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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 1-9 The Medical Renaissance in England, c1500-c1700: Cards 10-17 Medicine in eighteenth- and nineteenth-century Britain, c1700-c1900: Cards 18-27 Medicine in modern Britain, c1900-present: Cards 28-37 T͟h͟e͟ ͟B͟r͟i͟t͟i͟s͟h͟ ͟s͟e͟c͟t͟o͟r͟ ͟o͟f͟ ͟t͟h͟e͟ ͟W͟e͟s͟t͟e͟r͟n͟ ͟F͟r͟o͟n͟t͟,͟ ͟1͟9͟1͟4͟-͟1͟8͟:͟ ͟i͟n͟j͟u͟r͟i͟e͟s͟,͟ ͟t͟r͟e͟a͟t͟m͟e͟n͟t͟ ͟a͟n͟d͟ ͟t͟h͟e͟ ͟t͟r͟e͟n͟c͟h͟e͟s͟ The historic environment: (not started) Key factors: (not started) (This isn’t an official topic, but you do need to understand how factors worked together to bring about developments, so I think it’s worth including.) Note: This was made using Issue 5 of the specification, which only applies for exams taken in 2025. However, Issue 6 is very similar.
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 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 public health problems were there in medieval England?
The centralised organisation of Ancient Rome had vanished as regions fragmented.
This contributed to worse public health standards
The Thames became so dirty that the “Great Conduit” was built to bring drinking water into London. Wardens protected and repaired pipes to keep the supply clean.
The city also tried to keep streets clean and to improve the sewage problems.
The unsanitary conditions were partly because of population growth and urbanisation.
More people lived in towns, so towns became crowded.
People lived close together in houses made of wood and overcrowding meant that disease spread quickly.
Towns were not clean because people did not know that dirt could cause disease and nobody understood germs or bacteria.
Miasma (bad air) was still believed to be the cause of illness.
Towns smelt bad, people then got ill so people thought the bad air (smells) made people ill.
Rivers were used for sewage as well as for drinking water. This meant that there was a lack of clean water.
Lots of towns didn’t have clean water or sewage systems. Often there weren’t the systems of aqueducts and sewage that the Romans had used.
Cesspits were used for people to throw their liquid waste and sewage into.
Houses were also used for business by butchers and barbers.
Their waste and rubbish was often thrown in rivers and the street.
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 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 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 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 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.
What was Germ Theory? What was believed before it?
Before Louis Pasteur’s work in 1861, there was a debate over how infections were spread. Before Pasteur, most scientists believed spontaneous generation and that diseases could be spread by miasma or contact.
Surgeons thought that microbes were caused by disease in something called “spontaneous generation”.
The microbes were a symptom and diseases developed randomly, creating bacteria.
The two main groups were contagionists and anti-contagionists.
Contagionists believed disease could spread through contact.
Anti-contagionists believed disease spread through miasma.
In 1857, Pasteur tried to explain why the sugar beet used to ferment alcohol soured. Pasteur thought that germs in the air were responsible.
He found that sterilised water was still sterile if the flask was closed, but was not sterile if the flask was open. This suggested that there were germs in the air.
In 1861, he published his theory – germs were causing infections.
Microscopes (invented in the 17th century) eventually allowed Pasteur to see the micro-organisms that he described.
Pasteur faced serious opposition for his theory.
A famous doctor called Charlton Bastian supported the theory of spontaneous generation, which contradicted Pasteur’s Germ Theory.
Pasteur’s research focused on how liquids, such as milk went sour (pasteurisation). Many did not see the connection to humans.
Doctors did not believe that small germs could cause such harm to humans.
How did Pasteur’s Germ Theory influence medicine in eighteenth- and nineteenth-century Britain?
People gradually began to believe (and treat people in accordance with) Germ Theory.
Most of the gains from Germ Theory came in the 20th century.
It proved that disease was not spread by miasma.
It proved that spontaneous generation was wrong.
It proved that an imbalance of the Four Humours did not cause disease, thus meaning the Four Humours were wrong.
In 19th century Britain, medical treatments became safer.
The survival rate in surgery increased, hospitals became cleaner and vaccinations became more popular.
Technological developments meant that diseases could be identified and stopped more effectively.
Following Germ Theory, drugs were developed and became far more popular.
How did Koch’s work on microbes influence medicine in eighteenth- and nineteenth-century Britain?
Using Pasteur’s Germ Theory, a German doctor called Robert Koch explained that germs could cause human disease. He linked a disease to the microbe that caused it. This was the beginning of ‘bacteriology’.
Koch showed that germs were not all the same.
He identified the different microbes that caused anthrax in 1876, septicaemia in 1878, tuberculosis in 1882 and cholera in 1883 by injecting animals with diseases. He then dyed bacteria and viewed them using microscopes.
Other scientists then discovered typhus in 1880, pneumonia in 1880, tetanus in 1884, diphtheria in 1884 and the plague in 1890.
Koch and Pasteur’s studies were picked up by many scientists in Britain.
John Tyndall gave lectures on Germ Theory to British doctors. He refuted Bastian’s ideas of spontaneous generation.
Dr William Roberts created a medical version of Germ Theory.
William Cheyne translated Koch’s work and highlighted that not all microbes caused harmful disease.
Koch and Pasteur inspired a generation of scientists who were called ‘microbe hunters’.
These scientists became interested in diseases and how to prevent them.
Pasteur and Koch tried to apply Germ Theory to develop more advanced vaccinations.
In 1879, Pasteur accidentally showed that vaccinations could prevent disease.
After a researcher Charles Chamberland left out a cholera culture over the weekend, they discovered that weakened (attenuated) cholera germs could make a chicken immune from later stronger bouts of cholera.
In 1881, Pasteur produced a weakened (attenuated) vaccine for anthrax in sheep.
By 1884, Pasteur created a vaccine for rabies. A year later this was applied to human subjects.
Pasteur’s contribution to vaccines is so significant because it allowed some of the world’s deadliest diseases to be eradicated.
In 1871, the Franco-Prussian war (between France and Germany) ended. Some historians think national rivalry between Pasteur and Koch drove developments.
Scientific advances were propelled forward by competition.
There was internal rivalry to understand a germ called diphtheria.
By 1890, Pierre Roux had shown that diphtheria produced a poison.
Later in 1890, Emil Behring showed that if diphtheria was diluted it could produce an antitoxin.
Why was the Public Health Act (1975) passed? What did it enforce?
1848 Public Health Act: The Public Health Act set up a Central Board of Health to improve public health.
Towns were asked to set up their own Local Board of Health.
Town councils were given the power to spend money on improving street cleanliness.
The result of the act was mixed because councils had their own autonomy. Some cleaned their streets but some didn’t.
In 1854 the Central Board of Health was shut down as it was seen as a violation of the government’s laissez-faire approach.
In 1858 London was struck by the ‘Great Stink’.
The River Thames was so full of sewage and the weather was so hot that London smelt very bad.
Parliament (located right on the Thames) noticed the smell.
This prompted them to improve the London’s hygiene and sewage systems.
Politicians funded an engineer called Joseph Bazalgette to build a new sewer system for London.
Over 1300 miles of sewers were built to take sewage out of Central London.
Bazalgette completed this within a year and these are still used today.
1867 Second Reform Act: In 1867, more working class men won the right to vote.
This shift in the voting population helped to improve living conditions across the UK.
1875 Second Public Health Act: The 1848 act was voluntary, but the 1875 Act was mandatory. It forced local authorities to:
Provide clean water
Provide proper sewage systems
Collect rubbish on the street
Appoint a Medical Officer of Health
These laws seem to have been enforced for a few reasons:
Political changes: The 1867 Reform Act gave more working class men the vote. This meant that politically to stay in power, improving living conditions for this group was more important.
The Chadwick Report of 1842 could have had an effect in increasing awareness but most of the change came a lot later than 1842.
Chance: The Great Stink of 1858 was only really created by unusually hot weather.
The smell from the Thames reached parliament and it took this to lead to Bazalgette’s reforms of the London sewage system.
Scientific advances: Pasteur’s Germ Theory and advances in medical surgery showed that disease and illness were more preventable than they had previously been perceived.
Previously supernatural factors had been blamed.
Statistics collected around deaths and death rates also showed the differences in living conditions and this may have shamed the government into action.
Individuals: The below all contributed to change:
Pasteur’s discovery of germs/microbes as a cause of disease.
Edwin Chadwick’s report and recommendations.
Dr Snow’s findings around cholera.
How did anaesthetics impact surgery in eighteenth- and nineteenth-century Britain?
Problems with surgery in the 1800s: Pain – Patients often died from clinical shock because of the pain of surgery.
Infection – Before Germ Theory, people did not know that microbes could cause infections. Surgeons wore the same outfit and used the same equipment for multiple patients.
Bleeding – Patients often died during surgery because they lost too much blood.
In 1800, physicians and surgeons gave patients alcohol (made them drunk) or gave them opium (like heroin) to numb the pain.
Humphrey Davy was the first to use nitrous oxide (laughing gas) to stop patients from feeling pain. Horace Wells then used it in 1844 to numb the pain in dental surgery.
Dr James Simpson first used Chloroform in surgery in 1847. It was effective but it led to death in high doses. It killed Hannah Greener in 1848. Queen Victoria used Chloroform in childbirth in 1853.
Ether was first used by the American dentist William Clark in 1842 and then by Robert Liston for a leg amputation in 1846. Ether was effective but hard to inhale (it also led to vomiting) and was explosive.
Anaesthetics initially increased the number of deaths in surgery. People did more complex operations and hygiene was still bad in surgeries. Doing more complex surgery for longer in an unhygienic place increased the risk of infection and fatal blood loss.
Some army surgeons thought that soldiers should endure the pain.
Some religious people thought that the pain suffered during surgery was God’s will.
After Queen Victoria used anaesthetics in childbirth, anaesthetics became more popular.
Public demonstrations of the drugs also helped to make anaesthetics more widely accepted.
How did antiseptics and aseptic surgery impact surgery in eighteenth- and nineteenth-century Britain?
Anaesthetics reduced the pain in surgery but infection still killed lots of people in surgery. Antiseptics were used to kill the microbes close to wounds in surgery.
A British surgeon called Joseph Lister applied Pasteur’s Germ Theory to surgery. He thought that germs explained why wounds from surgery got infected.
Lister used carbolic acid as a chemical which could kill bacteria. This stopped germs from infecting wounds in surgery.
The death rate in Lister’s patients fell from 46% to 15%.
Covering surgical instruments, bandages and the surgeon’s hands in carbolic acid reduced the chance of infection.
Lister heard about Germ Theory in 1865.
He tested his ideas on a boy called Jamie Greenlees who had a broken leg.
Instead of an amputation, Lister healed Greenlees’ fracture and the wound was not infected.
Lister published the results of Greenlees’ and ten other patients’ surgery in 1867, proving Pasteur’s Germ Theory.
Lister was heavily criticised. Most doctors still believed that chemicals caused infections rather than germs.
Pasteur’s ideas were not yet accepted and people still believed in spontaneous generation.
Carbolic acid was unpleasant for doctors to use because it irritated their lungs and skin.
Many surgeons tried to copy Lister’s methods but did not do it properly. This made them think that the theory was wrong.
10x more surgeries were performed in the UK in 1912 relative to 1867 because the chance of survival increased so much.
Aseptic surgery methods tried to completely eliminate bacteria before and during an operation, rather than trying to kill microbes on a specific wound.
By 1880, Pasteur’s Germ Theory was widely accepted by British doctors.
By 1900, aseptic surgery had become very common.
In aseptic surgery, surgeons were scrubbed clean, wore new clothes and thin rubber gloves.
Surgeons used sterilised instruments and operating theatres got smaller to reduce the chance of infection.
These developments were largely advanced by wars, such as the Crimean War.
War provided test cases for surgeons to try out these new techniques.
How did hospital care improve in eighteenth- and nineteenth-century Britain?
The modern hospitals that we use today were born in the 17th and 18th centuries.
These hospitals were funded by wealthy people or by private subscriptions from the local community.
Specialist wards (like maternity wards) and specialist hospitals were established to treat certain diseases. This organisation was more effective at curing disease.
In the 18th century there was a significant increase in hospitals.
For example, in London there were 5 new general hospitals built between 1720 and 1750. Hospitals like Guy's Hospital opened.
This was accompanied by a rise in patient numbers.
Attitudes to illness began to change in the 18th century.
The idea that illness was a punishment for sin was increasingly less popular.
Florence Nightingale (born in 1820) helped nursing to become professional.
Her work with 38 nurses (chosen by her) in the Crimean War in 1854 reduced death rates hugely because of her improvements in the hygiene of wards.
Following the work of Nightingale, a higher level of cleanliness and organisation was demanded from hospitals.
Hospitals began to create pharmacies which could provide medicine.
When Nightingale got back from war, she published a book “Notes on Nursing”.
The status of nursing was enhanced as they were expected to care for patients and assist doctors.
The Nightingale School of Nursing was set up in St Thomas’ Hospital in London.
Surgeons’ status began to improve and in 1800, the London College of Surgeons was set up. It created training standards for surgeons.
How did Jenner develop vaccination? What was done beforehand? How did this impact eighteenth- and nineteenth-century Britain?
In the 1700s, smallpox was one of the most fatal diseases in the world.
Smallpox was very contagious (spread through coughing, sneezing or physical contact) and its symptoms were a fever, headache, rash and blisters filled with pus.
30% of people who got smallpox died. Those who survived were often blind or had very deep scars.
The existing way to treat smallpox was inoculation. It was first brought to Britain by Lady Mary Wortley Montagu who observed it in Turkey.
Inoculation involved putting pus from a person with a mild form of smallpox into a cut in a healthy person’s body. People believed this gave them resistance.
Inoculation was popular in the 1700s with aristocrats.
Many people did not get inoculated for religious reasons. They thought that it interfered with God’s will.
The inoculation dose could be too big and kill the patient.
People who had been inoculated could still pass smallpox onto other people.
Inoculation was a treatment that only rich people could afford.
Edward Jenner was a country doctor. He thought that the milkmaids did not get smallpox but did catch a milder disease called cowpox. He tested this theory scientifically and it seemed to be correct.
Jenner thought that people who had cowpox were immune to smallpox.
Jenner gave an 8 year old boy, James Phipps, cowpox before injecting him with smallpox. James Phipps didn’t catch smallpox.
Jenner tested this on 16 more patients and concluded that cowpox was an effective vaccination against smallpox.
He published his research in 1798.
Some people in the Church thought that vaccination wasn’t natural and should not be done.
The level of opposition is seen by the formation of the Anti-Compulsory Vaccination League in 1866.
This was 13 years after the vaccination was made compulsory.
Publishing his discovery in 1798, Jenner faced serious opposition.
He faced criticism because he could not explain why the vaccination worked.
Many doctors did not wish to use the vaccination because they profited from the smallpox inoculation.
Jenner was not part of the clique of fashionable doctors in London. For this reason, he was excluded from academic favour.
Attempts to replicate the experiment failed.
Although this was because of contaminated equipment, they believed Jenner was wrong.
Despite all this opposition, the vaccination came to be accepted.
The vaccination was less dangerous than the traditional smallpox inoculation.
Gaining the favour of the royal family helped sway popular opinion.
Parliament gave Jenner £10,000 to further his research in 1802.
By 1853, the vaccination was made compulsory under law.
What public health problems were there in eighteenth- and nineteenth-century Britain?
The Industrial Revolution happened in Britain between 1760 and 1840. It saw lots of people move to cities and begin to work in manufacturing industries (instead of agriculture).
Thousands of people migrated from the countryside to cities such as London, Birmingham and Manchester.
For the first time, more people lived in British cities than the countryside.
Most people living in cities lived in terrible living conditions.
Workers lived in very small houses, houses were very close together and sometimes families lived in one small room.
Workers received very low wages and they often lived in poverty.
Private toilets were rare, most families used toilets outside the house which were shared with others. Sewage would fall into a cesspit, which was often washed away by rain or thrown in rivers.
Water came from local rivers, which is where sewage from cesspits often went. This was sometimes a worse situation than Ancient Rome (with its aqueducts).
The streets were also dirty with wastage and sewage.
People’s health may have been worse than any other time in history.
Because of these poor conditions and overcrowding, disease was very common. Some of the worst diseases were typhoid, tuberculosis and cholera.
Typhoid was caused by contaminated food or water, it was spread through unhygienic conditions.
Tuberculosis was caused by germs spread by sneezing or coughing, it was spread through overcrowded areas.
Cholera was caused by contaminated water or food.
Local councils were usually responsible for these health problems.
Some people thought government should intervene but often they did not (laissez-faire approach).
Local taxpayers made decisions and many of these did not want to pay more money to improve health conditions (for others) in their town.
How did people attempt to prevent the spread of cholera in London in 1854?
Cholera is a disease transmitted through water. At the time, people thought that it was produced by rubbish and human waste and was spread through the air (miasma). Streets were cleaned but water was often not clean.
Cholera epidemics affected Britain every few years between 1831 and 1866.
Symptoms of cholera included vomiting and having painful diarrhoea.
Although governments were concerned about cholera epidemics they did not know what caused cholera and, therefore, how to prevent it.
After the cholera epidemics, Edwin Chadwick wrote a report on living conditions for the working classes in 1842. It was called the “Report on the Sanitary Conditions of the Labouring Population”.
Chadwick thought that bad health was being caused by people’s awful living conditions.
He thought that the disease was being caused by bad air and damp.
People were shocked by how bad living conditions were for the poor.
Chadwick suggested that laws should improve drainage and sewer systems.
He thought medical officers should be appointed to improve the situation for the poor.
Although the explanation for disease was incorrect, Chadwick recognised the need to improve public hygiene, particularly the need for clean water and streets.
Chadwick stressed that improving public health (by raising taxes) would benefit Britain as the workforce would work harder and make more goods.
The government’s ‘laissez-faire’ policy meant they did not take action following Chadwick’s report. They believed that the government should not interfere in the poor’s lives.
Some towns like Manchester and Liverpool did improve their sewage and water systems.
In 1848, Parliament passed an act that set up a Board of Health to encourage local councils to improve conditions.
But not many authorities did much. In 1872, there were only 50 Medical Officers of Health appointed.
It did not have a huge impact and it was not compulsory.
Dr John Snow (born in 1813) was a physician who examined the link between cholera and contaminated water after an outbreak of cholera in London in 1854.
Dr Snow saw that all the victims of the cholera epidemic in 1854 lived near the Broad Street water pump.
He removed the pump’s handle and forced everyone to use another pump.
This stopped the spread of the disease in the area.
Snow discovered that the pump’s water had been contaminated by a leaking street toilet.
This confirmed that cholera was not airborne but waterborne.
William Farr collected medical statistics that recorded how people died.
Dr Snow used Farr’s statistics to see whether there was a link between water contaminated with sewage and deaths from cholera.
His statistics showed that deaths from Cholera seemed to be linked to specific water sources.
These statistics were very important to prove Dr Snow’s hypothesis.
What improvements in diagnosis have there been in modern Britain?
In the 20th century, there were a lot more ways to diagnose and monitor illnesses. Advances that allowed this include:
Blood tests: After blood groups were discovered in 1901, blood tests began to increase in popularity.
Doctors today can use blood tests to examine a patient's level of cholesterol (measures risk of heart attack), a patient's DNA (genetic material) and some indicators of their risk of developing cancer.
Body scans: Rontgen discovered X-rays in 1895. This allowed us to scan bones.
In 1972, Geoffrey Hounsfield created CAT scanners, which could produce 3D images of the human body using X-rays.
In 1987 MRI scanning was developed, this gave doctors a scan of a human body using magnets and radio waves. They can also give an image of the human body.
Self-monitoring: Doctors and patients can now monitor their blood pressure, heart rate and lots of other things.
People suffering from diabetes need to measure their blood sugar levels to keep it at the right levels.
Wearable technology like the Fitbit and Apple Watch help people to monitor their own health.
In 1972, Geoffrey Hounsfield created CAT scanners, which could produce 3D images of the human body.
In 1976, endoscope probes were developed which meant doctors could look inside human bodies.
In 1987 MRI scanning was developed, this gave doctors a scan of a human body using magnets.
What advances in medicines have there been in modern Britain?
In the 1890s, a German doctor called Paul Ehrlich built upon Koch’s work. This is an example which shows how scientists build upon each other’s work. Discoveries could only be made because of what others have done before. Ehrlich won the Nobel Prize for Medicine in 1908.
People knew that antibodies (found in the body) attacked different types of microbes.
Because of this, they were called magic bullets.
Paul Ehrlich decided to create magic bullets that behaved like antibodies using chemicals.
Ehrlich argued that if certain dyes could stain bacteria, certain chemicals could also kill bacteria.
This was the foundation of the idea of ‘chemotherapy’.
Ehrlich found a dye (methylene blue) that killed malaria germs and he tried hundreds of compounds to kill the bacteria behind syphilis.
He thought he had failed to find a dye to kill syphilis bacteria, but the 606th compound tried – Salvarsan 606 – worked.
It was used on humans in 1911.
This was the start of the modern pharmaceutical industry.
The second magic bullet (prontosil) was found by Gerhard Domagk (worked for Bayer) in 1932.
Prontosil is a red dye that contained sulphonamide. This killed the streptococcus microbe, but it also had bad side-effects and could damage the kidneys and liver.
Despite these developments in antibiotics, scientists learned that they could be overused.
If antibiotics were used too much and not all bacteria dies when antibiotics are taken, then bacteria can evolve and become resistant.
If antibiotics stop killing bacteria then surgery and infections would be more similar to the Middle Ages.
If the bacteria can’t be killed this would make surgery less common because more people would die from infections.
The first resistant bacteria called methicillin-resistant Staphylococcus aureus (MRSA), appeared in 1961.
MRSA infections have been reduced after the NHS encouraged medical staff to wash their hands continuously throughout the day.
This is consistent with Pasteur’s Germ Theory and aseptic surgical methods. Things like disposable surgical gloves are useful for this.
What new approaches to prevention have there been in modern Britain?
Vaccination campaigns and lifestyle campaigns have both been used in the 20th century to stop people from getting diseases or illnesses in the first place.
If a high percentage of the population is vaccinated against a disease, then the spread of contagious disease is a lot slower.
Vaccination is still very effective, even if not everyone is vaccinated.
Vaccination campaigns can get enough people vaccinated for there to be herd immunity.
The diptheria vaccine was introduced in 1942. Before then it killed around 3,500 children each year.
Diptheria was a bacterial disease that could cause heart failure and paralysis.
People feared that wartime conditions would make diptheria more common, so the government introduced and advertised the vaccination (in newspapers, radio and posters).
Polio is caused by a virus and can cause paralysis. It attacks the body's nervous system and blood.
Polio caused up to 750 deaths and thousands of disabilities each year.
The polio vaccine was introduced in 1956 and a campaign to vaccinate everyone under 40 was launched.
By 1980, polio had been almost eradicated in Britain.
The government tried to improve people's health choices in the second half of the 20th century.
The Change4Life campaign was launched in 2009. It tried to improve people's diet and encourage exercise. Obesity has risen in the UK and it causes lots of health problems.
The consumption of alcohol has risen in the last 50 years. The government's 2004 Drinkaware campaign aims to reduce drinking.
These interventions are very different to the laissez-faire policies of UK governments 100-300 years ago.
From 1946 to 1969 free vaccines were made available in the UK.
These were for diseases such as tuberculosis, diphtheria, tetanus, polio, measles and rubella.
In the 1950s, Peter Medawar developed anti-histamine, which helps prevent allergies.
In the 1970s, Patrick Steptoe discovered IVF fertility treatment to help pregnancy. In 1978, Louise Brown was the first IVF baby.
How have medical and surgical treatment in hospitals changed in modern Britain?
The two World Wars drove improvements in surgery in Britain. Orthopaedic surgery and neurosurgery both began in World War One.
Anaesthetics were developed which enabled patients to remain unconscious for longer.
This meant doctors could try more complicated procedures.
In 1950, William Bigelow performed the first open-heart surgery. Anaesthetics made more complex surgery like this possible. In 1958, a pacemaker was fitted in the heart.
Keyhole surgery was created. This means the surgeon could perform an operation through small incisions.
Keyhole surgery needed improvements in video so that tiny cameras could be put into the body to do surgery.
Using miniature instruments and fibre-optic cameras, surgeons can perform operations which reconnected nerves and blood vessels together.
Radiation therapy was advanced in the 20th century by Henri Becquerel and Marie Curie. This means the surgeon uses high-energy radiation on a patient with cancer.
This helps surgeons kill cancer cells and reduce the size of tumours.
X-ray machines were used to make surgery more effective. They could identify what was wrong with a patient before and during surgery to make it more effective.
Laser surgery was first used in 1987 in eye surgery.
Alongside eye surgery, lasers can also help treat skin conditions, remove ulcers, control bleeding and help remove blockages in arteries.
A prosthetic limb is an artificial body part that can replace arms or legs. Pare had designed some prosthetic limbs but investments after the world wars improved the technology.
In 1972, John Charnley made the first hip replacements and in 1984, skin grafts became widely available.
In the 1990s, prosthetic limbs with microprocessors were released.
Some surgeons now do robot assisted surgery.
The robot is controlled by the surgeon. This became more common after 2000.
Robot assisted surgery can make smaller cuts than surgery done by humans. This reduces the size of scars and the chance of infection.
In 1952, surgeons successfully performed an organ (kidney) transplant. The first organ transplant in Britain was in 1960.
The first heart transplant in Britain was in 1968.
In 1986, a British woman called Davina Thompson becomes the first patient to successfully receive a heart, lung and liver transplant.
Transplanted organs were often “rejected” by the body because the body’s immune system recognised that the body parts were not from that person.
Immunosuppressant drugs can stop the body from rejecting transplanted organs.
In 1970, a British scientist called Roy Caine developed a drug (immunosuppressant) which stopped the body rejecting transplanted organs. This was called cyclosporine.
In 2006, the first partial face transplant was successfully performed.
In 2008, the first full face transplant was successfully performed.
Henri Becquerel and Marie Curie discovered radiation in 1898.
Since then, radiotherapy has been used to kill cancer cells. Radiotherapy targets cancer cells using gamma rays and X-rays.
In World War 2, doctors found that some drugs could treat cancer. This is called chemotherapy.
Some drugs like folic acid can stop cancer cells from growing.
The latest treatments of cancer are called immuno-oncology.
They involve using the body's immune system to attack cancer cells.
White blood cells called T cells can target and kill the cancer cells.
In 1953, Leroy Stevens discovered stem cells.
These are cells which can renew themselves.
In 2013, the first human liver was grown only using stem cells.
What advances in understanding the causes of illness and disease have there been in modern Britain?
Viruses are pathogens (micro-organisms that cause disease). They are not bacteria and could not be seen under microscopes by people like Koch and Pasteur.
In 1892, Dmitry Ivanovsky stumbled upon the tobacco mosaic virus in plants. He found that some microbes stayed even after all bacteria microbes were killed.
Martinus Beijernick was the first to call these microbes 'viruses' in 1898.
Viruses could not be killed by antibiotics. This meant that a new treatment had to be found and they were approved for use on people.
Antiviral drugs can stop viruses from growing in the body, but they were not discovered until a lot later in the 1950s.
Antibiotics kill bacteria, but antivirals only stop viruses from growing, they don't kill them. The body (and its immune system) must kill the virus.
Today, doctors cannot cure all infections and diseases.
Viral infections like AIDS and some types of cancer cannot be completely cured.
Today, lots of illnesses are created by people themselves.
Smoking cigarettes (tobacco) can cause cancer (usually lung cancer).
Eating too much unhealthy food can lead to obesity, which is linked to type 2 diabetes and heart disease.
Drinking excessive amounts of alcohol can lead to cirrhosis of the liver.
In 1953, Francis Crick and James Watson from the University of Cambridge mapped out DNA structure.
This allowed developments in gene therapy, genetic screening and genetic engineering.
In the 1990s, the Human Genome Project was launched, this was designed to identify all 40,000 genes in the human body.
How has access to care improved in modern Britain?
Before the 20th century, the British working classes suffered from poor living conditions. Overcrowding and unsanitary housing was a problem for the working classes living in poverty.
In the 20th century, the government began to change their policy from ‘laissez faire’ to the creation of a welfare state.
This was influenced by the reports of Charles Booth and Seebohm Rowntree.
Booth investigated living conditions in London in his 1889 report “Life about Labour of the People in London”
He discovered that 30% of the London population lived in poverty, despite having jobs. Some wages were so low that people couldn’t afford to live.
He showed that poverty was linked to the nation’s high death rate.
He highlighted that there was a poverty life-cycle. This meant that people’s economic status could fluctuate during their life.
Rowntree was a factory owner in York. He investigated the living conditions in York in 1901.
Rowntree invented the term ‘poverty line’. This meant the minimum amount of money a person needed to earn to stay out of poverty.
He estimated that at 28% of the city’s population, at some point in their life, were below the poverty line.
The Boer War was fought between Britain and the Boers (Dutch settlers) in South Africa.
In 1899, when it started, over a third of volunteers to join the army were unfit for service.
Lots of people had illnesses that were linked to poverty and poor living conditions.
A governmental committee discovered that many men were unfit for service because they led unhealthy lives.
Booth, Rowntree and the Boer War all showed that public health could be improved. The Liberal Party, led by David Lloyd George took action from 1906. The Labour party was founded in 1900 and the Liberals wanted to keep the support of the working classes.
Politicians were also anxious to improve public health as they feared it was causing a decline in Britain’s industrial power.
For example, Germany had greater industrial strength and had passed social reforms to help workers.
In 1906, the Liberal Party provided free school meals for poor children.
In 1907, a medical service for school children were established. This gave children free inspections and later free treatment.
In 1908 the government passed the Children and Young Person’s Act. This meant that children were protected in the eyes of the law against parental neglect and abuse.
In 1908, Old Age Pensions were introduced for the elderly, supported by taxes.
In 1909, the first job centres (labour exchanges) were created.
In 1911, The National Insurance Act was introduced. This provided unemployment benefits, free medical treatment and sick pay.
These reforms improved the living conditions of the poor, the unemployed, the elderly and the young.
Improving quality of nutrition and living conditions was a big preventative step in stopping people becoming ill.
When children were evacuated to the countryside during World War One, more people realised the differences in living standards between people in different areas.
Some evacuated children were in a very unhealthy state.
The need to raise large armies made the government aware of the problems created for society by an unhealthy workforce.
The government realised the importance of having a healthy population. David Lloyd George wanted to have ‘homes fit for heroes’.
After the First World War, overcrowded housing was banned.
In 1918, it became compulsory for local councils to provide health visits and support for pregnant women.
In 1919, councils started to build housing for poor families.
In 1919, a Ministry for Health was set up.
This looked after sanitation, healthcare and the training of doctors and nurses.
In 1934, the Free School Milk Act meant children could have free milk in schools. This was critical as Britain was hit by the Great Depression.
Evacuated children in the Second World War triggered outrage as people saw how unhealthy they were.
Almost 1 million homes were built by the Labour government between 1945 and 1952. The New Towns Act of 1946 created whole new towns (like Milton Keynes and Telford) close to large cities.
In 1942, Sir William Beveridge (a Liberal politician) wrote a report about the state (government) called the Beveridge Report. It was very popular and sold over 100,000 copies within a month.
The report claimed that everyone had a right to be free of the ‘five giants’: disease, want, ignorance, idleness and squalor.
It highlighted that people’s quality of life needed to improve and suggested that the government should be responsible for this.
The report suggested that welfare should be available to everyone in need. It should be paid for by tax payers, non-means tested and compulsory for everyone.
The government’s involvement in improving public health and social security is called the welfare state.
The welfare state was implemented by the Labour Party led by Clement Attlee in 1945.
The welfare state included a health service that was “free at the point of delivery”, a weekly allowance for families to look after their children and a ‘benefits’ system to give financial help to the very poor.
In 1946, the New Towns Act was set up to plan new towns.
In 1956, the Clean Air Act established smokeless zones in cities.
In 1980, the Black Report said that there were still inequalities in health between the rich and poor.
How has the NHS impacted medicine in modern Britain?
The National Health Service (NHS) was set up by Aneurin Bevan in 1948. People had received free healthcare during the war (from the Emergency Medical Service) and people wanted the service to continue.
There was not unanimous support for the NHS.
Doctors did not want to be employed by the government. This public good meant that doctors could lose some of their income.
Bevan promised to pay doctors a salary and allowed them to continue working privately as well.
Lots of Conservatives disliked the NHS, but it was too popular to abolish.
The cost of the NHS has increased dramatically in the last 70 years.
The original plan was to pay for the NHS through National Insurance contributions. But this only covered 10% of costs.
In 1948, the NHS budget was estimated to be £15 billion.
In 2015/2016, the NHS budget was estimated to be £116.4 billion.
The NHS has been relatively successful.
Child mortality rates have fallen (and maternity services are likely to have helped this).
New and improved hospitals have better facilities
Vaccinations provided under the NHS have got rid of diseases like tuberculosis.
Healthcare and affordability of treatment is a lot better in Britain relative to the United States.
Today, drugs are very expensive. Medicine lets people live longer, but older people on average need the NHS more. This increases the cost of the NHS.
The question today is, who should pay for which treatments and how can enough money be raised to pay for all the treatments needed?
To deal with these questions, the National Institute for Health and Care Excellence (NICE) have a metric called a Quality Adjusted Life Year (QALY) valuing a life at £30,000 per year. This metric helps to compare where money should be spent.
Preventative health care is often cheaper than medical treatments. Campaigns encouraging healthy eating & discouraging smoking and drinking have been introduced.
The healthy eating campaign promotes eating five portions of fruit and vegetables every day. In 2005, tobacco advertising became banned by law.
Things like cancer screening are preventative measures that try to find people vulnerable to cancer or in the early stages so that treatment is more cost effective and people get less ill.
How did factors work together to bring about developments in medicine in modern Britain?
Communication and knowledge: Revolutionary ideas can diffuse slowly. Fleming’s discovery was not recognised for many years.
However, the printing press allowed his publications to be read more widely and they reached Florey and Chain.
Discoveries from France (Pasteur) and Koch (Germany) spread faster because of improvements in communication.
Government: The US government funded the initial mass production of penicillin.
The improvements in living standards in the UK only really came from government action.
Mandatory reforms in the form of the 1875 Second Public Health Act and the Welfare State seem to have had the largest impact on living conditions.
War: Chain and Florey received funding to mass produce penicillin partly because of World War Two.
The World Wars meant that a lot of people needed plastic surgery and prosthetic limbs.
Blood transfusions were needed on the battlefield.
The Boer War made Parliament realise that a malnourished population was not in their interests.
Individuals: Individuals like Louis Pasteur, Robert Koch, Alexander Fleming, Sir William Beveridge and Seebohm Rowntree all had impacts on society larger than you would expect from one individual.
Science involves the objective observation of outcomes, but it also requires building upon the knowledge of previous scientists.
Blood transfusions needed an understanding of blood groups, which relied on the discoveries of William Harvey around circulation.
Chance: Fleming discovered penicillin because he left bacteria out in his laboratory.
Lots of people only discovered the unhealthy state of British children because of evacuation in the war.
The Liberal Party was influenced by the launch of the Labour Party in 1900 as it pushed through its reforms at the start of the 20th century.
How was penicillin developed?
Alexander Fleming worked in an army hospital in World War 1. He saw lots of soldiers die after their wounds became infected with the Staphylococcus bacteria.
In 1928, Fleming accidentally left out some Staphylococcus bacteria in his laboratory. Mould grew on one of the plates with the bacteria and this stopped the bacteria from growing.
This mould was a fungus called Penicillin. Fleming called it a natural antiseptic (it is actually an antibiotic).
He published his research in 1929, but this was not recognised immediately.
Howard Florey and Ernst Chain read Fleming’s article. They experimented on mice at the University of Oxford and then tested penicillin on humans.
It worked, but the doctors did not produce much penicillin.
The scientists had to find a way to mass produce penicillin.
In 1939, the British government would not fund the project because they were too focused on the war and chemicals companies were producing explosives.
In the Second World War, lots of soldiers got infected wounds.
The USA government funded the team and then Britain in 1943 began to mass produce penicillin.
Fleming, Florey and Chain won the Nobel Prize in 1945 for their discovery of penicillin.
In 1945, Margaret Hutchinson Rousseau developed the technology to produce penicillin on a large scale. It is estimated that 15% of injured US and British soldiers would have died if they did not have penicillin.
After the war, chemical companies began to sell penicillin to the general public as an antibiotic. The cost of producing penicillin fell as more was produced.
Following this, other antibiotics were also developed. This included streptomycin (1944) for tuberculosis and tetracycline (1953) for skin infections.
Fleming only discovered penicillin because he accidentally left out some bacteria samples. This was very lucky.
Penicillin could only really be mass produced because of government funding.
Again, the importance of funding and communication were important in the development of medicine.
How has lung cancer been fought against in the twenty-first century?
36,000 people in the UK die from lung cancer each year.
Scientists think that 89% of lung cancer cases are preventable and these are usually linked to smoking tobacco (cigarettes).
Smoking became very popular in the First World War.
Doll and Hill found a link between smoking tobacco and cases of lung cancer in 1950. Scientific research (often funded by governments) helped to find this link.
X-rays and CT scans can create images of people's lungs to help diagnose lung cancer.
Modern cancer treatments like chemotherapy and radiotherapy can treat lung cancer, as well as surgery (taking out tumours or a lung).
The Royal College of Physicians recommended stopping tobacco companies from advertising in 1962.
TV adverts were banned in the UK in 1965.
Health warnings were put on cigarette packets in 1971.
In England, smoking in public places was banned in 2007.
19% of men and 15% of women still smoked in 2019, despite these campaigns and scientific advances.
Although smoking is less common, attitudes in society have not shifted completely. This may be because of complex social factors, as well as the addictive nature of cigarettes.
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