from Hunter’s scientific method.

What was known about inoculation before Jenner?

- In 1718, Lady Mary Montagu, who was married to the British ambassador in Turkey, had her son inoculated against smallpox.
- This involved giving someone a small amount of pus from a smallpox victim, which protected them against the disease. On her return to England, she promoted inoculation and the procedure became widely used.
- There were risks with inoculation. Someone might contract the full-blown disease when they were being inoculated, or they might not be given enough so they would not develop immunity.

How did Jenner develop vaccinations?

- Edward Jenner heard milkmaids claim that they would not catch smallpox as they had already been infected with a far less serious disease, cowpox. Jenner decided to test this theory.

- In 1796, Jenner took cowpox pus from a milkmaid, Sarah Nelmes, and smeared it into a small cut in the arm of eight-year-old James Phipps. Phipps became mildly ill with cowpox. Next, Jenner gave Phipps pus from a smallpox victim and James did not become ill.

- Jenner had proved that cowpox gave people protection against smallpox. He called this procedure ‘vaccination’ after the Latin word for ‘cow’, vacca.

What opposition was there to Jenner's vaccination?

- Some members of the Church believed that disease was sent by God, so the vaccine interfered with God’s will.
- The vaccine worked by giving people an animal disease. Some people felt that this was not safe and that vaccinated people would grow horns.
- Jenner did not know about germs. Because of this, he could not fully explain how his vaccine worked.

What forms of anaesthetic was there in the 1800's?

- nitrous oxide
- ether
- chloroform

Why was there opposition to anaesthetic in the 1800's?

- some army surgeons thought that soldiers should put up with the pain
- while chloroform was still being developed, some patients died, as women and men of different sizes needed different amounts
- there was religious objection to pain relief in childbirth, as it was seen as a punishment from God
- Queen Victoria used anaesthetic in her labour, which convinced people

What did doctors believe before Germ Theory?

- Doctors were aware that germs existed in the late 17th century.
- However, there was not a belief that germs caused disease.
- People believed in spontaneous generation. This led to the belief that germs, which appeared at the site of disease or illness, were a consequence of the illness rather than the cause of the illness.

What did Louis Pasteur do?

- Louis Pasteur was a French chemist. In the 1850s, he was asked by a French winemaker to investigate why their wine was going off. Pasteur used a microscope to see that there were bacteria - a type of microbe - in the wine. He believed this was what was making it go off. He successfully heated the wine to kill the bacteria.

- Pasteur carried out further experiments to prove his theory. He put some broth in two swan neck flasks and boiled it, which killed any microbes that were already there. He then broke the neck off one of the flasks. The flask that was exposed to the air went bad, but the sealed flask did not. This further proved Pasteur’s theory that microbes were in the air and caused disease in humans.

- In 1861 Pasteur published his work on germ theory. This was a hugely significant moment. It allowed further advances to take place in vaccines, surgery and antibiotics.

What did Robert Koch do?

- Robert Koch was a German doctor. He used industrial dyes to stain bacteria. This made them easier to identify when viewed under a microscope.
- In 1876, he identified the germ that causes anthrax. This was the first time the bacteria responsible for a specific disease had been identified.
- Identifying specific bacteria was crucial in being able to develop effective treatments and vaccines.

- Pasteur and Koch were rivals, but their work led to significant advances in medicine.

Which factors helped Pasteur and Koch?

- Technology - Koch’s assistant, Julius Richard Petri, invented the Petri dish. This enabled Koch to grow bacteria. He could then use industrial dyes to stain the bacteria. Finally, he could use powerful microscopes to identify the bacteria.
- Chance - Pasteur developed the chicken cholera vaccine when he left some cholera germs unrefrigerated before going on holiday. When his assistant, Charles Chamberland, injected these germs into a chicken on their return, the chicken did not become ill. Pasteur realised that the old germs had given the chicken immunity without making it ill.
- War - In 1870-1871, France and Germany were fighting each other in the Franco-Prussian War. This led to rivalry between Pasteur and Koch. Their respective governments invested in their research to show they had more advanced science and for national pride.
- Key individuals - Pasteur and Koch are both significant figures in the fight against disease. Their work relied on careful observation, scientific experiments, and years of work to develop new methods and treatments.

What did Lister discover?

- He experimented using a chemical, carbolic acid, to soak bandages before applying them to a wound. He found that it prevented infection and helped wounds to heal.

- Carbolic acid spray started to be used widely in surgery. It would be sprayed from a pump at the side of the operating table. This sterilised the air and equipment being used in the surgery.

- Carbolic acid was hugely effective. Lister reported that mortality rates in his surgery fell from 40 per cent before its use to 15 per cent afterwards he started using it. This was a huge step forward in making surgery safer.

What opposition was there to Lister's work?

- Some surgeons complained that the acid irritated their eyes and hands, making it difficult to carry out delicate surgery. Instruments and equipment were soaked in the acid, making them slippery.

- Some surgeons found the machine spraying the acid was getting in the way and making it more difficult for them to concentrate.

How was aseptic surgery developed?

- An American surgeon, William Halsted, asked a tyre company to make rubber gloves for him to wear during operations. Halsted came up with the idea after speaking to a nurse who had suffered from dry skin on her hands due to the use of carbolic spray. The use of gloves helped to make surgery cleaner and therefore safer.

- Halsted went on to encourage aseptic surgery. The aim was to sterilise equipment and hands, so there were no germs that could cause infection during an operation. This meant there was no need for carbolic acid to be used.

What was the 1848 Public Health Act?

- In 1848, the government responded to Chadwick’s report and passed a Public Health Act. The act set up a Central Board of Health to oversee the improvement of public health. This meant that:

- Local authorities could set up a local board of health to oversee public health. If an area had a mortality rate higher than 23 per 1,000 people, the local authority had to set up a board.
- The local board of health could then raise taxes to pay for clean water supplies and new sewerage systems.

- The act was limited in that there was little funding and the local boards of health were usually not compulsory. However, it was an important first step in the government taking action to improve public health.

How did John Snow discover the cause of cholera?

- Focused on cholera cases in Soho, London.
- Snow plotted all the places where people had died from cholera.
- From the map, he was able to work out that they had all drunk water from the same pump on Broad Street.
- It is believed that the drinking water was contaminated by sewage leaking into the water supply from a nearby cesspit.
- Snow knew that none of the workers at a local brewery had been taken ill with cholera, as they has been drinking mainly beer.
- Snow persuaded the local council to remove the handle from the pump so it could not be used.
- Cases of cholera in the area stopped as people were forced to go to other pumps for their water.

What was the Great Stink?

- The summer of 1858 was warm and dry. As a result, the water level of the River Thames dropped. This meant the sewage and waste that were being dumped in the river were no longer being quickly washed away.

- The resulting smell was awful and became such a problem that the Houses of Parliament were closed. Miasma theory was still widely believed. As a result, people cleaned the walls of their homes with chloride of lime to take away the smell.

- The event became known as the Great Stink.

What did Bazalgette create?

- As a result of the Great Stink, the government invested in the construction of a new sewerage system for London. This was designed by Joseph Bazalgette. The new system was designed in 1858 and completed in 1875.

- The system was built in response to the Great Stink. However, it also resulted in the end of significant cholera outbreaks in London.

How did Fleming discover penicillin?

- In 1928, he went on holiday while researching Staphylococcus bacteria. When he tidied his laboratory after his holiday, he discovered that a mould had grown on one of his Petri dishes. The bacteria around the mould had gone.

- When he investigated the mould, Fleming realised it was Penicillium fungi. He researched further and discovered that it killed Staphylococcus bacteria. He wrote about his findings in a medical journal.