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Will contain everything you need to know for a grade 9 in History: Medicine in Britain
What was the Church?
What was the effect of the Church in medieval medicine (x3 details)?
The Roman Catholic Church was an extremely powerful organisation and seeked to control views on disease.
They encouraged people to view disease as a punishment from God. This hindered progress as people were encourages to just pray and repent instead of trying to find the real cause.
Scholars of Medicine were taught the works of Hippocrates and Galen, as this was in line with the Christian belief that God created human bodies and had to make them perfect.
Human dissection was banned so medieval Doctors could not discover correct ideas about Human anatomy but relied on Galen’s incorrect ideas which were based on animal dissection.
Supernatural beliefs for the causation of disease (x3 details) in medieval England?
Disease was seen as a punishment from God because of people’s sins.
Disease could be caused by supernatural evil beings such as demons or witches - so people were tried and executed for this.
People believed that it could be caused by evil spirits living inside someone. So members of the Church would attempt to use chants to expel these spirits
Rational theories for the cause of disease in medieval England (x2 ideas):
The Four humours:
Idea created by Hippocrates in ancient Greece: It claimed that the body had 4 fluids (or humours): blood, phlegm, yellow bile and black bile. An imbalance caused disease.
It was developed by Galen in ancient Rome: He suggested that this imbalance could be treated with food which had it’s own humour e.g. someone with a cold with too much cold, wet phlegm could be given something dry and hot such as pepper.
Miasma Theory:
This was the belief that bad smelling air caused disease.
It could be caused by anything: from dead bodies to human waste.
The idea originated from ancient Rome and Greece.
Even Galen acknowledged it
It remained influential until the 1860s, when it was disproved by German Theory
Hippocrates & Galen (x4 points):
Role of the Church?
Influence of their ideas?
They wrote their beliefs about medicine down in books. That were translated into Latin by the Catholic Church.
The Catholic Church taught it as the absolute truth so it could not be challenged
Many of the ideas were taught for centuries and the incorrect ideas continued and since the ideas were based on animal dissection and Human dissection was banned the ideas could not be challenged.
Some of their ideas are still used today such as the Hippocratic Oath. The idea that the doctor should observe the patient when diagnosing is also still used today.
Religious medievals treated disease by (x3 ways)…
Pray and repentance:
Since disease was seen as a punishment from God, sick people prayed.
Medieval people went on pilgrimages to sacred places to attempt to cure disease. (This just spread it to other people though). Even doctors encouraged did this.
Flagellants were people to whipped themselves in public to show to God that they were sorry and for God to cure them.
4 Humours way of treating disease (2 methods):
Bloodletting and Purging:
These aimed to balance the 4 humours.
If someone was believed to have too much blood in them, blood was removed (via leeches or a cut). Many people died when too much blood was removed.
Purging is similar but removed different bodily fluids through vomiting or excreting. Doctors gave their patients laxatives to help with this.
Food and drinks:
These had properties and were used to balance the 4 humours. E.g. when someone had a fever which was “hot and dry”, a doctor would give something “cold and wet” such as a cucumber.
(Most) rational method medievals prevented disease:
Purifying the Air to remove miasma:
Miasma theory stated that bad air caused disease. So people would clean and/or purify the air.
Physicians carried fragrances such as oranges and posies when visiting patient to protect them from miasma.
Homes had herbs and frangrents placed inside and incense was burned to reduce the bad smell (especially during the Black Death).
Name of medications medievals used to treated disease?
Remedies:
These could be brought from an Apothecary, local wise women or made at home.
They contained herbs, spices, animal parts and minerals. These remedies were either passed down by word of mouth or recorded in books. Some of these books were called “Herbals”.
Some remedies were based on superstition such as lucky charms which had “powdered unicorn’s horn”.
Who was the most trained at treating disease in medieval England?
Physicians:
They were male doctors who had been to university for at least 7 years.
The read ancient texts and writings from the Hippocrates and Galen as well as the Islamic world but had little practical experience.
They carried handbooks (vademecums), which (alongside clinical observation) would be used to check a patient’s condition.
In 1300, there were less than 100 physicians in England: only the rich could afford them
Who prescribed medication in medieval England?
Apothecaries:
They prepared and sold remedies and gave advice on how to use them.
Apothecaries were trained via apprenticeships and most were men. But there were also some “wise women”, who sold remedies.
Apothecaries were the most common form of treatment at the time, as they were accessible by being cheaper than a Physician.
There were also “Quacks”, people without medical knowledge who sold remedies. There were often found at fairs and markets, their remedies often did more harm than good.
Who dealt with operations in medieval England?
Barbers: (Not doctors)
They also cut hair and had very little to no medical training.
These barbers with little medical insight meant that they neither could experiment with new treatments and wanted to.
Surgery was dangerous because of blood loss, infection and pain. It was only done for minor procedures such as pulling teeth, or treating cataracts.
Where were patients treated in medieval England on mass (x5 points)?
There were few public Hospitals so people were mainly treated at home, by their family (usually the women).
Most hospitals were run by monasteries and were highly regarded and popular.
They were good for a patients health because they were more hygienic than anywhere else. They seperated clean and dirty water, they had one water supply for cooking and drinking and one for drainage and washing, so people did not drink dirty water (which could cause disease). They also had a good system to deal with sewage.
The main purpose for hospitals was to care for the sick and elderly but not to treat them. They provided food, water and a warm place to stay.
They also provided some basic medical treatment as monks had access to books, knew how to grow herbs and make herbal remedies.
What was the Black Death?
What were the subtypes of Black Death?
How many did it kill?
These were a series of plagues, first arriving in Europe in the mid 14th century.
There are 2 types:
Bubonic plague: this was spread by bites of fleas from rats carried on ships. They caused headaches, a fever and pus filled swellings on the skin.
Pneumonic plague: This was airborne and spread via coughs and sneezes. It attacked the lungs causing victims to cough up blood and find it painful to breathe.
It arrived first in England in 1348. It caused the death of about 1/3 of the British population from 1348-1350.
What did people believe caused the Black Death (x4 ideas)?
No-one knew the right answer but several ideas were suggested:
Religious: It was a punishment from God to the sinners of the world. People fasted and prayed with Flagellants whipping themselves to show to God that they were sorry.
4 Humours: Bloodletting and purging was attempted.
Miasma: So incense was burned and herbs placed.
Astrology: These believers carried diamonds and rubies to act as charms to protect against the Black Death. “Magical” potions with arsenic were also used.
But all was in vain as without knowing the cause, prevention and treatment was rendered ineffective.
Governmental (including local) actions during the Black Death (x4 actions):
People in Winchester believed you could catch the disease from dead bodies, so when the town’s cemetery became overcrowded they refused to expand it but created new burial grounds outside the city.
The town of Gloucester isolated itself after hearing the new disease had reached Bristol. This suggests they believed the disease spread from human to human contact. But the attempt failed and still many died from the Black Death.
By November 1348, the Black Death had reached London. In January 1349, King Edward III took the decision to shut down Parliament.
In 1349, Edward III sent orders to the Mayor of London to remove filth from the streets to reduce miasma, hoping to reduce disease.
Outline the change during the Renaissance (x5 details)
Rediscovery of knowledge: mainly from classical Greek and Roman times. Western doctors gained access to the original writings of Galen, Hippocrates and Avicenna (famous Persian physician who lived around 1000 AD). This lead to greater interest in the 4 Humours and theory of opposites.
Modern scientific method: People started to question old ideas and began to base ideas on the human body from direct observation and experimentation.
New books: These stressed the importance of dissection to anatomy and encouraged people to make their own conclusions from their own experiments.
Ideas of Galen declined: People began to question Galen’s thinking and that of other ancient doctors.
Religious change: The reformation by Henry VIII caused a decline in the Church’s power and the restrictions it had placed on the progress of medicine.
What major institution was set up in the early Renaissance (x3 details)?
The College of Physicians:
This was set up in 1518.
They read the books of Galen, however also studied recent medical advancement. Dissections for Physicians became a key part of medical training.
The College also encouraged the licencing of Physicians which reduced the impact of “Quacks” who sold fake medicine whilst holding no medical knowledge.
Some of the instituatio’s members such as William Harvey made important discoveries about disease and the human body.
What advancements of England helped medicine in the Renaissance (x3 details)?
New weapons like cannons and guns were used in War. This lead to new injuries and more of these injuries. This meant Doctors and surgeons were forced to quickly find new treatments.
Technological developments included the invention of forceps by Peter Chamberlen in the 1600s, which are still used today to help with childbirth.
Explorations came back with new ingredients for drugs. This included quinine, a treatment for malaria (made from the bark of a Cinchona tree) and guaiacum which was believed to cure syphilis.
Impact of religious change in the Renaissance (x2 details)?
The closure of Monasteries in England’s Reformation caused the closure of a large number of hospitals which were run by Monks of the Monasteries. In the short term this was bad.
These hospitals were gradually replaced by some free hospitals, which were paid by charitable donations. These were run by trained physicians and the focus shifted from just caring for the sick (like the monasteries) to curing and helping the patients get better.
Who was Vesalius?
What did he do?
Vesalius was a medical professor (born in 1514) who believed that surgery was only possible if doctors had correct anatomical knowledge.
He was allowed to perform dissections on criminals who had been executed and published his results in books (with help from the printing press). Most famous was “The Fabric of the Human Body” in 1543.
What was Vesalius’s impact (and its limitations)?
His found several mistakes in Galen’s works such as there being no holes in the septum of the heart. This was the beginning of the scientific method. It encouraged other doctors to further research and dissect.
But the limitations of his work was that it did not have a direct impact on the diagnosis or treatment of disease, but this was an essential first step for medicine.
Who was Thomas Sydenham?
What was his impact?
He was a Renaissance physician (1624-1689).
Long term impact: He wrote a book called “Medical Observation” in 1676, which was used as a textbook by doctors for 200 years because of its detailed description of diseases.
Short term impact: Not much as his work was believed in the short term.
What did Sydenham do (x3 points)?
He started the modern method of diagnosis by observing the symptoms to decide on a treatment.
He showed that scarlet fever was different to measles and introduced laudanum to relieve pain.
He was also one of the first to use iron to treat anaemia and quinine for malaria.
What did Sydenham believe (x3 points)?
He did not believe in the value of theoretical knowledge, instead he believed in practical methods such as treating patients. He made detailed observations and kept accurate record of patients symptoms.
He believed in diagnosis (identification of the nature of the disease based on examination of the symptoms) not former prognosis (predicting what the disease will do next).
He believed diseases could be classified like animals or plants and the classification could be based on the patient’s symptoms.
Who was William Harvey?
What did he do?
A member (1578-1657) of the Royal College of Physicians, Royal Physician to James I and Charles I.
He studied how hearts worked and proved the previous theory of blood being produced by the liver and lungs and being used up in the body was wrong. He proved this by measuring the volume of blood flow of an animal, which was too high for the animal to constantly be producing the blood: he concluded that blood was not produced and “burned” but flowed around the body.
What was Harvey’s short term impact (x3) and long term (x2) and its limitations?
Long term:
It was a breakthrough as his discoveries gave doctors a map (of blood vessels) to use during blood transfusions and complex surgery. Without it such things would not have been able to happen.
He proved how Vesalius was right about dissecting.
Short term:
This could be argued to be limited as blood transfusions rarely worked (die to blood loss, shock and wrong blood types were used). This created doubt around his theory.
Bloodletting, based on the 4 Humours, after the reasoning behind it was proved wrong, still continued to be performed.
But he did become a Physician for the Monarchy so he was partially believed.
What limitations were there regarding books before the Printing Press (x2 details)?
Making a single copy of a book by hand could take many months or even years.
Ideas had to be widely accepted before anybody would go through the effort of copying them by hand
When was the first Printing Press (in Britain) and what did it allow (x3 points)?
The first British example was in the 1470s.
It helped as ideas could be spread and debated more easily. Ambroise Pare (1510-1590) was a French army surgeon whose ideas were helped by the Press to spread. The ideas influenced many book and was translated into many languages.
This allowed allowed people to question old ideas, there were 600 different editions of Galen’s books printed between 1473 and 1599. This made his ideas more unclear and seem less reliable.
What was the Royal Society?
A prestigious scientific body founded in 1660 and was given the Royal Charter in 1662.
How did the Royal society improve progress (x5 points)?
It helped in spreading scientific ideas, validating them (by peer review) and funding translations to allow them to be read in Britain regardless of the original language.
It encouraged the usage of new technology such as the microscope.
It’s motto was “Nullius in verba”, take no one’s word for it. This encouraged the scientific method and questioned ideas, which allowed for progress by recognising wrong ideas.
It published a yearly scientific Journal showcasing the recent inventions and discoveries, speedlining the spread of ideas.
It published Robert Hooke’s “Micrographia” in 1665, which contained the drawing of a flea under a microscope.
What caused continuity in the Renaissance (x3 points)?
Some doctors refused to accept that Galen was wrong so they continued to treat disease like the medieval times. There was still a focus on reading book to become a better doctor rather than treating patients.
People continued to use other healers because doctors were still very expensive. Some people still relied on “quack” doctors, who sold fake medicines and treatments on the street.
Superstition can religion was still important e.g. people believed that to cure scrofula (a skin disease) you needed a King’s touch. Thousands of people with scrofula visited Charles I (1600-1649) hoping to get cured.
Where was a common place to seek care in the Renaissance(x2 points)?
In the Community or at Home.
Wise women, who were skilled in herbal remedies continued to provide medical help within the community. This role was sometimes taken by wealthy ladies who cared for local families.
One such woman was Lady Grace Mildmay (1552-1620), who was highly educated and read lots of medical books. She used her knowledge to treat patients and kept detailed records of her treatments.
How were Hospitals in the Renaissance (x5 points)?
Most were for the sick and “deserving” poor, those who led hardworking respectable lives.
Patients may also need to work in the hospital, not just get treated.
Those with incurable or infection diseases like smallpox were often not allowed in.
St Mary of Bethlehem’s (or “Bedlam”) was Britain’s first “lunatic” institution. Many of the inmates had learning disabilities or epilepsy or were just poor. People even visited the hospital to watch the patients for fun.
Other hospitals like St Bartholomew’s in London became centres of innovation and research.
What was the Great Plague and when was it?
What was the death toll?
Who was most and least affected?
In 1665, London was stuck by the Great Plague. This was a rare but deadly recurrence of the medieval Black Death.
In London, about 100,000 died (20% of the city’s population).
Many richer people were able to flee the city.
Doctors and priests were often the most affected because the poor went to them for help.
Compare the reaction to the Great Plague to that of the Black Death (x3 points).
People still believed in superstition also wore lucky charms, prayed and fasted.
Bloodletting was still used although this made the Plague worse as the wounds could get infected.
People still believed that miasma caused the disease so carried around herbs or flowers to improve the smell of the air.
Differences between the Black Death and the Great Plague (x5 actions)?
There was large governmental action to suppress the spread of the disease:
Councils quarantined plague victims to prevent the passing on of disease. The victim’s house was locked and a red cross was painted on the door, with the words “Lord have mercy upon us”.
Areas where people crowded were shut such as theatres.
Dead bodies were buried in mass graves away from houses. Carts organised with death bodies roamed the street with the cry of ”bring out your dead!”, to collect corpses for burial.
Local councils paid for cats and dogs to be killed because they thought they carried the plague.
And some change in the ideas of the people: they avoided touching on another and shopkeepers used a jar of vinegar to sterilise coins.
How many did smallpox killed?
How was it prevented before Jenner?
In the 1700s, smallpox was one of the most deadly disease. In 1751, it killed 3500 in London alone.
The prevention of smallpox was done by inoculation, which was the scratching of a patient’s arm then soaking it in pus taken from the swelling of someone with a mild form of smallpox.
How did Jenner theorise the solution (x4 points)?
Edward Jenner (1749-1823) was a country doctor. He heard that milkmaids did not get cowpox but got the milder cowpox.
Using scientific methods Jenner investigated and confirmed that the claim was true. This was unusual for the time as although there were experiments in the Renaissance, doctors did not test their theories.
In 1796, Jenner infected a small boy, James Phipps with cowpox form the sores of Sarah Nelmes, by scratching his arm then introducing the pus. Jenner then infected the boy with smallpox but James did not catch the disease.
Jenner published his findings in 1798. The term “vaccination” came from the latin for cow “vacca”.
Did Jenner meet opposition?
How was his discovery implemented (x4 points)?
Some people did resist the new idea, some doctors who specialised in inoculation saw this as a threat against their livelihoods. Others feared getting a disease from a cow.
But in 1802, Parliament approved Jenner’s discovery and gave him £10,000 to open a vaccination clinic. A few years later it have Jenner a further £20,000.
In 1840, Parliament passed an act which made it free for infants to get the vaccine.
In 1853, Parliament made it compulsory to get a vaccination. This was unusual for the mostly laissez-faire style government.
In 1898, this obligation was removed.
What was the positive and negative impact of Jenner (1 each)?
There was a big fall in the number of smallpox cases in Britain
But there was a lack of understanding, which meant more vaccines could not be developed until after the Germ Theory. So this was a fluke breakthrough that relied mostly on luck.
What was the main belief for Germs before Pasteur?
Germs were discovered as early as in the 17th century.
But people though they were created by decaying matter (spontaneous generation) and disease caused germs.
Others thought Miasma caused disease, such as in the cholera outbreak of 1831-32 which saw governments regulate body burial.
What arguably allowed Pasteur to make his discovery?
The invention of the microscope by Antonie van Leeuwenhoek in the 17th century, which were improved on the 1800s. This allowed Pasteur to actually see the germs in much less light distortion.
What was Pasteur’s theory called?
How did he reach his conclusion (x3 points)?
When was it published?
Germ Theory
In 1857, french chemist Louis Pasteur was employed by a beer company to explain why sugar beet used in fermenting Alcohol was souring. His answer was that it was germs that caused it to sour.
Pasteur proved that there were germs in the air that caused decay by showing that a sterilised water in a closed flask stayed sterile and sterilised water in an open flask bred germs.
In 1861, Pasteur published his Germ theory. In this he argued that microbes in the air caused decay not the other way around. He also suggested they also caused disease.
Short term (x2 points) and long term (x3 points) impact of Germ theory.
Short term:
The theory was met with scepticism, people could not believe such a small thing could harm such a large thing.
Furthermore, different germs caused different diseases so they needed to be identified individually. This made it take several years before the theory became useful.
Long term: The theory gained popularity in Britain and became the basis of other theories:
The theory inspired Joseph Lister to develop antiseptics
It proved John Snow’s findings about cholera
It linked disease to poor dirty living conditions (like squalor and contaminated water). This put pressure for the government to pass the 1875 Public Health Act
Who was Robert Koch?
What did he do (x5 points)?
He was a German scientist.
He built on Pasteur’s work by linking specific disease to what microbe caused them.
He identified the pathogen that caused anthrax (1876); septicaemia (1878), tuberculosis (1882) and cholera (1883).
He revolutionised scientific methods:
He used agar jelly to create solid culture to breed lots of bacteria
He used dyes to stain bacteria to make them more visible under a microscope
He employed the newly invented photography to record his findings.
In 1885, he developed the first vaccine for rabies which saved a boy’s life. By growing pathogens in a lab, helped scientists study them better and develop vaccines.
Who was Florence Nightingale?
What did she do?
A woman (1820-1910) who studied to become a nurse in 1849.
After hearing horror stories about the Barrak Hospital in Scutari during the Crimean War (1853-56), she wanted to go.
From help of the secretary of War (Sidney Herbert), who was also a family friend, she was sent along with 38 hand-picked nurses.
She use her training in Europe to ensure the wards were clean and hygienic.
The death rate at the hospital fell from 42% to 2% after her improvements, over a course of 2 years.
Who was Mary Seacole?
What did she do?
She was a women (1805-1881) who also nursed in the Crimea.
She came to England in 1854, to volunteer as a nurse in the Crimean War. She was rejected (possibly on racist grounds) but went anyway paying for her own passage.
She financed herself by selling goods to the soldiers and travellers. Using this money, she nursed soldiers on the battlefield and set up the British Hotel which served as a hospital, shop and canteen for soldiers.
But when she came back to England after the war, she could not find a job and went bankrupt.
What was Nightingale’s impact (x5 points)?
In 1859, after the Crimean War, she published a book, “Notes on Nursing”. This emphasised hygiene and professional attitude. It became a standard nursing textbook for generations.
The public raised £44,000 to help train her nurses. Using this, the Nightingale School of Nursing was set up in St. Thomas’ Hospital in London. Nurses were taught for 3 years before they could qualify. Discipline and attention to detail was important.
By 1900, there were 64,000 trained nurses in Britain from colleges across the country because Nightingale was credited to change nursing into a respectable profession for women.
In 1919, after her death, the Nurses Registration Act was passed, this made training compulsory for all nurses.
But Florence Nightingale believed that it was Miasma that caused disease not Germ theory.
What proved a change in attitudes towards nursing?
This was finalised in 1916, when the Royal College of Nursing was founded. This proved that nursing was now seen as a respectable career for women.
What change was there with hospitals in the 1800s?
There was massive increase in the number of hospital buildings.
They became cleaner and more specialist.
They began to cater for the poor as well as the rich.
Why was pain a problem with surgery (x2 reasons)?
This was a problem as patients could die from trauma of extreme pain.
Furthermore complex operations could not be done because the patient would squirm under pain.
Timeline of development of anaesthetics
In 1799, Nitrous oxide was identified as a possible anaesthetic by British chemist Humphry Davy. He was ignored by surgeons of the time.
In 1842, American doctor Crawford Long discovered the anaesthetic qualities of ether but did not publish his work.
In 1845, American dentist Horace Wells suggested nitrous oxide for use in dentistry but his public demonstration failed because of bad luck he had picked a patient unaffected by nitrous oxide.
In 1846, American dental surgeon William Morton performed a successful demonstration of ether being an anaesthetic but ether is an irritant and fairly explosive so usage was risky.
In 1847, James Simpson found that chloroform was a safe alternative anaesthetic for women during childbirth via self-experimentation.
In 1853, Queen Victoria gave birth to her eighth child using chloroform so it became famous and frequently used.
Disadvantage of chloroform.
If overdosed it could cause patients to die suddenly from a heart attack.
What was the early effect of Anaesthetics?
Why (x2 points)?
During the “Black Period” for surgery between 1846 and 1870, deaths due to surgery increased (even after anaesthetics).
Because anaesthetics led to longer and more complex surgeries being performed because unconscious patients were easier to operate on so longer was taken over the operation.
The longer operating times led to higher death rates due to infection because surgeons did not recognise that poor hygiene spread disease.
What was the issue of the practice of early Surgeons?
Examples (x3)
They did not recognise that poor hygiene spread disease so their methods were very unhygienic:
Clean clothes were not worn, they often wore the same coats for years, these were covered with dried blood and pus from previous operations.
Operations were carried in unhygienic conditions such as at the patient’s house.
The operation instruments caused infections because they were unwashed and dirty.
What were the two main approaches to reducing infection during an operation?
Antiseptic methods used chemicals to kill germs that get near the surgical wound.
Aseptic surgical methods aim to stop any germs getting near the wound.
What was the early form of antiseptic?
Impact (x2 points).
In 1847, Ignaz Semmelweis showed that doctors could reduce the spread infection by washing their hands in chloride of lime solution.
It drastically reduced death rate from 18% to 1% in his maternity ward.
This was not very pleasant though so it was not widely used.
Who was Joseph Lister?
What did he do?
A pioneer of antiseptic surgery (1827-1912).
After seeing the use of carbolic acid sprays in sewage works to keep down the smell, lister tried this in operating theatres and saw a reduction in infection rates.
After he heard about Germ Theory in 1865, he released germs could be in the air, on surgical instruments and on people’s hands. He used the acid on instruments and bandages.
What was Lister’s impact?
Short term: The death decreased from as high as 46% in 1864-66 to around 15% 1867-70.
Long term: The number of operations increased tenfold between 1867 and 1912 as a result.
How does Lister’s method differ from the method of the late 1800s (x4 developments)?
Surgeons changed their approach from the killing germs(antisepsis) to making a germ-free environment (asepsis):
Instruments were sterilised before use in 120°C steam.
Staff cleaned their hands and wore sterile gowns, masks, gloves and hats. Surgical gloves were invented by William Halsted in 1889.
Operating theatres were kept very clean and fed with sterile air. Special tents could be placed around the operating table to maintain even stricter hygiene in high risk cases.
Aseptic surgery reduced the need for carbolic spray, this was unpleasant to get on the skin or breathe in, many doctors and nurses did not like it.
How was waste water treated before John Snow (x3 points)?
Most houses did not have a toilet but instead shared an outside toilet, called a privy.
Each privy was built above a cesspit. Cesspit and household waste would be collected by Nightmen, who threw waste into rivers or piled it up for the rain to wash away.
Water companies set up water pumps in the street, these were shared by many houses. The pump’s water supply was often contaminated with waste from cesspits or rivers.
What was the state of Cholera before John Snow (x2 points)?
What did people believe and what was done about it?
Cholera reached Britain in 1831. Over 21,000 people in Britain died from Cholera in 1832.
Cholera spreads when infected sewage gets into drinking water. Both the rich and poor caught the disease.
People believed it was miasma so government started to regulate the burial of the dead, but this did not halt the spread of the disease.
Who was John Snow?
What did he do?
He was a London doctor (1813-1858)
He believed that Cholera was waterborne so he set out to prove it:
When cholera broke out in Broad Street area of London in 1854, Snow set out to test his theory.
He interviewed people living there and made a map of the area where cases of the disease had been.
Snow found that the people who drank from the pump died, even a person a few miles away who sent for the water from the Broad Street pump. But people even close to the outbreak who did not drink from the pump, such as in the Brewery, did not get Cholera (these men got their water from a deep lining of a nearby cesspit has split which had leaked into the pump’s water supply.
What was John Snows impact?
Short term:
He persuaded the local council to remove the handle from the water pump which brought the outbreak to an end.
He showed the power of the scientific method of observation and deduction.
Long term:
This link helped change attitudes, which promoted a government response to the issue to clean up streets and waterways. This contributed to the 1875 Public Health Act.
However, it took a long time for his ideas to have an impact, it was not until Germ theory that his discovery became accepted as it acquired a logic to it.
What early governmental findings led to a change in government involvement in medicine?
The impact (x2 points)
In 1842, Edwin Chadwick published a report suggesting poor living conditions caused poor health.
This led to the 1848 Public Health Act. This set up a central Board of Health and let councils set their their own similar boards.
But the impact was limited because few chose to and those that did open a board refused to spend the money.
What chance environmental factor led to progress?
It resulted in?
In 1858, sewage in the River Thames made a “Great Stink” in the middle of London due to a hot summer.
In 1865, a new sewer system was opened to prevent this from reocurring.
What was the change in Public opinion over public health in the 19th century?
Why (x3 points)?
For most of the 19th century, they believed in a laissez-faire style of government, which should not intervene in public health.
The changes were caused by:
Action of Individuals: Snow’s discovery linking dirty water to cholera and Germ Theory showing that cleaning up towns could stop the transmission of disease.
Change in Britain’s constitution: In 1867, the Second Reform Act was passed which have 1 million more men the vote, most of whom were industrial workers, who could now pressure the government to address the concerns around public health.
Writers: like Charles Dickens and philanthropists like Octavia Hill helped changed attitudes towards the poor who suffered the most unter this systems.
Timeline of the change in government attitude towards public health (x4 details)
In 1871-72, the government followed the Royal Sanitary Commission’s proposal to form the Local Government Board and divide Britain into “sanitary areas” cared after by officers for public health.
In 1875, the government of Benjamin Disraeli passed another Public Health Act it forced councils to:
Appoint health inspectors and sanitary inspectors who ensured rules were being followed e.g. on water supplies and hygiene.
Maintain sewerage systems to prevent further cholera outbreaks.
Keeps the town’s streets clean.
In 1875, there was the Artisans’ Dwelling Act which allowed councils to buy slums with bad conditions and rebuild them to fit the new government backed housing standards.
In 1876, River Pollution Prevention Act banned people from dumping sewage or industrial waste into rivers.
What was the major development in medicine for the cause of disease after discovery for bacteria?
Timeline (x2 points)
Importance?
In 1892, Russian microbiologist Dmitry Ivanovsky investigated TMV (did not know it was a virus though). He found that it was a very small microbe that remained after the bacteria were removed.
In 1898, Dutch Martinus Beijerinck found this microbes had different properties to bacteria, he called them viruses.
Viruses cannot be treated by antibiotics but only antivirals can prevent them from multiplying but the body must destroy them.
What discovery was essential for medicine in relation to hereditary diseases?
In 1953, Francis Crick and James Watson discovered the structure of DNA being a double helix
This allowed other scientists to find genes that cause genetic conditions (disease that are passed on generation to generation), such as cystic fibrosis, sickle cell anaemia etc.
In 2003, the human genome project completed which identified all the genes in the human genome, this is essential for diagnosis and treatment of genetic conditions as this allows scientists to find the issue and produce a synthetic protein to treat it.
Final factor related to disease that the patient had large control over?
In the 20th century, Lifestyle choices such as diet, exercise and among others were related to disease such as:
Smoking causes lung disease
Obesity increase chance of heart disease or diabetes
Alcohol consumption causes liver damage
Exposure to ionising radiation such as UV can cause cancers.
A change for the better in diagnosis for a range of issues in the 20th century?
What discovery kickstarted their usage?
Other uses (x3)?
Overall effect on diagnosis.
Blood tests
These were originally used after blood groups were discovered in 1901 by Karl Landsteiner as compatible blood must be used for blood transfusions.
They then got used for many other things:
Cholesterol level tests allow diagnosis of the chance for a heart attack or stroke.
DNA can be extracted and tested for whether the patient has a genetic disorder such as cystic fibrosis
Some can even be used to diagnose cancers such as ovarian, prostate and breast cancer.
This made diagnosis more accurate as it gave doctors clearer information on what was wrong allowing for more confidence in the best treatment.
What allowed doctors to view the problem better without surgery (x4 developments)?
Medical scans
First was in 1895 when Wilhelm Röntgen discovered the X-Rays, these could be used to see into the body as they could pass through soft flesh easily but not bone. This combined with the fact that they worked on photographic film turning it white. So a image of the inside could be produced.
In 1956, because of improvements in computer technology, ultrasound was invented. This used high frequency sound waves to bounce of patients organs and tissues to create an image on the computer.
In 1972, Computed Tomography (CT or CAT) scans were invented by Godfrey Hounsfield. They used X-rays and a computer to produce 3D images of the Patient’s body.
In the 1970s, the Magnetic Resonance Imaging (MRI) was invented and became widely used in the 1980s. These used very powerful radio and magnetic field to construct images.
What allowed patients to improve their own health (alongside their doctor) (x2 details)?
Overall effect?
Blood pressure monitors were developed in the 1880s and 1890s allowed for patients themselves to see what caused them health issues in the form of a high BP,. This allowed identification of whether disease, lifestyle factors or medicines caused the issue.
Sugar monitors came in the late 1970s, these allowed diabetic patients to monitor and keep their sugar levels at the right level at homes.
These important changes allowed individuals greater power over their health at home.
Who was Alexander Fleming?
What did he do?
Impact?
Alexander Fleming was a scientist (1881-1955)
He saw many soldiers die of septic wounds caused by staphylococcal bacteria when he worked in an army hospital in WWI.
In 1928, he discovered some old culture dishes on which he had grown staphylococci. He saw that they had stopped growing because a fungus Penicillium notatum had also grown (from a random fungal spore), this produced a substance which killed bacteria. He named this substance penicillin.
Fleming published his findings in articles between 1929 and 1931. But nobody was willing to fund further research so he could not take his work any further.
World’s first antibiotic had been discovered.
But, he was unable to provide an industrial process to develop it further.
What was the impact of Florey and Chain?
Penicillin was a natural product so a purification method was needed.
Between 1938 and 1940, they were able to devise the freeze-drying technique which was an important part of the purification process.
They did not have enough resources to produce penicillin in a large amount, but they made as much as they could by growing Penicillium notatum in any container in their lab that they could find.
In 1941, When given to their patient, who was suffering from certain death from septicaemia (blood poisoning), he began to recover, only tot die when the penicillin ran out.
What was the role of the USA in development of antibiotics?
UK chemical firms were too busy producing explosives for WWII.
So they turned to the US. There was not much enthusiasm until America joined the war in 1941. In December 1941, the US government began to give out grants to businesses who manufactured the drug.
By 1943, UK joined in and mass production allowed enough of the drug for military medics by 1944.
After the war, the cost of penicillin fell making it for accessible for general use.
How were those responsible for the development of penicillin recognised?
In 1945, Fleming, Florey and Chain were awarded the Nobel prize.
Who found the first Magic Bullet?
Antibodies when identified as a natural defense mechanism of the body against germs. It was known that they could only act against specific microbes so they were named magic bullets.
In 1889, Paul Ehrlich setout to find chemicals that could access synthetic antibodies. First he was able to identify dyes that could kill malaria sleeping sickness germs.
In 1905, the bacteria that caused the STD syphilis was identified.
He tried over 600 compounds based on arsenic to find a cure for syphilis without poisoning the rest of the body, but failed.
In 1909, Sahachiro Hata join the team. He rechecked the results and saw that compound number 606 actually appeared to work.
In 1911, it was used on a human under the trade name of Salvarsan 606.
Who found the second magic bullet?
Why was the significant?
How was it proven to work?
Further development showed (x2 details)?
In 1932, Gerhard Domagk found that a red dye, prontosil, stopped the streptococcus microbe from multiplying in mice without being poisonous to the mice.
This microbe cause blood poisoning which was often fatal and could be contracted from very minor wounds. Many surgeons, contracted it after cutting themselves in the operating theater.
In 1935, his daughter pricked herself with a needle and caught the disease. By afraid that she would die he gave her a large dose of Prontosil. She turned bright red but recovered.
The active ingredient of Pronto was identified as sulphonamide. A whole group of drugs based sulphonamides were made, including M&B 693, which works on pneumonia without turning you a strange colour.
But serious side effects were discovered such as damage to liver and kidneys.
The developments in the treatment of cancer.
The first treatment against cancer without surgery was radiotherapy, introduced after discovery of radiation in 1896 to 1898 by Antoine Henri Becquerel, Marie Curie and Pierre Curie. In radiotherapy they used x-rays and gamma rays to kill the cancer cells.
Chemotherapy is the treatment of cancer using drugs. It was first discovered after World War 2 when doctors found that nitrogen mustard (an ingredient in mustard gas) could reduce cancer tumors. Other drugs were later discovered including a compound in folic acid that blocked the growth of cancer cells.
Since the late 1990s, targeted therapy has been used to fight cancer a false of these used drugs to prevent cancer from spreading.
Issues with blood transfusion?
The solution (x3 details)?
Final result (x2)?
Since the 17th century, The idea of blood transfusions was known but these were not successful because the blood often clotted. Blood also clotted if it was stored outside the body.
In 1901, Karl Landsteiner discover blood groups. Certain blood groups can't be mixed as a blood will clot, blocking the blood vessels. He found that transfusions were safe as long as the patients blood match the donors blood.
In 1914, during World War I, doctors found that sodium citrate stopped blood clotting so it could be stored outside the body.
In 1916, blood was added to a citrate glucose solution, meaning it could be stored on ice for 10 to 14 days.
In 1917, this discovery was vital when the first ever blood bank was set up at the Battle of Cambrai at the suggestion of US Army doctor called captain Oswald Robertson who argued it would be better if blood was collected before it was needed.
In 1946, British National Blood Transfusion service was established.
First successful transplant?
First organ transplant?
Most major one yet?
In 1905, the first successful transplant of the cornea was performed.
In 1954, the first successful organ transplant was performed. (It was the kidney). Livers, lungs, pancreases and bone marrow can now also be transplanted.
In 1967, the first successful heart transplant was carried out by Christiaan Barnard. (The patient only survived 18 days before dying of pneumonia).
What was the main problem with transplants?
What discovery helped solve this?
How?
The main problem was rejection by the immune system: this is when the transplant is attacked because it is seen as a foreign invader (like a virus or bacteria).
The discovery of more effective immunosuppressants changed this.
Whilst before rejection was common, since the 1970s, it became less common as these drugs could suppress the immune system from attacking and destroying the transplants.
Developments with the methods of surgery (x2) and their uses (1 each)?
Impact?
In the 1980s, keyhole surgery was developed, this made surgery less invasive by using a small surgical camera called an endoscope which is put through a small cut, to allow the surgeon to see inside the body. Other instruments can be inserted via different cuts.
This is useful for investigating causes of pain or infertility. It is used for minor operations such as meding hernias, removal of the appendix etc.
In 1985, the first robot assisted surgery was introduced but it became common after the launch of the da Vinci system after 2000.
This is used for a wide range of surgeries such as on the heart, head and neck. 75% of cases of urological cancer are treated using robots in the NHS.
Both allow for smaller cuts, this means less scaring, blood loss, risk of infection and faster healing time.
What was the state of Public health around 1900?
Why?
People was health was poor at the start of the 20th century because access to healthcare was limited.
This was a very common in the poorer citizens who could not afford to go to the doctor or to buy medicine.
How did World War II help make a change of people's attitudes towards Healthcare?
The raising of a mass army made powerful people take notice of the health problems of the poor.
In 1940, the air raids of the Blitzt prompted the government to set up the Emergency Medical Service. This provided a centralized control of medical services and offered free treatment to air raid casualties. Improve successful under great pressure.
In 1942, social Reformer William Beveridge publisher report. The report called for government provision of social security “from the Cradle to the grave”. The report became a bestseller.
How was the demand for change action after World War 2?
In 1945, the Labour party was elected. They promise to action the recommendations of this report.
In 1948, the National Health Service (NHS) was founded.
Aneurin Bevan, the Minister of Health, introduced this. He wanted it to be free at the point of views, he set up a system of compulsory National Insurance to pay for it.
He persuaded doctors and dentists with fixed payments for each registered patient. There were also allowed to continue treating private fee paying patients.
By 1948 nearly all hospitals and 92% of doctors had joined the NHS.
What was the impact on the NHS?
It increased the number of people with access to health care.
The number of doctors also doubled between 1948 and 1973 to keep up with demand.
Today the NHS provides a range of health services, most of which are free and accessible to everyone. They include accident and emergency care, maternity care and even major surgery.
What is diphtheria?
How common was it and how many died from it?
What did the government do against it?
The impact?
This is a contagious disease that is called by bacteria in the nose and throat. Eventually attacks the heart muscles causing paralysis or heart failure.
Before the 1940s it was a major killer. In 1940, there were over 60,000 cases of the disease and over 3,000 deaths.
In 1940, the government started a vaccination campaign and ran publicity campaigns. They advertised it using posters, newspaper and radio broadcasts.
In 1957, the number of the Diphtheria cases had dropped to just 38 with only six deaths.
In 1940, they started vaccinating 5 to 15 year olds, even though younger children were more vulnerable, as older children were more likely to contract it from school. The establishment of the NHS in 1948, allowed the government to vaccinate all children by their first birthday.
What is polio?
How common was it?
The effect of it?
What is the government do against it?
The impact?
Polio is an infection that attacks the digestive system, bloodstream and nervous system. It can cause paralysis and particularly affects children.
In the late 1940s and early 1950s, Britain suffered a series of polio epidemics.
Between 1947 and 1958, over 30,000 children became disabled due to it.
In 1956, the first vaccine was introducing Britain, alongside a national campaign, it aim to vaccinate every person under the age of 40.
In the period of 1985 to 2002, only 40 polio cases were reported in Britain. But the disease was basically eradicated by the late 1970s.
Three problems in health since 1950 with governmental action to solve each.
An increase in a less active lifestyles has led to an increase in obesity.
In 2009, the government launched the Change for Life campaign, with the aim of improving diets and promoting daily exercise.
Excessive alcohol intake has been linked to several diseases, most notably liver cirrhosis. Alcohol intake rose between 1950 and 2004.
But since 2004, it has decreased, this may be due to the government's Drink Aware campaign launched in 2004. Its logo appears on many alcohol advertisements.
In 1952, a Great Smog was caused by coal fires in London. It caused 4,000 deaths. It proved the dangers of air pollution, which can cause breathing conditions like asthma and bronchitis.
The government passed laws and hope of limiting air pollution. These included the Clean Air Acts of 1956 and 1968.
Timeline from 1900 to present day about the occurrence of lung cancer.
Why was this?
What proved the impact of this?
In 1900 lung cancer was a rare disease but became more common by the 1940s. Today about 20% of all counter deaths in the UK are due to lung cancer. Approximately 43,500 people are diagnosed with each year.
Scientists estimate that around 90% of lung cancer cases can be linked to tobacco smoking. The popularity of this increased during the First World War particularly among soldiers. Smoking became popular among women too.
In 1950, the link between smoking and lung cancer was proven by Richard doe and Austin Bradford.
How has the advances in science and technology made it easy to diagnose and treat lung cancer?
Chest X-rays are the first means of diagnosing lung cancer. They can't show whether the person definitely has it but can show if there is anything in the lungs that shouldn't be there.
CT scans can give more detailed image of the lungs.
Doctors now use bronchoscopy to diagnose lung cancer. This involves putting a threatened thin tube into the lungs to take a sample suspected cells. It requires a local anesthetic to numb the throat.
Lung cancer can be treated using surgery, for example removing the part of the affected lung or even a lung transplant.
Other modern treatments include therapy and chemotherapy. Lung cancer chemotherapy uses a combination of several drugs which are normally injected directly into the bloodstream.
Timeline of the government's campaign against lung cancer?
In 1962, Commodore Royal College of Physicians recommended a ban on tarako advertising.
In 1965, the ads were banned from television.
In 1971, tobacco companies were forced to put a health warning on cigarette packages.
In 2006 (Scotland) and 2007 (England and Wales) they have put a band on smoking in public places.
In March 2015, Parliament passed a law requiring also great companies to use plain packaging on boxes or cigarette.
Numerate the decline in smoking.
In 1948, 65% of men smoked, whilst in 2010 around 20% smoke.
In the same period it has dropped for women from 41% to 20%.
List the key battles during World War I.
1914: The First Battle of Ypres
1915: The Second Battle of Ypres
1916: The battle of the Somme
1917: The Battle of Arras
1917: The Third Battle of Ypres
1917: The Battle of Cambrai
What happened at the First Battle of Ypres
This went on from 12th October 1914 to 11th of November 1914.
The battle was to prevent the German advancing towards the sea near the town of your prayers in West Belgium.
The British lost 50,000 troops in this battle but defended the position.
What happened at the Second Battle of Ypres?
This was a sequence of battles from April 1915 through to May 1915.
This is significant as it was the first time the Germans used chlorine gas in the Western Front.
Casualties were more than 59,000 men
By the end Germans moved about two miles closer to the town of Ypres on the Eastern side of the salient.
What happened during the Battle of the Somme?
This was from the first of July 1916 to November 1916.
On the first day alone British casualties were over 57,000 with 20,000 deaths. By the end they suffered 400,000 casualties.
This was the first use of tanks in Warfare but they were unsuccessful because they had many technical problems. The use of the creeping barrage so artillery loan from the transistors towards the German lines just ahead of British Infantry as advanced forward.
The British won forcing the Germans to retreat to the Hindenburg line.
Note 
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