Question four on your paper requires you to consider a range of factors in the development of

medicine. To help you with this, you will find those factors indicated throughout your revision guide
using the symbols below.
How do you remember the factors?

Remember: Ron Weasley Is Ginger: That’s So Cool!

R Religion
W War
I Individuals
G Government
T Technology
S Science
C Communication
! Luck
Common Treatments:

● Bloodletting – blood removed using leeches, or opening a vein. Used if the patient had
too much blood
● Drinking wine – for if the patient had too little blood!
● Herbal remedies were also common

What was the Black Death? What did they think caused the Black Death?

⮚ A combination of bubonic and ⮚ Position of stars and

pneumonic plagues planets
⮚ Spread by fleas ⮚ Bad air
 ⮚ Lumps were found on the person’s groin,
neck and armpits
⮚ High fever and vomiting of blood
What really caused the Black Death?
✔ Caused by bacteria Yersinia pestis
✔ Lived in stomachs of fleas, that lived
off the blood of rats
✔ When the rats died, the fleas moved to
humans
How did they try to deal with the Plague?
⮚ Drinking mercury
⮚ Shaving a chicken and
strapping it to the
lumps
⮚ Avoiding contact with other people
⮚ Some local councils set up a quarantine
of infected places (prevented them
from leaving, or anyone else from
entering)
⮚ Some wanted to show their love of God
by whipping themselves – they hoped
God would forgive them for their sins
⮚ Poisoning of wells by Jews
⮚ Punishment from God for their sins
Why did it spread so quickly?
⮚ Crowded ports and towns
⮚ Bodies were not properly buried (usually in
shallow pits)
⮚ Rubbish on streets provided the perfect
environment for rats
What was the impact of the Black Death?
⮚ Killed at least 1/3 of the population
⮚ Food was not harvested and rotted in
fields
⮚ Whole villages were wiped out
⮚ Towns and cities faced food shortages
⮚ Medieval lords changed
to sheep farming – required
fewer workers (this further
reduced the amount of food
available)
⮚ Prices of food went up
⮚ Peasants were encouraged for the first
time to leave their villages to seek work
⮚ Peasants demanded higher wages
⮚ Opinions of the Catholic Church began to
change – churchmen were criticised for
cowardice
What did people think caused the Great Plague of 1665?

● A punishment from God for their sins

● Movement of planets
● ‘poisonous’ air

How did they try to treat it?

● Bleeding with leeches

● Smoking to keep away the ‘poisoned’ air
● Remedies involved animals such as frogs, snakes and scorpions to ‘draw out the poison’

How did they try to cure it?

● Some rich people moved out to the countryside to avoid catching it

● They were beginning to notice that most deaths occurred in the poorest, dirtiest parts of the
city
● Plague victims were quarantined in their houses, and watchmen were put on guard
● Houses with plague victims were painted with a red cross as a warning
● Bodies were brought out at night when fewer people were
about
● Fires were lit to try to remove the poisons thought to be in the air
● Streets were swept
● Pigs, dogs and cats were not allowed in streets where there was plague
● Large crowds were banned

How did it end?

● NOT because of the Great Fire of London!

● The rats developed greater resistance to the disease
● Quarantine laws prevented epidemic diseases coming into the country on ships
How similar were the Black Death and Great Plague?
The Black Death The Great Plague
Beliefs ● Punishment from God ● Punishment from God
around ● Bad air ● Poisoned air
causes ● Lack of understanding of germs ● Lack of understanding of germs

Attempts ● Use of chickens strapped to the ● Use of animals in treatments e.g.

to cure the buboes frogs and scorpions
plagues ● Praying ● Praying
● Avoiding contact with other ● Quarantine set up
people ● New laws to halt the spread of
● Some local councils set up diseases
quarantines ● Crowds of people not allowed
● Streets to be swept
 ● Dead only to be brought out at
night

What was inoculation?

Inoculation had been used in Medieval China: a small dose of smallpox from a victim was given to healthy people. It became
popular in Britain around 1721. Lady Mary Wortley Montagu had it done to her children: she had seen it in Turkey.
Inoculation became more popular and by 1770s it became normal practice. There were still some problems:

Edward Jenner’s discovery

Jenner decided to test whether cowpox (a similar, but milder version of smallpox) could protect against smallpox.

Significance of Smallpox Vaccination: First there was a ROW, then it SAVE(d) lives!

At the time

R = Royal Family The Royal Family was vaccinated; Parliament agreed to give Jenner £10,000 for his research;
O = Opposition Jenner faced opposition as he was unable to explain how vaccination worked.
W = Wrong In London Smallpox Hospital, William Woodville and George Pearson carried out tests. However
their equipment was contaminated and one of their patients died. They concluded Jenner was
wrong.
Later
S = Safer (and People eventually realised vaccination was more effective and less dangerous
Scientific method) Scientific method made people take notice of vaccination
A = America By 1800s, doctors were using his technique in America and Europe; and in 1853 the
British government made smallpox vaccination compulsory

Today
V = Vaccinations Other vaccinations have been developed e.g. polio; diphtheria; tetanus
E = Eradicated Smallpox was declared officially eradicated in 1980
The Great Public Health Debate
What is the significance of Robert Koch’s contribution to Germ
Theory?
Remember: MAD
Which factors contributed to the scientific breakthroughs in the 1880s and 1890s?
(Ron Weasley Is Ginger: That’s So Cool!)

War: Individuals: Government:

● Prussian War between France ● Cheyne translated work of ● Both Koch and Pasteur were
and Germany intensified the Koch into equipped with a laboratory
rivalry English paid for by their governments
between ● Pasteur:
Koch and determined
Pasteur and
hardworking;
developed vaccines for cholera
and anthrax
● Koch: identified cholera germ

Technology: Science: Communication:

● Improvements in the
microscope enabled Koch and
Pasteur to observe microbes
● Koch demonstrated the ● Pasteur demonstrated his
importance of repeated vaccine in
experimentation in identifying front of
microbes responsible for politicians,
disease farmers
and
journalists
● Koch’s discoveries were
spread by scientific articles

Luck:

● By accident, Charles Chamberland, one of Pasteur’s assistants, used an old and

weakened version of chicken cholera.
● When the chickens were infected, they survived
● They showed that weakened microbes built up the chicken’s defences
● They proved how vaccines worked
Public
Health
Mediev
al
Towns
and
Monast
eries
Why
were
condition
s in
monaster
ies
better?
⮚ They
were
wealt
hy –
they
could
build
good
sanit
ation
facili
ties
⮚ They
were
often
involv
ed in
farmi
ng/w
ool
prod
uctio
n–
this
 mean
t
they
had
to be
away
from
town
s
⮚ They
were
well
disci
pline
d–
they
wash
ed
regul
arly
⮚ They
had
acces
s to
medi
cal
book
s–
they
knew
that
they
shoul
d
keep
clean
wate
r
separ
ate
from
wast
e
wate
r

Medieval Towns Medieval Monasteries

Toilets/ ● Most towns had privies ● Lavatoriums – waste water was emptied
Dealing with cesspits into a river
with underneath ● Waste was dug out and used as manure
sewage ● Toilet waste sometimes ● Privies and cesspits could be flushed by
thrown into street diverting local rivers through them
● Cesspits collected
sewage which were dug
out by gong farmers

Attitudes ● Open drains would often ● Routines of cleanliness e.g. monks were
to overflow ordered to use baths
cleanliness ● Cesspits may overflow ● Clothes were washed regularly
when it rained ● Feet washed in a religious ceremony
● Streets outside twice a week
wealthier people’s ● Monasteries were often away from
houses were swept towns, which enabled them to maintain
● Laws were passed to good sanitation
encourage people to
keep the streets in
front of their houses
clean and remove
rubbish

Water ● Often contaminated by ● Used a system of pipes to deliver water

supply businesses such as ● Filter systems removed impurities from
leather tanners and water
meat butchers
● Mostly used rivers and
streams to remove
waste

Education/ ● Had no knowledge of ● Well educated and disciplined

understan germs ● Had access to medical books and
ding ● Believed disease was manuscripts
spread by ● Knew that good sanitation was to
‘bad air’ separate clean water from wastewater

Public Health: 18th and 19th century Hospitals

 Public Health: Cholera Epidemics
What were the problems facing Towns and Cities in the early 1800s? SHE said
there were problems!

Edwin Chadwick
 ⮚ The government set up an enquiry into living conditions

⮚ Over 10,000 free copies of Chadwick’s report were handed to politicians, journalists
and writers
⮚ The report highlighted the need for cleaner streets and a clean water supply

⮚ Showed people were wrong to blame the poor for bad housing and living conditions

BUT…
 Public Health: The Great Stink
In the summer of 1858, a heat wave caused the River Thames to smell worse than ever. As the
Houses of Parliament were right next door, MPs asked to meet somewhere else. This finally
convinced the government to do something about the problem of dirty water.

Joseph Bazalgette’s Sewers

● Was asked by the government to draw up plans for a network of sewers

● His design used gravity and the slope of London’s river basin to get sewers to flow
downstream towards the sea
● Built a pump to pump sewage up to the level of the Thames; at high tide it was released into
the river
● Was given £3 million in 1858
● Used 318 million bricks
● Built 83 miles of sewers, removing 420 million gallons of sewage a day
● Finished in 1866 – cholera never returned to London again

Which factors led to an improvement in Public Health in the 19th century?

(Ron Weasley Is Ginger: That’s So Cool!)

Individuals: Government: Technology:

● Chadwick carried out an enquiry
which reported the need for
cleaner streets and water
● Snow investigated the causes of
cholera and found the link
between dirty
water and the
disease
● Bazalgette built
London’s sewers
● Commissioned ● Bazalgette built the world’s largest
Chadwick to pumping station in London’s sewage
carry out an system
enquiry
● Introduced 1848 Public Health
Act
● Provided £3 million for
Bazalgette to build London’s
sewers
● Introduced the 1875 Public
Health Act which said councils
had to look after sewers

Science: Communication:
 ● Snow recorded the deaths on Broad Street and ● Chadwick’s report was distributed for free 10,000 times
traced them to the water pump on that ● 20,000 copies were bought by the public
street
● He created a map of all cholera deaths as
part of his investigation

Public Health: Liberal Reforms in early 1900s

Why did the Liberal Government try to improve the nation’s Health?

Remember: there is no need to BRAG about it!

B = Boer ✔ 40 out of every 100 volunteer soldiers were unfit
War
✔ Set up the ‘Physical Deterioration of the People’ committee to investigate

✔ In 1904 it said – unhealthy lives were preventing men from reaching the army

R = ✔ Charles Booth published life and Labour of the People in London

Reports
✔ It found 30% of Londoners were so poor they could not eat properly

✔ Demonstrated link between poverty and high death rate

✔ Seebohm Rowntree published Poverty: A study of Town Life (1901)

✔ Found 28% of the population did not have minimum amount of money to live on at
some point in their lives

A = ✔ Politicians from the Liberal Party believed direct action from the government was
Demands
a way to improve the public health and productivity
for Action
✔ Were also worried the Labour Party would become more popular

✔ Wanted measures to appeal to working people

G = ✔ There were fears that unhealthy workers could lead to a decline in Britain’s
Germany
power
✔ At the same time, Germany had a good system of state welfare

✔ Was gaining on Britain in production of coal, iron and steel

What was the impact of social reforms on
public health?

⮚ Infant mortality dropped

⮚ In 2015: infant mortality was 4.2 per

1000 (in 1900 it was 163 per 1000)

Public Health: The NHS

Which factors contributed to the introduction of the
NHS?

War Government Communication

● Had a major impact on ● Success of previous Liberal ● Sir William Beveridge

attitudes Reforms made governments wrote a report published in
● People felt the sacrifices more willing to intervene 1942
made during ● Labour Party promised in ● Said that people had the
WWI and the right to be free of the
WWII should election ‘five giants’
mean that the after that could
future was WWII to ruin their
better follow the lives
● Middle-class people in the advice of Beveridge ● Sold over
countryside were shocked ● Labour easily won the 100,000 copies in its first
by the state of children election month
from cities ● Recommended the
government should take
charge of social security
What is the significance of the NHS?

At ⮚ Initially opposed by doctors who did not want to be under government control
the
time ⮚ 41,000 out of 45,000 doctors did not want the NHS

⮚ Doctors gave their support when they were promised a salary

⮚ 8 million people had never seen a doctor until 1948 – now everyone could

Later ⮚ Women are now 4 times more likely to consult a doctor than men

⮚ Women’s life expectancy has risen from 66 to 83 since 1948

⮚ Men’s life expectancy has risen from 64 to 79

⮚ Cost of NHS rose rapidly – charges for prescriptions and dental treatment were
introduced

Today ⮚ Everyone has access to family planning, physiotherapy, child care, cancer screening etc.

⮚ Government continues to be involved in public health initiatives:

⮚ Tobacco advertising banned in 2005

⮚ Smoking ban 2007

⮚ Smoking while in a car with children banned 2015

Surgery: Medieval Surgery

Evidence of progress in this area Evidence of lack of progress in this area
Highly ● Surgeons would learn on ● Most common surgeons were
trained the battlefield barber-surgeons: they cut hair and
surgeons ● Or they would learn by performed minor surgeries
being apprenticed to
another surgeon

Detailed ● Mondino wrote the book Anathomia ● Knowledge of anatomy was based on
knowledge of which was the dissection manual for Galen – he did not carry out
human over 200 years dissections on humans
anatomy (the ● If dissections did not match Galen’s
body and how teachings, they assumed
it works)
the body was wrong, not
Galen
● Dissections were
restricted by the Church

Necessary ● Muslim surgeon, Abulcasis invented ● Tools would not have been kept clean
equipment: 26 new surgical instruments
operating
theatres and
surgical tools
 ● Tools included saws for amputation,
arrow pullers, cautery irons and
bloodletting knives

Anaesthetics ● Hemlock, opium or mandrake root ● Too much of these could kill the
(pain killers) were used to dull pain patient
● Patients would drink alcohol to dull ● No anaesthetics to put patients to
the pain sleep during surgery
● Patients would sometimes die from
the shock of pain in surgery

Techniques ● Cauterisation was used – burning the ● Cauterisation was extremely painful
to prevent wound to stop blood ● Surgery had to be performed quickly
blood-loss ● Ligatures were used for tying off to stop a patient bleeding out
and infection blood vessels ● No knowledge of germs – equipment
● Hugh of Lucca and his son Theodoric would be dirty
used wine on wounds to reduce ● No antiseptics
changes of infection

Sophisticated ● Frugardi of Salerno, Italy warned ● Most common form of surgery was
methods of against trepanning bloodletting (opening a vein)
treatment ● Trepanning was drilling a hole in the
skull – it was believed this would let
out a demon which was believed to
cause epilepsy
 Surgery: Renaissance Surgery
What is the Renaissance and why is it important?
⮚ During this period, people began to question, find evidence for themselves and experiment
with new ideas, rather than accepting what they were told
⮚ It changed the way people viewed their lives

⮚ Before the Renaissance books were rare and expensive – in 1451 the printing press was
invented

New ideas could be spread more quickly, cheaply and accurately

New ideas about Anatomy and Surgery

 Surgery: John Hunter
Teaching Specimen Collection
⮚ Admitted to the company of surgeons in
1768
⮚ Encouraged students to continually
review their work and update their
methods
⮚ Helped bring about famous teaching
hospitals in 19th century Britain and
America
⮚ Trained with Edward Jenner
Books and Medical Discoveries Scientific Method
⮚ Writings based on
observations from his dissections
⮚ 1771 published The
Natural History of Teeth
⮚ Published On Venereal Disease (1786)
based on self-experimentation
⮚ Ended the idea that gunshot wounds
were poisonous
⮚ Discoveries about nature of disease,
infections, cancer and circulation of the
blood
Compare the work of Andreas Vesalius and John Hunter. In what ways were they
similar?
Vesalius
Methods ▪ Carried out dissections himself
▪ Stole bodies of executed criminals to
examine
▪ Used scientific method to ensure he
was accurate: would observe and then
test theory
⮚ 3000 stuffed or dried animals, plants,
fossils, diseased organs, embryos, and
other body parts
⮚ Experimented with inflating narrow blood
vessels to study blood flow
⮚ Collection included skeleton of 2.3m tall
Irish giant, Charles Byrne
⮚ Promoted careful
observation and scientific method in
surgery
⮚ Experimented on himself: injected himself
with gonorrhoea, but unknown to him the
patient also had syphilis
⮚ 1785 treated a man with an aneurysm on
his knee joint: restricted blood flow so
vessels would bypass the lump: was
successful and saved him from amputation
Hunter
▪ Carried out over 2000 dissections
▪ Promoted careful observation and
scientific method
▪ Stole the body of Irish Giant, Charles
Byrne for his specimen collection
 ▪ Bodies were dug up from graves to be used
in dissections at his school

Teaching ▪ Taught others how to carry out ▪ Trained young surgeons

dissections properly ▪ Taught them to review their work and
▪ Demonstrated that Galen was wrong – methods
that scientific knowledge should be
questioned

Discoveries ▪ Had advanced anatomical knowledge ▪ Had some of the best anatomical knowledge
of the time: proved Galen was wrong of the time: understood the lymphatic
▪ Showed that blood moved from one system; circulation of the placenta

side of the heart to the other

Surgery: Anaesthetics
The Development of Anaesthetics:

How significant was the development of Anaesthetics?

At ⮚ Surgeons were used to operating quickly

the
time ⮚ Religious objections of removing the pain of childbirth: believed to be God’s will and
punishment for sin
⮚ Some patients died: Hannah Greener died during an operation to remove a toenail – the wrong
quantity of chloroform was calculated

Later ⮚ Queen Victoria made it more accepted: used it during the birth of her child

⮚ Surgeons could attempt more complex operations, but this introduced infection
deeper into the body: many still died during surgery

Today ⮚ Longer operations are now possible

⮚ More developments in anaesthetics e.g. local anaesthetics, or anaesthetics used to keep the
patient conscious during brain surgery

Surgery: WWI and WWII

 Surgery: Technology
How has surgery developed as a result of technology? Best ask Mr Tek!