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This set contains the notes from Seneca about medicine through time (Paper 1) for Edexcel GCSE History. This is currently unfinished. M͟e͟d͟i͟c͟i͟n͟e͟ ͟i͟n͟ ͟B͟r͟i͟t͟a͟i͟n͟,͟ ͟c͟1͟2͟5͟0͟-͟p͟r͟e͟s͟e͟n͟t͟ Medicine in medieval England, c1250-c1500: Cards 1-8 The Medical Renaissance in England, c1500-c1700: Cards 9-16 Medicine in eighteenth- and nineteenth-century Britain, c1700-c1900: (not started) Medicine in modern Britain, c1900-present: (not started) T͟h͟e͟ ͟B͟r͟i͟t͟i͟s͟h͟ ͟s͟e͟c͟t͟o͟r͟ ͟o͟f͟ ͟t͟h͟e͟ ͟W͟e͟s͟t͟e͟r͟n͟ ͟F͟r͟o͟n͟t͟,͟ ͟1͟9͟1͟4͟-͟1͟8͟:͟ ͟i͟n͟j͟u͟r͟i͟e͟s͟,͟ ͟t͟r͟e͟a͟t͟m͟e͟n͟t͟ ͟a͟n͟d͟ ͟t͟h͟e͟ ͟t͟r͟e͟n͟c͟h͟e͟s͟ The historic environment: (not started)
What supernatural explanations of the cause of disease were there in medieval England?
Some people believed that supernatural spirits could live inside a person and cause illnesses.
Some people in the Church did “exorcisms” to get these spirits out of people's bodies.
Witches were also thought to be responsible for some diseases spreading across a town.
Other supernatural reasons were based on astrology (how the stars and planets were aligned).
Astrology was first used in Arabic society but it was used in Europe after 1100.
Doctors used star signs and an almanac (calendar showing planetary movements) to diagnose and treat diseases.
How did Christianity affect medicine in medieval England?
The Church promoted the belief that illness was because of supernatural causes. Because of this, Christians believed that God would heal illness.
Prayers were viewed as the most important kind of treatment.
Christians would go on pilgrimages to relics or to the resting place of saints in the hope of miraculously recovering from illnesses.
The Church only allowed dissections to happen on criminals that had been executed.
This meant that Galen’s mistaken beliefs about the anatomy (holes in the heart and blood being absorbed not circulated) could not be corrected.
Here, religion and superstition slowed progress.
Some historians have claimed that the Church’s encouragement of the Crusades diverted funds away from hospitals and health towards wars.
However, the Crusades meant that Western Europeans met Muslim doctors.
This meant that ideas from the Islamic Empire could be used in Europe.
Lots of Ancient Roman and Greek medical texts were lost when the Roman Empire fell.
Monks tried to copy and preserve medical texts.
Dissent began to be caused by people questioning the Church’s reliance on old books.
For example, a monk called Roger Bacon was arrested for challenging the books in the 1200s.
Following Jesus Christ’s example, Christians believed that helping the sick was a Christian duty.
Monasteries were usually hygienic and had clean water and good sewage facilities.
Because of their religious beliefs, the Church promoted the creation of hospitals. Hospitals were funded by the Church or aristocratic patrons.
These hospitals were usually overseen by priests not doctors.
Hospitals were designed to help look after the sick, not treat and heal them. Most medicine in medieval times was palliative (relieve symptoms not cure condition)
For example, Bedlam in London was founded in 1247 to look after those with mental illnesses.
People with leprosy were isolated in “lazar houses”.
Who was Hippocrates? What theories about medicine did he develop?
Hippocrates (born in 460 BC) lived in Ancient Greece.
He advocated for using natural treatments to treat diseases and developed lots of theories about medicine.
These included:
Clinical observation.
The Four Humours Theory.
Hippocratic oath.
Hippocrates invented the idea of ‘clinical observation’.
This involved a doctor being objective (independent) and using observation and logic to deduce what was wrong with a patient.
A doctor should examine and monitor a patient’s symptoms to diagnose their disease or illness.
Doctors today take the Hippocratic oath and this binds them to keep to a set of ethical standards to treat their patients well.
Hippocrates also developed the theory of the four humours.
To be healthy, the Ancient Greeks believed that a person needed to have balanced humours. People got diseases if they had too much or too little of a humour.
What were the Four Humours? What was suggested to remedy an imbalance of the humours?
Blood was related to spring and air. The Ancient Greeks believed blood was produced in the liver. Blood was considered hot and wet.
To remedy a blood imbalance, doctors used bloodletting or suggested eating red meat and drinking red wine.
Black bile was related to autumn and earth. The Ancient Greeks believed black bile was produced in the gallbladder. Black bile was considered cold and dry.
To remedy a black bile imbalance, doctors gave laxatives and suggested eating more vegetables.
Yellow bile was related to summer and fire. The Ancient Greeks believed bile was produced in the spleen. Yellow bile was considered hot and dry.
To remedy a yellow bile imbalance, doctors forced patients to throw up or change their diet.
Phlegm was related to winter and water. The Ancient Greeks believed phlegm was produced in the brain and lungs. Phlegm was considered cold and wet.
To remedy a phlegm imbalance, doctors suggested breathing steam, or eating vegetables filled with water.
Who was Galen? What theories about medicine did he develop?
The Greek physician Claudius Galen was born in 129 AD in Greece but he then lived in Rome later in his life.
Galen believed that imbalances in the four humours of the body caused diseases.
He supported clinical observation and encouraged doctors to monitor a pulse or take a urine sample to find out what was wrong with a patient.
But Galen thought that blood was absorbed or taken in by the body, rather than pumped around it.
Galen advanced the understanding of the humours through his Theory of Opposites.
He thought that humours could be rebalanced by giving a patient something opposite to their symptoms.
For example, if you had an excess of blood (hot and wet), doctors should prescribe a treatment which was cold and dry.
Although Galen lived in the Roman Empire he believed in monotheism (one single God).
Because of this, the Christian Church supported his ideas of medicine.
As the Church put their weight behind Galen’s ideas of medicine, it was frowned upon to question Galen.
The miasma theory was also included in Galen’s thinking.
Miasma theory said that bad air made someone ill when they breathed it in.
It was very popular in medieval England and it was probably the most powerful theory of disease until late into the 1800s.
Because of the Church’s support, Galen’s ideas endured as the foundation of medicine for 1,400 years.
The fact that he was monotheistic and had the Church’s support shows that chance can lead ideas to spread and be used everywhere.
What types of “doctors” were there in medieval England? How could they treat patients?
Medieval doctors usually learned through word-of-mouth or through personal experience.
They experimented with herbs, charms and learned from apothecaries (people who sold medicines), travelling healers and wise men/women.
Barber surgeons were people who had access to razors and did a lot of medical procedures.
Barber surgeons did not get training.
They could cut people’s hair, do bloodletting and even amputate peoples’ arms and legs.
However, a lot of people died because their wounds were infected or they lost too much blood.
The closest thing to our view of a modern-day doctor was someone who had been trained in Hippocratic and Galenic methods.
The Christian Church was influential and popular in Europe in medieval times.
Lots of doctors were trained at universities that were set up by the Church.
Most of these were based in Italy (e.g Bologna and Padua).
The Church (monasteries) generally controlled education and Galen’s ideas were usually taught in the Church’s medical school.
The Christian Church liked Galen’s ideas.
They thought it fitted with their view of God and doctors believed that his ideas were correct.
Doctors had some tools to treat patients.
These included:
A book which recorded possible illnesses.
Leeches to remove blood.
Aromatic objects which could stop miasma (bad smells which were believed to cause disease).
A zodiac chart to predict future illnesses.
Most doctors were in large towns and they were still rare.
Doctors were expensive and most people couldn’t afford to see them.
Some doctors began to observe (and treat) their patients on the battlefield (in wars).
The poor could only receive medical treatment in hospitals set up by monasteries.
However, lots of people who were very ill were not treated, because people were scared that the disease could spread to other people.
Apothecaries were people who sold herbal remedies in medieval times.
Female apothecaries were called "wise women".
Most people couldn't afford to pay physicians, so they used apothecaries.
What was surgery like in medieval England?
In the medieval times, surgery was rudimentary and dangerous. Few patients survived surgery. There were 3 main problems with surgery in medieval times:
Surgery was excruciatingly painful.
No anaesthetics existed and only natural anaesthetics (like hemlock or opium) existed to numb the pain.
Natural anaesthetics were dangerous because high doses could kill the patient.
There was a very limited understanding of what causes diseases and infections.
Nobody had discovered the link between dirt and disease and many doctors believed that pus in wounds helped a patient to recover.
Many people died from infections after surgery.
Patients often lost a lot of blood in surgery.
There were not blood transfusions or anything similar.
Blood loss could also be fatal.
Surgery was not a respected job in medieval Europe. Lots of surgery was performed by barber surgeons. Some military surgeons learned skills to treat wounded soldiers on the battlefield. The most common surgical procedures were:
Bloodletting - unlike doctors, there was little formal training for surgeons.
Training was through apprenticeship.
Surgeons performed bloodletting when humours were imbalanced. By removing blood, it was believed a patient would become healthy again.
An amputation was when a surgeon cut off a body part.
This was often needed if a body part was painful or infected through wounds.
Given the scale of blood loss, amputations were very dangerous.
Trepanning was when a surgeon would make a drill hole into a human’s skull.
Surgeons used trepanning if patients were acting abnormally.
This included being possessed by bad spirits, having a mental illness or suffering from epilepsy.
Cauterisation was when surgeons burned a wound to stop blood flow or close up an amputated wound.
What was the Black Death? How did people attempt to prevent its spread? What were its impacts on medieval Britain?
The Black Death was an epidemic that hit England in 1348. The disease was a mixture of bubonic plague (spread by fleas on black rats) and pneumonic plague (airborne spread by coughing/sneezing). The plagues could cause death within 2 days of the first symptoms.
The disease began in Asia and spread to Europe on merchant ships.
At the time, people thought that the epidemic was caused by supernatural things like the position of the stars (or God’s wrath) or natural reasons such as miasmas or humour imbalances.
The bubonic plague was caused by a bacteria in fleas’ stomachs.
Fleas were able to pass between humans quickly as many people lived close to each other, and the disease spread quickly.
Suggested remedies for the Black Death included prayers to appease (satisfy) God.
Some tried to use herbs to keep them safe from miasma.
Others tried purging, vomiting and bloodletting to keep humours in balance.
Others tried to move away or avoid those who had become infected.
Some people thought that the plague was caught from dead bodies. Some towns, like Winchester tried to build cemeteries away from people's homes.
Some towns like Gloucester tried to stop anyone outside the town entering but this did not succeed. Towns tried to set up quarantine zones, but they didn’t usually work.
Ships were quarantined and had to wait 40 days before unloading in Britain.
30-45% of the British population are estimated to have died from the Black Death.
Whole towns were killed by the Black Death.
The Church was harmed because lots of experienced priests died. New clergymen demanded higher wages.
The Black Death killed lots of workers. Peasants asked for higher wages and moved around to earn higher wages.
The cost of buying land fell because of the lower population and this allowed some peasants to buy land.
The 1349 Ordinance of Labourers tried to stop peasants moving around so much.
Some historians think these kinds of measures and the Black Death contributed to the Peasants’ Revolt in 1381.
The worst of the Black Death was over by 1350.
But plagues continued for centuries. The worst example was the Great Plague of 1665.
What continuity and change in explanations of the cause of disease and illness was there in the Renaissance?
Scholars were paid to restore old texts and fix the bad translations that had been published in the Middle Ages.
The theories proposed by Hippocrates and Galen became popular again.
There was an increased focus on the importance of human factors rather than supernatural things. This was called humanism.
There was also a focus on direct observation and experiments to explain things rather than blame them on something supernatural.
This led some people to question the Church.
Renaissance means rebirth. It was a time of rebirth in the arts and science. The printing press (created in 1440) was very important to share and spread ideas.
The printing press allowed knowledge to be shared with more people very cheaply.
Books and leaflets could be printed and sent across Europe whereas previously, a lot of information was only told person-to-person.
The rediscovery of Galen and Hippocrates' work meant that people began to see the importance of dissection and human anatomy.
The focus on humans and the increased spread of ideas all encouraged experimentation and the search for explanations.
People began to dissect human bodies (corpses) and there were illustrations in medical writings and books.
Guns became a lot more common in 17th century warfare. This led to new injuries and doctors had to find new ways to treat gunshot wounds.
Dissections became a more integral (important) part of medical training.
The College of Physicians (founded in 1518) improved training and encouraged scientific observation.
What continuity and change in approaches to treatment and care was there in the Renaissance?
Doctors in the Renaissance period still didn’t have much training.
They still used old methods that people like Harvey thought were ineffective but some began to use more modern techniques.
The printing press and the works of Harvey, Pare, Vesalius and Sydenham helped to spread new ideas.
However, blood transfusions only offered a solution to treat patients using Harvey’s theory of circulation in 1628.
Europe in the Renaissance was still a very religious place.
Doctors still believed that supernatural things caused illness.
Pilgrimages and prayers were still prescribed to cure illnesses.
The people believed the ‘Royal Touch’ could cure disease.
People would flock to the King to be cured of scrofula.
People still sought wise women and apothecaries to cure disease.
There were advances in approaches to medicine.
Hospitals began to focus on treating patients, not just caring for them.
Lots of towns had pharmacies.
Books were being published which covered how to treat illness at home.
Quackery was a form of medicine based on spectacles and displays.
Many people viewed this as fraudulent medicine and this became more common in the 17th and 18th century.
Quacks claimed their medicines could cure everything but they were usually ineffective.
Quacks often gave patients depressants like opium, which gave patients the impression that they were getting better. In reality, they were giving their patients an addiction.
Not much changed in nursing during the Renaissance.
Reformers like Florence Nightingale drove a lot of reforms in hospitals, but this was not until the mid-1800s.
Poor people were often looked after in workhouses.
Workhouses were large buildings where the unemployed, ill or elderly could be looked after.
Conditions in workhouses were often very bad, although they got better after 1850.
Hospital treatment was free but most treatment was still based on the four humours.
Between 1536 and 1541, Henry VIII closed a lot of Britain's monasteries.
Because hospitals were often run by monasteries, there were actually fewer hospitals in this period than in previous years.
The College of Physicians was set up in 1518. Most British doctors were trained here and they were still learning Galen’s works.
By this point in time, there were 2 main types of surgeon:
Professional surgeons, who had trained at university and were expensive and well paid.
Barber surgeons, who were unqualified and not very well respected.
Who was Thomas Sydenham? How did he improve diagnosis in the Renaissance?
Thomas Sydenham was born in 1624. He was a British physician who advanced the use of the scientific process in medicine. His records were a first stage to the statistics kept by William Farr over 100 years later.
Sydenham prioritised treating patients and observing the outcomes rather than learning from books.
He recorded his observations of patients' illnesses and treatments and this allowed him to see patterns between illnesses and treatments.
Sydenham used his records and the patterns he spotted to classify (sort) diseases into different types based on which symptoms a patient had.
For example, Sydenham showed that measles and scarlet fever were different types of diseases.
In 1676, he published a book named "Medical Observations".
Medical Observations was used by doctors for centuries.
He described different illnesses and suggested ways to treat them (e.g for illnesses like gout).
How did the printing press influence the transmission of ideas in the Renaissance?
The printing press was a new technology in towns that allowed ideas and theories to spread a lot faster across Renaissance Europe. Johannes Gutenberg started to build it in 1436.
Before the printing press, books had to be copied by hand.
This either took months for each copy or was not done because it took too much effort.
In 1480, there were 110 printers in Europe. By 1500 they were in 77 cities in Italy and by 1600, 151 cities had printing presses.
Being able to print more books quickly meant that more people could read other people's ideas and theories.
The writings of Galen and Pare could be reprinted in lots of different languages for people all across Europe to read.
By 1500, 20 million copies had been made by Western European printing presses.
If people do not fully understand a theory, it is hard to critique it.
Publishing lots of copies of a theory can mean that lots of people understand a theory in more detail and can then work out what is wrong with it and whether it is right.
Students studying medicine and other things could use books and textbooks for reference more often.
How did the Royal Society influence the transmission of ideas in the Renaissance?
The Royal Society was created with the support of King Charles II in November 1660. It is an institution whose job was to promote and support scientific research.
The motto of the Royal Society was "Nullius in verba". This means "take nobody's word for it".
This motto sounds similar to the scientific process: make observations and question assumptions underlying different medical treatments and scientific theories.
The Royal Society's journal was called "Philosophical Transactions".
This journal was well-respected and helped to spread scientific and medical ideas across Britain.
Isaac Newton's first paper "New Theory about Light and Colours" was published in Philosophical Transactions.
Who was Vesalius? How did he influence medicine in England in the Renaissance?
Andreas Vesalius was a physician who studied in Paris and Louvain. He then became a professor of surgery at the University of Padua.
Vesalius thought that surgery would only get better if people understood the body and the anatomy better.
He used dissections (of executed criminals) to show that Galen’s understanding of the human body was wrong.
He faced opposition for criticising Galen and had to leave his job at the university.
Vesalius published his Six Anatomical Pictures in 1538 and then published On The Fabric of the Human Body in 1543.
On The Fabric of the Human Body had illustrations based on Vesalius’ dissections.
Copies of Vesalius’ work reached physicians in Britain.
Doctors were encouraged to do dissections themselves after Vesalius’ work.
Vesalius is credited with inspiring other anatomists, such as Fabricius and Fallopius.
Who was William Harvey? What did he discover? What impacts did this have?
William Harvey was an English physician (doctor) who was born in 1578. He studied medicine in Padua and was particularly interested in physiology. He was the physician for the English Kings James I and Charles I.
Harvey challenged Galen’s understanding of blood and how it circulated around the body.
He thought that blood circulated around the body. This view was different from Galen’s view that new blood was made in the liver and used as fuel.
Harvey used valves to show that blood could only flow one way in the body and he thought that too much blood was in the body to be continually created as fuel.
He showed that the heart was a pump for the blood in the body.
When Harvey first published his theory, he was ridiculed.
Professional opinion did change, but it took a lot of time and lots of doctors continued to use bloodletting despite Harvey showing it would not be effective.
This highlights the limited impact of one individual. Although Harvey made this major discovery, his ideas needed to be accepted by the medical community.
Harvey’s theory implied that bloodletting was a counterproductive (ineffective) method of treatment.
But this continued for many years as doctors didn’t know what else to do.
Despite his discoveries, Harvey did not understand why blood needed to circulate around the body and why blood in arteries and veins was different.
His theory of circulation was the first stage towards blood transfusions becoming possible to save people’s lives.
In 1901, the discovery of blood groups made blood transfusions successful.
In 1661, after Harvey had died, a microscope was developed. This microscope showed that veins and arteries were linked by capillaries.
What was the Great Plague? How did people attempt to prevent its spread and treat it?
In 1665, the bubonic plague reappeared in Britain. The epidemic killed 100,000 people (almost 25% of London’s population).
People still blamed miasma or supernatural/religious causes (God’s will) just like they did in the Black Death.
Remedies for the plague included bloodletting through leeches, smoking, using animals such as frogs or snakes to ‘draw out the poison’ or moving to the countryside.
In 1666 the plague seemed to be ending. Some people think that the Great Fire of London (1666) killed a lot of the bacteria causing the plague and helping to end the epidemic.
There were some significant improvements in the 317 years between the Black Death and the Great Plague.
People recognised the connection between dirt and disease.
Local governments were more organised. Quarantine was more effective, bodies were collected and buried at least 6 foot deep in plague pits, trade stopped and communal gatherings were banned. The England-Scotland border was closed.
People were locked in their houses to stop the disease spreading.
Plague doctors wore special suits to protect them against “miasma”. They had masks stuffed with aromatic herbs to stop the “bad air” from reaching them.
This was not based on correct science but luckily the suits probably helped to reduce the spread of the plague.
Local governments and special suits helped to deal with the plague better, but nobody really understood why it had happened or what caused it.
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