Medicine Through Time

Medieval and Renaissance Medicine

Medieval Individuals:
Hippocrates:
● He was an Ancient Greek doctor, and his books and ideas were very
influential.
● Hippocrates dismissed the idea that God caused diseases and believed
that there was a physical reason for illness.
● Most of his treatments were based on bleeding and purging but also
diet, exercise and rest. He used clinical observation.
● Hippocratic Oath:
○ Doctors swre to respect and prevent harm when treating their
patients.
Galen:
● Galen was a Greek doctor who worked in ANcient Rome. He wrote many
books, and his ideas were the basis of medical training in the
Medieval period.
● He developed Hippocrates’ ideas and mainly used bloodletting or
purging to prevent and treat illness, as well as his own treatments
based on his Theory of Opposites.
● He also drew the detailed diagrams of the human anatomy using the
knowledge he gained from operating on wounded gladiators and
carrying out dissection on dead bodies.

Approaches to Treatments:
● Rational Treatments:
○ Bloodletting was the most common treatment. It was done by
either cutting a vein, using leeches or by cupping. Different
points in the body were used for different illnesses. It was
mostly performed by barber-surgeons.
○ Purging was another treatment which involved either making a
patient vomit or go to the toilet. Emetics or laxatives were
mixed by apothecaries, wise women or sometimes physicians.
● Traditional remedies:
○ The most common ones were made with herbs, which were drunk,
sniffed or bathed in.
○ Also included different food to rebalance the humours and
ointments to apply to the skin. They were made at home or
mixed by an apothecary.
 ● Religious Treatments:
○ Healing prayers and incantations
○ Fasting
○ Praying for a special mass to be said
○ Going on a pilgrimage, especially to the tombs of people noted
for their healing powers.
● Supernatural Treatments:
○ Included specific ideas for certain illnesses.
○ Treatments varied according to the horoscope of the patient.
The alignment of the planets was then checked at every stage
of the treatment prescribed.

Ideas About The Cause Of Disease & Illness:

Rational Explanations:
● Miasma:
○ Disease was transmitted through ‘bad’ or ‘corrupt’ air. This
was sometimes related to Go because bad smells were thought to
be a sign of sin.
○ Theory originated in the ancient world but continued into the
Medieval period and well into the 19th Century.
● The Theory of the Four Humours:
○ Ancient Greeks believed that the body was made up of four
different elements.
○ Believed that when people became ill, it was because the
mixture of elements was unbalanced.
○ To make people better, they tried to rebalance the humours.
○ Galen developed the theory further, by creating the Theory of
Opposites to treat illnesses. It was aimed to balance the
humours by giving the patient the ‘opposite’ of their symptoms

Supernatural & Religious Explanations:

● Astrology:
○ The alignment of stars and planets were thought to cause some
diseases.
○ Astrology was used to help diagnose what was wrong with the
patient.
○ The use of it wasn’t new in 1250, but was increased throughout
the Medieval period, especially after the Black Death.
● Religion & The Church:
○ The Church taught that God made them ill because He was either
displeased with them or was testing their faith.
○ Most people thought this was an acceptable explanation for the
cause of illness.
 ○ This belief and trust in ancient medical practises held back
medical research and meant that few new ideas about the causes
of illnesses appeared.
○ The Church had most control over people’s beliefs and ideas,
as the majority of people in the Medieval period were unable
to read and write. Due to lack of education, they were reliant
on the Church to teach them.
○ The Church also controlled education and therefore what
Physicians were taught.

Who Treated the Sick:

● Barber-Surgeons:
○ No training but could become an apprentice to learn.
○ Was cheaper than visiting a physician.
○ Basic surgery e.g. amputating limbs, with a very low success
rate.
○ Bloodletting, pulling teeth and lancing boils.
● Physicians:
○ Expensive, mainly used by the wealthy.
○ Very few of them, 1300 - less than 100.
○ Medically trained for 7-10 years at university and passed
exams.
○ Diagnosed illnesses and gave treatments or sent patients to
the apothecary or barber-surgeon.
○ Sometimes they never met the patients when treating or
diagnosing.
● Apothecaries:
○ Received training but no medical qualifications.
○ Cost money, but still cheaper than a physician.
○ Mixed medicines & ointments based on their own knowledge or
directions of a physician.
○ Herbal remedies could sometimes be effective.
● Women:
○ Mostly acted as Midwives.
○ Offered a range of herbal remedies which they mixed up or
collected.
○ Not allowed to go to University - could be apprenticed and
paid.
● Hospitals:
○ Offered comfort but no real treatment
○ Offered food, prayer and warmth for the elderly.
○ 1500-1000 hospitals, 30% controlled by the Church.
○ 500 hospitals for guild members.
 ● Care in the Home:
○ Most ill people throughout this period were treated at home by
a female family member.
○ The village ‘wise woman’ would also tend to people in their
homes for free.

Approaches to Prevention:
Many of these prevention methods were recommended in the Regimen Sanitatis - a set
of instructions provided by physicians.
● Rational Methods:
○ Bleed purging.
○ Trying to keep the streets clean.
○ Purifying the air and spreading sweet herbs or carrying a
bunch of flowers.
○ Bathing and washing.
○ Exercising and not overeating.
● Religious and Supernatural Methods:
○ Chanting incantations.
○ Carrying lucky charms and amulets.
○ Living a Christian life by praying, going to Church and
obeying the Commandments.
○ Self-punishment such as flagellation as a way of punishing
yourself so God would not.

Care in Hospitals:
● Patients and their surroundings were kept clean.
● Patients were given fresh air and plenty of rest.
● Some hospitals were built for specific infectious diseases.
● Number of hospitals increased in the Medieval period.
● Places of recuperation rather than places where people were treated
for diseases.
● Many run by the Church, emphasis was on God & healing souls.
● Many placed where travellers and pilgrims stayed on their journeys.
● People with infectious diseases or incurable conditions were usually
not admitted.

Role of the Church:

The Church’s influence over medicine meant that there was very little change in ideas
about cause of disease until the Renaissance - because the church held so much power
people found it hard to question them :
● The Roman Catholic Church was an extremely powerful organisation
during this time.
 ○ Dominated the way people studied and thought about a range of
topics including medicine.
● Encouraged people to believe that disease and illness was a
punishment from God.
○ Prevented people from trying to find cures for diseases and
illnesses - if it was a punishment from God then all they
could do was pray and repent for their sins.
● The Church made sure people learned the works of Galen as it fit the
Christian belief that God created human bodies and made them to be
perfect. It was difficult to disagree with him as Galen’s work was
so central to medical teaching.
○ Galen had used the Four Humours Theory created by Hippocrates
to make his own ideas as well.
○ Four Humours Theory - belief that the body was made up of four
fluids or humours: blood, phlegm, yellow bile and black bile.
○ The Four Humours linked to the four seasons and the four
elements. They needed to be in balance to be in good health.
○ Galen believed that diseases could be treated using opposites
using different foods, drinks, herbs and spices for certain
humours.
■ A certain food/drink/spice/herb could balance the
excessive humour that could be causing the disease or
illness.
○ Galen also incorporated the miasma theory that bad air could
also cause disease and illness. This was incorporated into his
work on the Four Humours.
● The Church outlawed dissection, which pushed back development in
medicine.
○ Meaning that medieval doctors couldn’t discover ideas about
human anatomy for themselves and had to learn Galen’s
incorrect ideas.
○ Not to dissect human bodies as it wouldn’t allow them to enter
the afterlife as their bodies would have been destroyed - thus
it was banned for the Church.

However, the Church started to lose power in the Renaissance period. New religious ideas
challenged the Church, weakening its influence. People were still very religious, but they
no longer relied on their religion for exploring the causes of diseases. Galen’s ideas were
supported by the Church, so they were relied upon less as well.
Factors causing change and continuity:
Continuity:
● Humoral Treatments:
○ People continued to treat illnesses using bloodletting and
purging to balance the humours.
● Herbal Remedies:
○ Remained popular because they were often fairly effective,
chosen because of their colour and shape.
● Miasma Theory:
○ Many believed in this, and it was especially popular during
epidemics.
● Prevention:
○ Cause of disease was still not fully understood so there was
little change in this, but people started to take more steps
to improve prevention against miasma.
● Cleanliness:
○ Remained important and people still practised the Regimen
Sanitais.
● Theory of the Four Humours:
○ It was less practised by physicians by the time of the
Renaissance, but many people still believed it and it was
still widely accepted.
Change:
● Transference:
○ Idea that disease could be transferred to a different
organism- animal or plant.
● New Herbs:
○ Exploration on different continents brought new herbal
remedies to England.
■ Quinine for Malaria
● Alchemy:
○ People begin to look more into using chemicals for cures than
humoral treatments or herbal remedies.
● Rational Ideas:
○ New ideas lead to people believing a little less in
supernatural causes of disease.
● Reduced Control from the Church:
○ Ideas spread more quicker as well as the development of more
scientific approaches to diagnosis.
● Prevention:
○ Less people going to public baths, as they found that going
would only increase the spread of disease, and it didn’t help.
● Sydenham:
○ That illness was caused by external factors.
■ Rejected the theory of the Four Humours.
 ■ Suggested grouping diseases and treating symptoms all
together rather than separately.

In the Renaissance period there was further investigation into Ancient Greek, and Roman
theories on disease and anatomy. Ideas from the Medieval period began to be challenged
and existing assumptions were tested. However, some things did still stay the same.

Physicians and Scientists:

Way in which disease was diagnosed by physicians gradually began to improve.
● Fewer believed in astrology and physicians stopped using astrology
charts.
● Due to improved knowledge on digestion, physicians realised that
urine was not a good way to diagnose disease.
● Physicians carried out more direct observations of their patients.

Transmission of Ideas:
Royal Society:
● They aimed to further scientific understanding by carrying out and
recording the result of experiments, sharing scientific knowledge
and encouraging new theories and ideas.
● From 1665, they published a journal called Philosophical
Transactions, in which scientists could study, challenge and build
on each other’s ideas. In this way, theories could spread through
the medical community quickly.
Printing Press:
● Invented around 1440 by Gutenberg. By the start of the Renaissance,
there were 100s across Europe.
● Many exact copies of text could be produced in a short amount of
time.
● Helped reduce the Church’ control of ideas as it could no longer
prevent the publication of ideas it did not approve of.
● Ideas and books of scientists and doctors could be spread more
effectively and much faster.

Renaissance Individuals:
Andreas Vesalius:
Andreas Vesalius’ work didn't have an immediate impact on the diagnosis or treatment
of disease. However, by producing a realistic description of the human anatomy and
encouraging dissection, he provided an essential first step to improving them.
 ● Born in 1514, studied in Paris in 1533 and then became a professor
of surgery in Padua, Italy.
● Believed that successful surgery would only be possible if doctors
had a proper understanding of the human anatomy.
● He was able to perform dissections on criminals who had been
executed.
○ Would also do grave robbing to operate on dead bodies to find
out more on the human anatomy.
● Would write books based on his observations using accurate, detailed
diagrams to illustrate his work.
○ Six Anatomical Pictures - 1538
○ The Fabric of The Human Body - 1543
● His findings encouraged others to also start questioning what they
already knew from Galen’s work.
○ Was able to point out some of Galen’s mistakes that he made
through his theories in the past.
■ The jaw bone wasn’t made up of 2 bones.
■ The septum of the heart had no holes in it.
○ This encouraged other medical professionals to carry out the
dissections and make further discoveries.
● Showed that dissecting bodies was important, as it was important to
find out exactly how the human body was structured.

Thomas Sydenham:
Sydenham’s work on classifying diseases helped make diagnosis a more important part
of doctors’ work. Before, the emphasis had been on prognosis - predicting what the
disease would do next.
● Thomas Sydenham (1624-1689) was a physician who worked in London.
○ Son of a country squire and fought in the English Civil War
before becoming a soldier.
○ Has been called an ‘English Hippocrates’ because of the big
impact from his medical achievements.
● Didn’t believe in the value of theoretical knowledge.
○ Thought that it was more important to gain practical
experience in treating patients.
○ As a doctor, he made detailed observations of his patients and
kept accurate records of their symptoms.
○ Had the idea that disease had nothing to do with the nature of
the person.
● Thought that disease could be classified like animals or plants.
○ Different types of disease could be discovered using patients’
symptoms.
● Known mostly for showing that scarlet fever was different from
measles and for introducing laudanum to relieve pain.
○ One of the 1st doctors to use iron to treat anaemia.
 ○ Also used quinine for malaria.
● Published a book called ‘Medical Observations’ in 1676.
○ Used as a textbook by doctors for 200 years.
○ His descriptions of medical conditions like gout helped other
doctors to diagnose their patients more easily.
● Based his treatments on the disease as a whole and did not treat
individual symptoms.

William Harvey:
William Harvey’s work played a huge role in the improvement of medicine, as he proved
that blood circulates the body and isn’t just created. A new type of water pump was
invented around the time of his birth, which is what essentially gave him the inspiration
and a comparison to how the heart worked.

● He was born in 1578 and worked at the Royal College of Physicians

before becoming Royal Physician to James I and Charles I.
○ Studied medicine at Cambridge, the Padua.
● Harvey studied both humans and animals for his work.
○ Realised that he could observe living animal hearts in action,
and that his findings would also apply to humans.
○ Known for carrying out public dissections.
● Taught the importance of observing patients and recording symptoms
rather than relying on books.
● Before Harvey, people thought there were only 2 types of blood, and
that they flowed through 2 completely separate systems of blood
vessels.
○ Purple Blood - ‘nutrition-carrying’ blood was produced in the
liver and then flowed through veins to the rest of the body,
where it was consumed.
○ Bright Red Blood - ‘life-giving’ blood that was produced in
the lungs and flowed through arteries to the body where it was
consumed
● Harvey realised that the above theory was wrong.
○ From experiments - knew that too much blood was being pumped
out of the heart for it to be continually formed and consumed.
○ Instead he thought that the blood must circulate - it must go
round and round the body.
○ Disproved Galen’s theory of blood being produced by the liver.
● Researched Vesalius’ theory that blood flowed towards the heart.
○ Used pumps and dissected bodies to prove Vesalius right.
○ Discovered arteries and veins were part of 1 system and that
blood was pumped around the body by the heart.
○ Without this map,blood transfusions or complex surgery
couldn’t be attempted.
 ○Discoveries gave doctors a new map showing how the body
worked.
● Not everyone believed Harvey’s theories-it took a long time before
doctors used them in their treatments.
○ Blood transfusions were rarely successful when attempted.
■ Blood loss, shock and use of wrong blood types.
○ Bloodletting , which was supposed to keep the 4 Humors in
balance, also continued to be performed, even though he had
proved the reasoning behind it to be wrong.

Medical Training:
Continuity with Medieval period
Physicians continued to train at universities but
there was very little change in their
training.New ideas were starting to emerge but
Physicians
it was slow to take effect along with diagnosis
and treatment.People were still learning from
books and lectures which were still in latin.
Apothecaries continued to mix remedies to help
Healers,
treat people and surgeons still performed
Apotheca
simple surgeries on people to help cure them of
ries and
an injury or illness.The continued to provide the
surgeons
services that physicians could not.
Herbal remedies were still mixed at homes to
help treat illnesses. This was because
communities were very close together and still
gave each other advice on how to treat a
Women specific disease through various cures. They
made ailments to help purge the body and
herbal remedies, which was cheaper than going
to physicians or apothecaries.
Change from the Medieval period
There were changes in the curriculum such as
iatrochemistry and anatomy. People were
starting to challenge the new ideas, which
meant that more dissection was taking place as
the Church began to lod=se power.This gave
trainee doctors more content to learn from and
use in their studies.Printing press made books
available and fugitive sheets with pictures of
certain parts of the textbook was also available
for those who couldn’t afford it.
New ingredients and herbs from the New
World meant that they could experiment with
it to see if it can be used in treatments, having
to help soldier’s injuries from war gave more
experience in surgery and helped to further
the education along with the help of new
technology. Both surgeons and apothecaries had
to have licences to continue with their
practises.
Well-born ladies like Lady Grace Mildmay kept
notes of healing techniques and different
treatments that they used to help people. This
also included poor women living in cities, who
were prosecuted by the London College of
Physicians for practising medicine without a
licence.

Although there was little tactical change in medicine in the Renaissance period, there
were important changes in medical training and discoveries made by individuals that led
to change in care and treatment after 1700.
Hospitals:
● 1500 - hospitals were treating more sick people and were being used
less by travellers and pilgrims.
● Most had their own apothecary to mix medicines and physicians
frequently visited the patients.
● 1536 - dissolution of the monasteries by Henry VIII caused most
hospitals to close.
● Some free, charity-funded hospitals were set up, but it wasn’t until
well into the 1700s that the number of hospitals returned to
pre-dissolution numbers.
● More pest houses began to appear, where people suffering from a
particular contagious disease could go for care.
● When hospitals did begin to reappear, they were run by physicians
focused on reading the sick rather than by religion.

Prevention, Treatment & Care:

Continuity:
● Community Care:
○ As in Medieval times, most people who became ill were cared
for at home, usually by a female relative.
○ Physicians were still too expensive for most people.
○ Members of the community helped with advice and remedies. Some
were paid for their services.
● Prevention & Treatment:
○ Traditional herbal remedies
○ Cleanliness
○ Purifying the air
○ Bleeding and purging
○ Superstitions and prayers
○ Healthy living

Change:
● More emphasis on removing miasma through draining swamps and
removing sewage and rubbish from the streets.
● People regularly changed their clothes to keep clean rather than
just bathing.
● Alchemy caused chemical cures using metals or minerals to become
popular.
● The theory of transference led people to try and rub objects on
themselves to transfer the disease onto the object.
● New herbal remedies from newly discovered countries appeared in
England, and some were effective.
○ Sarsaparilla - treat the Great Pox
○ Ipecacuanha from Brazil - cure for dysentery
However, the improved knowledge and discoveries of the Renaissance had a limited
impact because ideas were slow to be accepted and the discoveries did not improve the
understanding of the cause of disease.

18th & 19th Century Medicine

Continuity:
There were few new ideas about the cause of disease in the 18th Century, though some
scientists thought that germs were produced by decaying matter - this was called
spontaneous generation. Most people still thought miasma was a cause of disease, but
this was becoming a less popular theory than it was in the Renaissance.

Spontaneous Generation - rotting matter created microbes, which were spread through
miasma.
Germ Theory:
● 1861 - Louis Pasteur, published his germ theory, which showed that
spontaneous generation was incorrect.
○ He proved that microbes in the air cause decay.
○ Discovered this when investigating why liquids turned sour for
the brewing industry.
○ Also theorised that germs also caused disease but was unable
to prove this.
● Robert Koch read Pasteur’s work and began to study microbes.
○ He proved that Pasteur’s theory was right, microbes caused
disease as well as decay.
○ He identified the specific microbes that caused TB and
cholera.
● Koch developed a new easier way of growing bacteria on agar jelly.
○ Discovered that chemical dyes stained bacteria, which made
them easier to see under a microscope.
○ Other scientists used these methods to identify the microbes
that caused other diseases.
● These discoveries were to eventually have a direct impact on the
prevention and cure of many diseases.
Pasteur’s germ theory had very little impact on medicine in Britain, as he was not a
doctor and his work was focused on food and drink, not disease. Most doctors still
believed in the spontaneous generation theory, but there were some who did make the
link between microbes and disease.

Koch’s work had more of an impact and he inspired others to research other microbes.
But, it still took some time for most doctors & the government to accept the Germ
Theory of disease. Even though the real cause of many diseases had been discovered, it
didn’t yet have an impact on their treatment and prevention.

Germ Theory - microbes caused decay, and were not created by rotting matter, and that
microbes were spread through the air.

Microscopes:
● 1700 - microscopes had developed so that cloudy images of bacteria
or germs could be seen.
● 1850 - microscopes had further improved so that extremely tiny
images could be seen clearly.

Key Individuals:
Florence Nightingale
● Florence Nightingale was born on May 12th and came from an upper
class British family, in Florence Italy.
○ Expectation of women and girls from upper class families
during the time was to get married and bear children
○ Nightingale never married as was expected from her nor had
children.
● From a wealthy family but became a nurse even though there was some
opposition from her family.
● Worked as a nurse in the Crimean War (1854-56) to help sort out
nursing care in the English camp.
● Improved ward hygiene, which made huge improvements in the death
rate (reduced it by ⅔)
○ Spread out the wounded soldiers
■ In hopes of stopping spread of illness from one to
another
○ Increased the ventilation in the rooms
■ She had a strong belief in miasma, so through it was
best to keep the air clean so that disease couldn’t be
carried through it
○ Made sure nurses were properly cleaning the rooms in the
English camps.
○ Provided a balanced and healthy diet for the recovering
soldiers
○ Made sure to keep the sheets that were used by the soldiers
clean
● She was promoted to head nurse after only a year into her job
● Nightingale is really well known as a pioneer of public health and
has also improved the opinion of nurses during the time.
 ● She received a medal from Queen Victoria, and was known as the Angel
of Crimea as well as the Lady with the Lamp.
● She gained fame and popularity for her work.
○ Popularity meant that she could have a huge impact on hospital
care, to help improve it.
● Helped to improve the skill of the nurses working there, so that
they could help treat the wounded and ill better and more
efficiently.
● Nightingale is also known for laying the foundation of professional
nursing
● Her work helped to establish money for future nurses.
● Florence Nightingale passed away on August 13th in 1910 in her
London home.

Louis Pasteur
● Before Pasteur came up with Germ Theory, there was the Spontaneous
Germ Theory in the 18th Century.
○ Dirt created microbes, use of microscopes showed microbes on
decaying matter and this was supported by Dr Henry Bastian.
● Louis Pasteur published his idea on the Germ Theory in 1861 and
later on tested the theory on animals in 1865.
● The 4 Basic Principles of the Germ Theory:
○ The air contains living microorganisms.
○ Microbes are not evenly distributed in the air.
○ Microbes can be killed by heating them.
○ Microbes in the air cause decay.
● Strengths/Advantages of this Discovery:
○ Pasteur’s work challenged spontaneous germ theory and miasma.
○ When Koch identified specific bacteria, it made the work
useful.
○ Lister read the germ theory & linked it to infection problems
his surgical patients had experienced.
○ John Tyndall discovered that there were small organic
particles in the air, then linked it to Germ Theory & Lister’s
work on wound infections.
○ Tyndall used Germ Theory as a basis to infer that dust
particles carried the germs that caused disease.
● Limitations/Disadvantages of this Discovery:
○ There are many microbes visible in healthy people, so how do
we know which ones are harmful?
○ People preferred to stick with the Spontaneous Germ theory as
Dr Henry Bastian supported the idea.
■ Dr Bastian was a very powerful doctor at the time and
had a major influence.
○ Pasteur was a scientist, not a doctor, so how can others trust
these ideas on people?
 ■ His work was based on rotting food, and not on actual
people.
○ Tyndall was a physicist, not a doctor, so people didn’t
believe his ideas either.
○ Pasteur was not able to fully prove this theory.
■ It was difficult to tell apart good and bad microbes.
In 1860, the French Academy of Science challenged scientists to produce evidence to
either prove or disprove the spontaneous generation theory. Using microscopes, Pasteur
was able to observe unwanted microbes in wine and vinegar, which turned them sour.
Pasteur published these findings in 1861 - Germ Theory.
Pasteur proved that spontaneous generation was inaccurate, as decay didn’t happen to
sterilised matter that was left undisturbed. Instead, something in the air was causing the
decay.
Pasteur went on to theorise germs were causing decay, so they may also be causing
disease in the human body. He observed one particular type of microorganism killing
France's silkworm population. However, the Germ Theory of Infection was only published
in 1878.

Robert Koch
● Robert Koch was a German scientist. Who began linking disease to the
microbe that caused the specific disease.
● He developed a solid medium to grow cultures, and dyeing techniques
to colour microbes.
○ Koch viewed these through high-powered microscopes.
● Koch’s work made Pasteur’s Germ Theory useful.
○ It meant it could be applied to different bacteria & could be
shown to cause certain diseases.
● Nobel Prize for Medicine in 1965 - Father of Bacteriology
● Identified the bacteria which caused anthrax, by injecting it into
mice to prove it.
● Helped understand that the microbes created the symptoms of disease
& that they needed to be removed
● Found microbes for diphtheria, pneumonia, meningitis, plague,
tetanus and other.
○ Tuberculosis-1882
○ Tetanus-1884
○ Pneumonia-1886
○ Plague-1894
○ Cholera-1883
● He took bacteria from the body, isolated it to make a pure culture
then tested it on animals (rats) to confirm it.
● Koch inspired others to look for microbes responsible for other
diseases.
 ● In the short term, the British government chose to ignore his
discoveries.
● His new methods of growing microbes made it easier for other
scientists to study specific diseases.
● By developing the dye to stain microbes, Koch made it easy to see
microbes.
● Before his discoveries, symptoms were studied, Afterwards, diseases
themselves were being studied by scientists.
Pasteur had been the 1st scientist to identify microbes & their role in decay, but Koch was
successful in identifying that different germs caused many common diseases.
Koch discovered the bacteria tuberculosis in 1882. He discovered cholera in 1883 & in
1884 proved that it was spread in the water supplies when he found it in drinking water.

Joseph Lister
● Lister was a surgeon who worked at Glasgow Royal Infirmary.
● When he 1st started working in 1861, ½ of the patients were dying
from postoperative infections.
○ Infection that occurs within 30 days of an operation.
● 1864-read Pasteur’s Germ Theory & learnt that carbolic acid killed
parasites in sewage.
● Lister used this information and started soaking bandages in
carbolic acid to avoid his patient’s wounds becoming infected.
● He also used the acid to clean wounds and equipment as well as
inventing a spray to kill germs in the air.
○ The spray was used in surgery, by spraying it directly onto
the area that was being worked on to avoid any germs from
entering and infecting but it was too messy.
● In 1867, he stated that his ward had been free from infection
(sepsis) for 9 months.
○ Sepsis - the body’s extreme reaction to infection, and is a
life-threatening medical emergency.
● He then went on to publish his ideas.
● Thought to have slowed down surgery & could not be proved to be
true.
● Could cause hands to become flaky and dry during surgery.
● Surgeons understood that they had to perform safer surgeries, as
this helped to make sure wounds healed properly/cleanly.
● Use of surgical gowns, rubber gloves and face masks, and equipment
used became sterilised.
● ORs were also scrubbed down and cleaned properly.
● Helped the death rate from surgery to drop by ⅔.
● Took a long time for doctors & surgeons to believe in the germ
theory & therefore accept Lister’s discoveries.
James Simpson
● Simpson was a children’s surgeon and a midwife.
● James Simpson discovered chloroform after he accidentally inhaled
the substance along with his friends.
● It was a better substitute for laughing gas or ether.
○ Ether was highly explosive & flammable.
○ Laughing gas makes it hard to operate on the person as they
would be constantly moving around, could also cause irritation
to the lungs.
○ But chloroform could still be dangerous/fatal if too much was
given, as it could affect the heart.
● This put them all to sleep relatively quickly, so when he woke up he
realised that he could use it on patients.
○ This could make surgery easier, as they wouldn’t be conscious
and wouldn’t need to be held down.
○ Normally they would move around lots because of the
excruciating pain that they would have to go through during
the procedure.
● This meant deeper surgeries could take place and it wouldn’t cause
any extra harm to the patient compared to if they were awake.
● Many significant people used it at the time when it was discovered.
○ Queen Victoria used it for the birth of her child in 1853.
● Led to some unexplainable deaths as the dosage could not be measured
or controlled.
● Amount of surgeries that took place increased because of the use of
it.
● However, it was new and untested so it scared surgeons, and led to
infection and bleeding to become a big problem.
● People worried about long-term effects, though that being
unconscious made patients more likely to die.
● Victorians were still very religious.
○ Thought that God inflicted pain for a reason, so it was wrong
to integer with His actions.

Edward Jenner:
● Born in 1749 & trained in London as a surgeon & apothecary before
working at St George’s hospital.
● Returned to Gloucestershire to work as a GP.
● Since the 1720s, doctors had been inoculating people against
smallpox.
○ Infecting them with a mild version of the disease
○ Could kill & only the rich were able to afford it.
● Jenner collected evidence of the success and failure of the smallpox
inoculations.
 ● Regularly treated people for cowpox, and noticed that they never
caught smallpox.
● 1790s - Jenner used scientific methods for carrying out experiments
to test his theory, observe & record the results.
○ Infected local people with cowpox & then tried to infect them
with smallpox.
● 1798 - Royal Society refused to publish his ideas.
○ Paid to print his findings in An Enquiry into the Causes and
Effects of the Variolae Vaccinae.
○ Included detailed instructions for others to follow.
● 1800 - around 100,000 people worldwide had been vaccinated.
● But the practice took a long time to become popular in Britain.
● 1802 - Royal Jennerian Society was set up to promote vaccination.
● 1804 - over 12,000 British people had been vaccinated.
● 1840 - vaccinations were provided for free of charge for the poor.
● 1853 - vaccinations were made compulsory.
● 1979 - World Health Organisation announced that smallpox had been
eradicated.
Jenner’s work proved that scientific methods could lead to a disease being wiped out. He
saved many lives, but he didn’t know why it worked. The link between cowpox & smallpox
was unique so it didn’t lead to other vaccinations and other diseases were still killing
people.
Many people opposed his work because they thought it was wrong to give people an
animal’s disease, it interfered with God’s plan, doctors lost money when the government
made it free, and some doctors didn’t vaccinate people properly so it didn't work.

Nurses:
● Nightingale changed how nurses worked and treated the wounded during
the Crimean War.
● Nurses were organised to treat nearly 2,000 wounded soldiers.
● Nightingale & her nurses demanded 300 scrubbing brushes to get rid
of any dirt near patients that were being treated.
● Before Nightingale’s work, nurses had very bad reputations.
○ They were thought to be flirting with other men, rather than
doing their job ad helping those that were in need of help
○ It was seen as a disgrace to be a nurse.
● Trained the nurse properly so that they could effectively help those
that were wounded during the war.
● Nightingale published her book ‘Notes on Nursing’-1859.
○ Emphasised the need for hygiene and a professional attitude.
○ It was the standard textbook for generations of nurses.
● The public raised £44,000 to help her train nurses, and she also set
up the Nightingale School of Nursing in St Thomas’ Hospital in
London.
 ○ Nurses were given 3 years of training before they could
qualify.
○ Discipline and attention to detail were important.
● By 1900 - 64,000 trained nurses in Britain form colleges across the
country.
● 1919 (after Nightingale’s death)-Nurses Registration act was passed.
○ Made training compulsory for all nurses

Hospitals:
● Changed the style to make it a pavilion, so that there would be more
ventilation.
○ Nightingale believed in the miasma theory, so thought that
clean air should be kept to keep people from getting ill.
○ It was effective, but not because of the miasma theory, but
because of germs spreading.
■ Stopped spreading as the air was constantly changing and
kept clean.
● Spread out the beds for each individual patient to stop spreading of
disease.
● Cleanliness was important-so sanitised and made sure that everything
was clean.
● Different injuries were split up into different wards.
● Modern hospitals were developed quickly & attracted donations to
create funds for nurses.

Example:Great Ormond Street Hospital

1856:
● Newhospitals opened during the 19th century to look after the sick.
○ Financed by charities and local councils.
● The 1st cottage hospital opened in 1859.
○ Small buildings where nurses gave care and GPs prescribed a
home treatment.
● Middle and upper class could afford doctors to continue to treat
them at home.
● The elderly, sick or disabled were forced to enter workhouses.
● Most hospitals tried to create a home atmosphere.
● Parents and visitors had to help nurses look after the patients.

1875:
● Due to the work of reformers, hospital cleanliness and organization
improved and nurses were better trained.
○ Key example of a reformer is Florence Nightingale.
● Pasteur’s Germ Theory led to better hygiene in hospitals as well.
● Nurses were given a more central role in caring for patients and
assisting doctors.
 ● Public pressure led to infirmities being set up for the poorest in
society.
○ Separate from workhouses.
● Specialist hospitals were also starting to be developed.
○ Asylums for the mentally ill
○ Fever houses for infectious diseases.

Role of the Government:

Public Health Act - 1848:
● In 1842, the government had asked Edwin Chadwick to report on the
living conditions of the poor.
○ He reported that poverty was the cause of ill health as it was
caused by terrible conditions in which people lived.
○ Claimed that ratepayers can cut their taxes and save money in
the long-term by looking after the poor and to spend money
improving their health.
○ He said that industrial towns should:
■ Provide a pure water suppl
■ Organise drainage and refuse collection
■ Appoint a Medical Officer of Health.
● The government did nothing based on Chadwick’s recommendations at
first.
● But, there was another cholera outbreak in 1848.
○ This puts pressure on them to do something.
○ Parliament reluctantly agreed to pass the Public Health Act.
● It was not compulsory, but they had set up a Board of Health to
encourage local authorities to improve conditions.
● They gave local authorities money to improve their area if they
wanted to and had the support of local ratepayers.
● Only a few local authorities took any new measures.
● By 1872 only 50 Medical Officers of Health had been appointed, and
the Board of Health was abandoned in 1854.

Second Reform Act - 1867:

● Working class men were given the right to vote.
● This meant that the ratepayers weren’t the only ones who got a sya
in improving public health.
● MPs were forced to improve the living conditions of the poor.

Second Public Health Act - 1875:

● This public health act actually forced local authorities to
introduce the following measures:
○ Provision of clean water
○ Proper drainage and sewage
○ The appointment of a Medical Officer of Health
 ● There was a weakening Laissez Faire attitude from the government.
○ They saw that they could no longer leave public health
measures to individuals or councils, and realised that they
had to take action.
● The result of the Public Health Act of 1875:
○ Improved the standard of housing
○ Made education compulsory
○ Made it illegal to add ingredients that made food unhealthy
○ Shortened working hours in factories for women and children
○ Stopped the pollution of rivers from which people got their
water.

Disease Prevention:
Process of Developing Vaccinations:
● Pasteur began to carry out experiments to observe microbes and
published his result in 1861 - Germ Theory.
● Pasteur’s team of scientists discovered that a weakened version of a
disease-causing microbe could be used to create immunity from that
same disease.
● Pasteur admired Jenner and called his new discovery ‘vaccination’ in
tribute to him.
● Pasteur developed vaccines against anthrax and chicken cholera for
animals, and against rabies for humans.
● Pasteu’s work inspired other scientists to develop vaccines for
human diseases.
Government Intervention:
1875 Public Health Act - done to improve living conditions.
● City authorities had to provide:
○ Clean Water
○ Public Toilets
○ Sewers
○ Public Parks
○ Street Lighting
● Necessary to inspect lodging houses for cleanliness
● Monitor the building of new houses
● Check the quality of food sold in shops
● Employ a public officer of health to monitor disease.
 20th Century Medicine
Improvements in Diagnosis:
Developments in science & technology in the 20th century have improved the diagnosis
of illness and the cause of disease.
The 20th century saw big changes in the ways that doctors diagnosed illness. Although
doctors today still use their own knowledge & medical books, they combine this with
medical testing, using science & technology to discover what is wrong.
This included the use of:
● Laboratories:
○ to test skin or blood samples
● X-Rays, Scans, Endoscopes:
○ to ‘see’ inside the body with more clarity than ever before
● Monitors:
○ to see what is going on over a period of time
Improved scientific understanding and technology has made diagnosing disease more
accurate.
Blood samples are taken and tested by a pathologist in a laboratory. Analysing blood
means that a huge number of diseases are now diagnosed and monitored without the
need for surgical investigation.

Medical Technological Advancements:

Examples of technology used in 20th and 21st century medicine include:
● X-Rays
● Microscopes
● Incubators
● Hypodermic Needles
● Prosthetic Limbs
● Endoscopes
● Pacemakers
● Dialysis Machines
● MRI, CT & Ultrasounds
● Insulin Pumps
● BP & Blood Sugar Monitors
Advances In Understanding Causes:
By 1900, the correct cause of many diseases had now been discovered & the knowledge
had been used to produce effective vaccines to prevent certain diseases. The 20th
century witnessed a search for the cause of other conditions and greater understanding
of the reasons for poor health.
Lifestyle Factors:
Since 1900, people have discovered that some lifestyle factors can negatively affect
health and increase the chance of contracting diseases.
● Smoking:
○ Research now links smoking with many diseases, such as high
blood pressure, emphysema, heart disease and many concerns.
● Diet:
○ Scientific research has confirmed that eating a balance of
different foods and limiting sugar & fat reduces the chance of
getting certain types of cancer or heart disease.
● Drinking Alcohol:
○ Research now links drinking too much alcohol to many cancers
as well as liver & kidney diseases.
Genetics:
● 19th Century - Gregor Mendel showed how human characteristics could
be passed between generations.
● 20th Century - new technology allowed scientists to analyse human
cells in greater detail.
○ Found that every cell in the body contains DNA.
● James Watson & Francis Crick worked together on how the genetic
codes of DNA fitted together.
○ They analysed x-ray crystallography by Maunce Wilkins &
Rosalind Franklin.
○ 1953 - eventually worked out the double helix structure of
DNA.
Discovering the structure of DNA & the work of the Human Genome Project has led to:
● Better understanding of some genetic conditions
● Predicting whether individuals are at a higher risk of developing
some cancers
● Discovery that stem cells can be grown into different cells
However, there is not yet a cure or effective treatment for most genetic conditions or a
way of preventing most genetic diseases.

Change in Care & Treatment:

The 20th century saw major advances in treatments from new ‘miracle’
drugs that cured diseases to advanced surgical treatments.
Paul Ehrlich
● Ehrlich found it as he was trying to find a cure to syphilis, which
became the 1st magic bullet.
● He had help from Dr Sahachiro Huta, a Japanese doctor.
○ He found that the 606th try to make a cure actually worked, &
was accidentally ignored.
● The 1st magic bullet was called salvarsan 606.
 ● It killed the bacteria that cause syphilis, but had some side
effects.
○ E.g. rashes, liver damage and risk of life.
● Overuse of it however, could cause the bacteria to become resistant
against it.
● Magic bullet
○ Chemical cure that specifically targets + kills bacteria in
the body, early antibiotics
● It relies on Koch’s work on being able to identify different types
of bacteria.
● It was difficult to mass produce it and would need government
funding.

Magic Bullets:
● Robert Koch discovered that different chemical dyes stained specific
microbes.
● Emil von Behring discovered that the body manufactures antitoxins
that only attack the microbe causing the diseases.
● Paul Ehrlich & his team of researchers searched for a ‘magic
bullet’.
○ A chemical compound that would attack & kill the microbe
causing a specific disease.
● The team worked for many years, and tested many compounds of
Salvarsan to find the one to cure syphilis.
● 1909 - Dr Hata joined the team & discovered they had rejected a
compound that worked.
● 1932 - Gerhard Damagk developed the 2nd magic bullet, Prontosil.
○ It cured some types of blood poisoning.
● Other scientists checking Damagk’s work found that they key
ingredient in Prontosil aslo cured pneumonia, scarlet fever &
meningitis.

Antibiotics:
● Antibiotics destroy bacteria to prevent its growth.
○ 1st to be discovered - penicillin.
● Scientists experimented with other moulds and found more antibiotics
that were effective against different diseases.
○ Throughout the 1940s, 50s, & 60s.
● Once the chemical structure of different antibiotics were
discovered, scientists were able to make antibiotics.
○ Solved the problem of having to grow them first in order to
amend them to treat further diseases.
● Antibiotics have saved & extended millions of lives but due to
overuse,some bacteria have evolved to become resistant to
antibiotics.
Advances: Robotic Surgery:
Some surgery can now be carried out remotely, with surgeons controlling robots though
computers, This has also mde surgery more precise
.Advances: Keyhole & Micro-surgery:
With the development of tiny cameras and surgical instruments, surgeons can use small
incisions instead of large cuts to access the body, which reduces the patient’s recovery
time. The small instruments also make it possible to reattach nerves & blood vessels.

Approaches to Prevention:
The NHS:
Since 1948, taxes have funded a wide range of healthcare services provided by the NHS:
● Seeing a GP
● Hospital care & operations
● Health care for the elderly
● Ambulances & emergency treatment
● Health visits for pregnant women & young children

Improved Access to Care:

The establishment of the NHS improved access to healthcare because all treatment was
entirely free, so everyone had access to the same level of care. However, healthcare
provision was unequal across different parts of the country, both in terms of the number
of doctors & hospitals and their standards - this took time to improve.

Compulsory Vaccinations:
Although many vaccines that successfully prevented some diseases had been developed
in the late 19th and early 20th centuries, people had to pay to receive them, and many
could not afford it. 1938 - 3000 people died in a diptheria epidemic, which led to a
government-funded immunisation programme. Vaccination is still controversial, and
some people choose to not have their children vaccinated.

Lifestyle Campaigns:
Since 1948, the government has funded publicity to raise awareness of illness & dangers
to health. There was some success in the 1980s ‘AIDS don’t die of ignorance’ campaign,
which reduced cases of HIV infection.
More recently, events & initiatives have encouraged healthy behaviour to prevent
diseases.
Prevention Measures:
Since 1948, the government has taken more action to prevent people getting ill:
● Laws improving health & safety at work
● Better disposal of rubbish & sewage
● Funding more testing & vaccinations
● Laws reducing air & water pollution
● Environmental health officers inspecting food outlets
● Laws banning advertising of cigarettes & smoking in public areas

Medicine: Case Studies

The Black Death
The Black Death reached Englnd in 1348, killing about ⅓ of the population. Most
historians think this disease was bubonic plague, carried by fleas living on lack rats,
which brought the disease to different countries on trading ships. Bubonic plague is
passed to humans when an infected flea bites them and the disease enters their blood.

Symptoms:
● Swelling of the lymph glands into large lumps filled with pus
● Headache
● Fever and chills
● Vomiting, diarrhoea and abdominal pain

Ideas about Causes:

● Religion:
○ God sent the plague as a punishment for people's sins.
● Astrology:
○ Position of Mars, Jupiter and Saturn was unusual at this time.
● Miasma:
○ Bad air or smells caused by decaying rubbish.
● Volcanoes:
○ Poisonous gases from European volcanoes and earthquakes
carried in the air.
● Outsiders:
○ Strangers or witches had caused the disease.
● The Four Humours:
○ Most physicians believed that disease was caused by an
imbalance in the Four Humours.

Treatments:
● Cutting open buboes to let out the pus.
● Praying and holding lucky charms.
● Eating cool things and taking cold baths.
 ● Holding bread against the buboes and then burying it in the ground.

Prevention Methods:
● Clearing up rubbish in the streets.
● Not letting unknown people enter the town or village.
● Carrying herbs and spices.
● Lighting a fire in the room, ringing bills or having birds fly
around the room.
● Smelling their toilets and other bad smells.
● Praying and fasting.

The Great Plague:

Both the Black Death & the Great Plague were the same, but occurred within a 300 year
difference.

Ideas about Causes:

People’s beliefs about the causes of the Great Plague were mostly the same as their
beliefs about the causes of the Black Death.
● Miasma was the most common belief about the cause of the Plague.
● People knew that diseases could be passed from person to person.
● Fewer people believed that it was caused by an imbalance in the Four
Humours.

Treatments:
Like it’s causes, many treatments for the Great Plague were similar to those for the Black
Death. As most people with the illness were quarantined, little is known about
treatments. Many used herbal remedies, either mixed in the home or by apothecaries
and ‘quack’ doctors.
● Theory of transference meant that people tried to ‘transfer’ the
disease to something else.
● Though that people could sweat diseases out, so sufferers were
wrapped up in thick blankets and put by the fire.

Government Action:
A big difference between 1665 and 1348 was far greater actions by local councils, who
were ordered by the King to try and stop the plague from spreading.
● Theatres were closed and large gatherings were banned.
● Streets were regularly cleaned, dogs & cats were killed.
● Barrels of tar were burnt in the streets.
● Every day, carts collected the dead who were then buried in deep
mass graves.
● Days of fasting and public prayer were ordered.
 ● Household was boarded into its home for 40 days or taken to the pest
house if a member caught the plague.

Cholera:
What it was:
● The first cholera epidemic in Britain occurred in 1831 and was
followed by another in 1848-49 and another in 1854.
● It causes severe diarrhoea and vomiting leading to dehydration.
● Known as the ‘blue death’.
● Mostly affected the poorest, slum areas oof cities byt the rich were
affected too.

Attempts at Prevention:
Most people, including the government, believed cholera was caused by miasma and
spontaneous generation. Therefore people tried to keep their homes as clean as
possible, and some local councils tried to clean the streets.

Work of John Snow:

● Snow was a well respected doctor and surgeon in London.
● He theorised that cholera was spread through contaminated drinking
water and not miasma.
● During an outbreak in Soho in 1854 where he lived, Snow mapped out
the deaths.
○ He found a strong link to the water pump on Broad Street.
● He removed the handle from the pump so that people would stop
drinking water from it, so that he could see if there really was a
connection.
● After he did this, there was an immediate drop in the deaths from
cholera.
● Later it was discovered that a cesspit close by wa sleaking waste
into the water.
● 1855-Snow presented his findings to the government.
● There was no actual scientific evidence, and the Germ Theory didn’
develop until 1861. Thus, the government did not act on his
findings.
● In the long-term, Snow’s work contributes to th =e completion of the
sewer system in 1875.
● It also helped to make the link between dirty water and disease
leading to the Public Health Act in 1875.
Penicillin:
The Development of Penicillin:
In 1928, Alexander Fleming noticed that bacteria on a Petri dish was being killed by a
penicillin mould. He tested it on other bacteria and discovered that mould produced an
excellent antibiotic - penicillin.

In 1929, Fleming published his findings but did not believe that penicillin would work on
living people and did not ask for funding to continue his research.

Several years later, Howard Florey, Ernst Chain and their team continued Fleming’s
research on penicillin. It proved effective on mice, so they tested it on humans. Penicillin
killed bacteria and therefore the infection - it was proved to work on humans.

Alexander Fleming:
● Antibiotics destroy bacteria to prevent it’s growth. The 1st one to
be discovered was penicillin by Alexander Fleming.
● In 1928 Fleming had come up to clean up old culture dishes that he
had been growing bacteria on for his experiments.
● A fungal spore had grown on one of the dishes and he noticed that
the colonies of bacteria around the mould had stopped growing.
● Fungus was then identified to be penicillin and was a substance that
killed bacteria.
● Fleming could not proceed more with his work, as the industrial
production of medicine still needed work.

Fleming worked on the battlefields of the First World War. Part of his job was to study
soldiers' infected wounds and try to find treatments for them. Many died from their
infections. After the War, he worked at St Mary’s Hospital in London where he continued
his work to try and find a way of healing bacterial infections.

Howard Florey & Ernst Chain:

● In the 1930s, 2 Oxford students became interested in Fleming’s 1929
paper.
● In 1939, Florey and Chain gathered a skilled research team and 3
days after the WW2 outbreak, they asked the government to fund the
team’s research into penicillin.
● British chemical firms were too busy making explosives to start mass
production, thus Florey went to the US instead.
● America helped to mass produce penicillin, as the casualties from
the war added to the urgency.
● By 1944 mass production was sufficient for the needs of the military
medics.
Florey was an Australian pathologist who was researching ways to kill bacteria at Oxford
Medical School. He assembled a group of scientists to help him. One of his first recruits
was the German biochemist, Ernst Chain. They, together with Fleming, won the Nobel
prize in 1945.

Mass Production:
Penicillin still wasn’t used for medical treatment because huge amounts were needed to
treat just one person, and growing the mould took time and lots of space and was
therefore expensive.

● Florey asked the UK drug companies and factories to help, but they
were being used for the war effort.
● In 1942, Florey asked US drug companies. Some agreed to help but on
a very small scale.
● The effectiveness of penicillin was demonstrated that same year.
● After the US joined WW1, the government saw the need for more
penicillin to treat casualties and so funded 21 companies to
mass-produce it.
● US drug companies began mass production in 1942 and the British
companies followed in 1943.
● This was effective as there was enough of it to go around to help
treat the soldiers on the D-Day invasion of Europe, which made it
successful.
● All allied casualties were able to get some form of treatment as
there was enough penicillin to go around.

Lung Cancer:
Fight against Lung Cancer:
The 201th century saw a huge rise in the number of lung cancer cases. Today, iy is the
second most common cancer in the UK, and has a poor survival rate compared with
other cancers. This is because it is difficult to diagnose and treat. The majority of lung
cancers are caused by smoking or passive smoking, though some people develop lung
cancer for no apparent reason.

Diagnosis:
Symptoms of lung cancer include a persistent cough, coughing up blood, breathlessness,
tiredness, unexplained weight loss, repeated chest infections, but there can also be
symptoms of many other conditions too and the cancer is often very developed by the
time symptoms begin.
If lung cancer is suspected, most patients are given a CT scan and if this shows a mass, a
sample of the cells are collected and tested.

Treatment:
● Surgery to remove the cancer or a lung transplant.
● Radiotherapy to try and shrink the tumour or prevent its growth.
● Chemotherapy to try and shrink the tumour, or prevent the cancer
returning.
Chemotherapy uses speccail drugs to shrink or kill the cancer cell whereas radiotherapy
kills these cells with high-energy beams.

Prevention:
● TV advertising for cigarettes was banned in 1965, and for cigars and
tobacco in 1991.
● Tax on tobacco products is regularly increased to make smoking more
expensive and, in turn, to encourage people to stop.
● In 2007, smoking was banned in public places where people worked and
this ban was extended in 2015 to cars carrying under-18s.
● Shops are not allowed to publicly display tobacco products.
● In 2007, the legal age for buying tobacco products was raised from
16 to 18.
● Various campaigns have been funded to educate people about the risks
of smoking.
● Cigarette packaging became standardised in 2016, adn with graphic
warning of the dangers.

British Sector of the Western Front

Britain declared war on Germany on 4th August and sent troops to
northern France to stop the German advance through Belgium. By the end
of the year, fighting was restricted to a line of trenches that stretched
through Flanders and northern France, from the English Channel to
Switzerland. This was known as the Western Front.

Battles on the Western Front:

● First Battle of Ypres
○ The British managed to hold on to Ypres, which was
vital in maintaining access and control of the
English Channel parts, but the Germans gained ground.
● Battle on Hill 60
 ○ The British tunnelled into and under the hill and
exploded five mines from the tunnels, which enabled
them to take the hill.
● Second Battle of Ypres
○ The Germans made a very slight gain towards Ypres.
○ Battle was notable as being the 1st time chlorine gas
was used by the Germans.
● Battle of the Somme
○ Notable for the extremely high casualties on both
sides.
○ It saw battles on both sides of the River Somme -
creeping barrage and the 1st use of tanks.
● Battle of Arras
○ In 1916, the British linked and expanded the
underground tunnels, quarries and caves for the
shelter and movement of troops.
○ The tunnels were used to launch the battle, which was
initially successful but ended with little progress
and high numbers of casualties on both sides.
● Third Battle of Ypres
○ The British used a creeping barrage to make small
gains and break out of the Ypres Salient.
○ The awful weather left the ground waterlogged and
many drowned.
● Battle of Cambrai
○ The battle was notable for the 1st large-scale use of
tanks, which were successful but were not backed up,
so the British were forced back.

The Trench System:

● Trenches were dug in a zig-zag pattern.
● The Frontline Trenches:
○ This was where attacks would be made from.
● The Support Trenches:
○ About 80 metres behind the frontline trenches.
○ Troops would retreat here if frontline trenches came
under attack.
 ● Dugouts:
○ Holes were dug into the sides of the trenches where
men could take protective cover when needed.
● The Reserve Trenches:
○ At least 100 metres behind the support trenches.
○ Where the reserve troops could be mobilised for a
counter-attack.
● The Communications Trenches ran between the other
trenches.
● At the very rear were artillery emplacements.

The 1st trenches were hurriedly dug out by troops. They often used existing
ditches or banks to make it easier. The trenches were constantly
maintained and improved.

Terrain varied in different places and according to weather conditions. It

could be very difficult to get around where there was deep mud and
waterlogging, and craters & holes from explosions.

Injuries & Illnesses:

● Trench Fever:
○ Produced flu-like symptoms, which could last for
months and keep recurring.
○ !918 - troops were deloused.
● Head Injuries:
○ Unexpectedly common and were mostly caused by
shrapnel.
○ Late 1915 - soldiers’ soft caps were replaced by
Brode helmets.
● Gas Attacks:
○ Greatly feared but not a major cause of death.
○ Caused temporary blindness, coughing and burns.
○ July 1915 - gas masks were given to all British
troops.
● Shell Shock:
○ Caused a wide range of symptoms, including mental
breakdown.
 ○ Some sufferers were accused of cowardice.
○ Many were treated close to the Frontline, but many
were evacuated to British Hospitals.
● Trench Foot:
○ Caused by standing in waterlogged trenches.
○ Lead to gangrene - therefore amputation.
○ Given whale oil and spare socks,pumps were used to
drain trenches, and duckboards were added for
soldiers to keep their feet above water.
● Bullets from rifles and machine guns could penetrate
organs and fracture bones.
● High-explosive Shells & Shrapnel:
○ Were responsible for most deaths and injuries.
○ Removed limbs and caused major internal injuries.

Specific Injury Problems:

Some injuries had rarely been seen before, while others had been seen on
such a large scale. All weapons could cause major blood loss. Bullets and
shrapnel had to be located and then removed. Extensive head wounds
required brain surgery and facial reconstruction.

Wound Infection:
Soil on the Western Front contained tetanus and gas gangrene bacteria.
These would enter wounds during attacks or when laying on the ground.
From late 1914, tetanus injections were given but there was no prevention
for gas gangrene.

RAMC & FANY:

The Royal Medical Corps and First Aid Nursing Yeomanry provided most of
the medical care. Initially , all medical workers were from the RAMC byt
later, volunteers were allowed. The volunteers were mostly used to drive
ambulances and for cooking & cleaning.
Transport Problems:
● Many roads and railways had been destroyed.
● Constant shelling and artillery fire made recovery of the
injured very difficult.
● Difficult terrain meant that in some places only
stretcher-bearers and horse wagons could be used.
● Initially, no motor ambulances were sent and there were
not enough horses to cope. Public appeal in Britain raised
money for 512 motor ambulances.

Underground Hospitals:
The hospitals were very close to the front line in the tunnels and
underneath the town. It included space for 700 beds, an operating theatre
and a mortuary. It was supplied with running water and electricity.

Stages of Evacuation:
● Stretcher Bearers:
○ At the front lines.
○ Carried wounded from front lines during day and
night.
○ Was given training for only basic first aid.
● Regiment Aid Post:
○ Some help from stretcher bearing.
○ Gave basic first aid.
○ Couldn’t deal with major injuries.
○ Located within 200 metres of the frontlines, in
communication trenches or deserted buildings.
○ Role was to give quick first aid, so that soldiers
could start fighting again.
● Field & Motor Ambulances:
○ Transported injured people on the front lines to get
basic first aid or needed treatment.
○ Were quick, but took long periods of time back and
forth.
○ 0 motor ambulances at the start, 512 by 1914 in Nov.
● Dressing Stations:
 ○ Located in abandoned buildings, dug-outs, or bunkers
to offer protection from enemy shelling.
○ Advanced Dressing Station - 400m from RAP.
○ Main Dressing Station - further ½ a mile.
○ 10 medical officers & medical orderlies.
○ Also had stretcher bearers from RAMC stationed.
● Casualty Clearing Stations:
○ Sufficient distance from the front to give safety
from attacks.
○ Close enough to be accessible by ambulance waves.
○ Operating on critical injuries.
○ Set up in factories & schools, near railways.
○ Triage: selecting and sorting the injured to decide
who to treat.
■ Walking wounded
■ Those who need hospital treatment
■ Those with no chance of recovering due to severe
injuries.
○ As the war went on, it gained more importance than
base hospitals in treating the wounded.
● Base Hospitals:
○ Located near the French & Belgium coast.
○ Became ways to try new medical methods.
○ Treat until they could return to fighting or till
they would go back home.
○ Increasingly less important as war progressed.

X-Rays:
In 1895, when Wilhelo Roentgen covered a test tube in black paper, he was
surprised to find that rays from the tube lit up the screen. He experimented
and found that these rays could pass through many objects, including
human flesh, but couldn’t pass through bone. He then put photographic
paper between the tube and his hand to create the 1st x-ray image.
Radiology departments opened the following years and were used to
diagnose embedded objects and bone problems.
● Large machines were too heavy to be moved easily.
 ● High doses of radiation were released, and patients were
burnt and lost hair.
● Photography was at an early stage so taking x-rays
required staying still for a long time.

Blood Transfusions:
● In the 17th century, doctors carried out blood
transfusions from animals to humans, but people rarely
survived.
● James Blundell performed the 1st human-to-human blood
transfusion.He developed useful techniques and equipment
but there were problems. Blood had to be transferred
directly from the donor to the recipient as it couldn’t be
stored.
● 1991 - Karl Landsteiner discovered 3 blood groups.
● 1902 - His colleagues found a 4th group.
● They discovered that transfusions would only work between
people of the same blood group.
● Blood loss could lead to shock. Blood transfusions were
used from 1915, but were limited as blood couldn’t be
stored.
● 1915 - Richard Lewisohn found that adding sodium citrate
to blood stopped its clotting, so it could be stored for a
short period of time.
● Richard Weil used refrigerators to store it for longer.
● 1916 - Francis Raus & James Turner added citrate glucose,
which allowed blood to be stored for even longer.
● In preparation for the Battle of Cambrais, Oswald Hope
Robertson stored 22 units of blood in the 1st ‘blood
depot’.
○ Used it to treat Canadian soldiers suffering from
shock and demonstrated potential.

Aseptic Surgery:
Thanks to the work of Joseph Lister, antiseptic surgery was well
established by 1900, and aseptic conditions began to be used.
● Operating theatres and wards were thoroughly cleaned.
 ● Surgeons and nurses wore sterilised clothing.
● Sterilised clothes covered surfaces and equipment.
● Surgeons and nurses wore masks to prevent breathing
infection into a word.
● 1878 - Robert Koch developed a steam steriliser for
surgical instruments.
● 1890 - Anyone touching the patient wore rubber gloves to
stop germs passing from their hands to the wound or onto
the instruments that they were using.

The Thomas Splint:

From December 1915, the Thomas splint was widely used & reduced the
death rate from broken limbs. This was because the splint kept the leg
rigid, which reduced blood loss.

Mobile X-Ray Units:

X-rays were crucial to locate bullets & shrapnel before operating. Static
machines were used in base hospitals from 1914 and in some casualty
clearing stations. Mobile units were used closer to the front. Their images
weren’t as clear as static machines but still helped to prevent many deaths.

Advances in Surgery:
The number of brain injuries during the war led to the development of new
surgery techniques. Large number of facial injuries led to huge
improvements in plastic surgery, led by Harold Gillies.

New Techniques for Infections:

● Antiseptic and aseptic surgery was not possible in
dressing stations and casualty clearing stations and many
wounds were already infected by the time the patient was
operated on.
● Surgeons went back to using chemicals to kill bacteria,
but this did not work against gas gangrene.
● 1917 - Carrel-Dakin method
○ Sterilised salt solution was moved through the wounds
using tubes.
 ○ Didn’t work when infections were very deep in the
body.
● Surgery was developed to remove the damaged and infected
tissue.
● If this didn’t work, the only way to save the patient was
to amputate their limbs.