Aqa Medicine Factors Teachit 34919

How to answer the 16-mark question (the ‘factors’ essay question) on AQA’s ‘Britain: Health and the people’
exam
Task 1: Read the following instructions about the structure and technique for this question then answer the comprehension questions
below.
The question will look something like this:
Has the government been the main factor in the development of public health in Britain since medieval times?
Explain your answer with reference to the government and other factors.
Use a range of examples from across your study of Britain: Health and the people: c.1000 to the present day. [16 marks + 4 SPaG]
Every question uses the following formula:

Has the (insert one of the seven factors) been the main factor in the development of (insert a field of medicine) in Britain since medieval times?
Explain your answer with reference to the (factor in question) and other factors.
Use a range of examples from across your study of Britain: Health and the people: c.1000 to the present day. [16 marks + 4 SPaG]
To answer this question, you need to write three paragraphs and a The question may ask about the impact of one of these factors on
conclusion. The first paragraph should be based upon the factor in the medicine in general, or the question may more specifically ask about
question. Each paragraph should be about a different factor, drawn a theme or a field of medicine. These could be:
from this list selected by AQA:
• Causes and cures of disease
• War
• Public health
• Superstition and religion
• Surgery and anatomy.
• Chance
• Government
• Communications
• Science and technology
• The role of the individual.
© www.teachit.co.uk 2023 34919 Page 1 of 33

How to answer the 16-mark question (the ‘factors’ essay question) on AQA’s ‘Britain: Health and the people’ exam
During your answer, you need to ensure that you include examples from all four of the time periods studied:
1. Medieval period / the Middle Ages
2. Early modern period
3. Industrial Revolution
4. Modern medicine.
To achieve higher SPaG marks, you need not only to avoid making SpaG mistakes, but you should also try to include a wide range of subject-
specific words.
Question 1: In the example question, which factor is being asked about? .........................................................................................
Question 2: How many paragraphs should you write, plus a conclusion? ...........................................................................................
Question 3: You should start your answer with a paragraph on the factor in the question. True or false? ...................................................
Question 4: There are seven factors provided by AQA. Should you invent your own as well or just use those factors?
..................................................................................................................................................................................
Question 5: There are three themes, or fields of medicine, which the exam board might ask you about. Two of them are ‘causes and cures of
disease’ and ‘surgery and anatomy’. Which one is missing from this list?
..................................................................................................................................................................................
Question 6: Can the exam board ask about medicine in general, or does it have to be specifically about one of the themes?
..................................................................................................................................................................................
Question 7: It does not matter which time periods you draw your examples from. True or false? .............................................................

Task 2a: For each of these essay plan tables, read the information on the following pages and sort the examples into the relevant boxes on
the essay–plan table. To do this, you need to read each example in the information and work out whether the example is relevant to causes
and cures, public health, or surgery and anatomy. Some examples fit in more than one column.
Task 2a: Essay–plan table: Factor = War

List broad reasons why this factor could have an impact:
Causes and cures: Public health: Surgery and anatomy:
Paragraph to suggest it was the most important factor:

Task 2a: Information for the factor of war
Medieval weaponry
Damaged limbs would
caused all sorts of
Some doctors during the often be amputated rather 1298 – Edward I complained of
puncture and stab or slash Paré promoted the use of
Crimean War felt that than attempting to save unhygienic conditions in York
wounds. Since soldiers ligatures in the amputations
soldiers should dutifully them. Cauterisation was that were endangering his
liked to dip arrows and that were common on the
put up with the pain also a common method to soldiers’ health. He ordered the
blades in faeces, wounds battlefield, instead of
rather than using prevent bleeding since it building of public latrines in the
tended to get infected. cauterisation.
anaesthetics. burned the wound to city.
There were also broken
prevent the flow of blood.
bones to deal with.
During WW1, Harold Gillies

The Crimean War Rivalry between Pasteur
developed what we now call
(1853–56) saw terrible X-rays had been (French) and Koch Surgery was done on the
plastic surgery. He set up a
conditions for the discovered in 1895, but it (German) increased after battlefield, and the surgeons had
special unit to do skin grafts
soldiers, with more dying was WW1 that made them France lost the Franco– to take more chances, which
for men suffering severe facial
from disease than common and accepted. Prussian war of 1871. sometimes led to them
wounds. He had treated over
injuries. Florence Mobile X-ray machines Defeating diseases was developing new methods on the
5,000 servicemen by 1921.
Nightingale and Mary were used on the now seen as having a big spot. An example of this was how
WW2 saw further advances in
Seacole worked to try to battlefield to find impact on the battlefield, Hugh of Lucca and his son
the field, such as those of
change this, improving shrapnel without the need and so there was Theodoric developed new
Archibald McIndoe, which were
hospital conditions and to cut the soldier open. competition to develop methods for removing arrows.
made possible by penicillin to
nursing. new cures.
help treat the wounds.
The Crusades brought Blood transfusions were

The First World War inspired Fleming to develop a better way
back Islamic ideas to Rivalry with Napoleon’s developed. In 1914 Albert Hustin
to treat infected wounds. He stumbled upon penicillin. Florey
Europe, e.g. Ibn Sina France led to the British discovered that glucose and
and Chain took up the challenge of mass-producing it, using
(Avicenna)’s great government making the sodium citrate stopped blood
the outbreak of WW2 to gain funding first from the British
encyclopaedia of smallpox vaccination from clotting. The British
government and then, in 1941, from the American
medicine Canon of compulsory in 1853, after National Blood Transfusion
government. An estimated 15% of wounded British and
Medicine, which became Napoleon had all his Service opened in 1938, and
American soldiers would have died without it. More
the standard medical soldiers vaccinated. large blood banks were
antibiotics follow penicillin’s success.
textbook. developed in WW2.

New techniques were

New technology like
developed in WW1 to
War could help drive medical knowledge forwards as it gunpowder meant new injuries WW2 saw a push to keep Britain
repair broken bones, e.g.
gave opportunities to test new ideas and practise skills. for surgeons to deal with. ‘fighting fit’; posters encouraged
the army leg splint (or
The need to keep troops healthy could also motivate Surgeons first thought people to keep healthy and
Keller–Blake splint). This
people to make new discoveries and to tackle public gunpowder wounds were warned against the dangers of
extended and elevated the
health issues. It could also encourage competition. poisonous and used boiling oil poor hygiene. There was also a
leg ‘in traction’ to help
However, it could disrupt learning and medical progress on them. Paré used cream national immunisation
bones knit together more
and cause ideas not to be shared or taken note of. when he ran out of oil, finding programme against diphtheria.
securely. It is still used
that it worked better.
today.
In the Boer War, alarmed army chiefs found that 40% of WW1 first brought the issue of
WW1 was followed by an
young men who volunteered were unfit to be soldiers. the psychological effects of
The shock caused by the influenza pandemic which spread
At the same time, people such as Charles Booth* and war on soldiers to the
evacuees in WW2 across Europe and the rest of the
Seebohm Rowntree showed the government they government’s attention, and
highlighted the issue of world, killing millions – more
needed to do something to improve the welfare of the the sheer number of soldiers
poverty in the cities. The than the war itself. It had started
country. This helped lead to the Liberal Reforms. suffering ‘shellshock’ meant
Beveridge Report (1942) in January 1918, but, in order to
* Booth reported that 40% of people living in London they couldn’t ignore it. Today
confirmed this and helped prevent the negative effect on
were so poor they did not have enough money to eat the condition is known as
lead to the start of the morale, the government
properly, despite having a full-time job. PTSD, and there has been
National Health Service in downplayed its significance, and
** Rowntree reported that, at some point in their lives, much research on it following
1948. this may have made its effects
28% of people living in York did not have the minimum recent wars like those in Iraq
worse.
amount of money needed to live. and Afghanistan.

Task 2b: Essay–plan table: Factor = Superstition and religion


Task 2b: Information for the factor of superstition and religion
In the medieval period, between In surgery, some patients had

During the Renaissance,
Religion and superstition could both help and hinder 1000 and 1500, more than 700 religious objections to using
people like Vesalius began
medicine. Many religions include a requirement to care hospitals were started in England. alcohol as a painkiller,
to question the work of
for the sick, and the idea of doing good works in order to These either were run by the preferring to sing hymns and
Galen, and the Church
get into heaven was a feature of Christianity which Church or depended on charitable cope with the pain. There
reacted by trying to stop
helped drive improvements in public health. However, donations. Many had no doctors was also a belief that women
this. Vesalius was forced
conflict between religions could lead to ideas from and were run by monks or nuns. should suffer during
to leave his job at Padua.
opposing religions being ignored. Organised religion could There were different types of childbirth since this was
It took powerful patrons
also hold back medical progress by refusing to accept new hospitals, including asylums for thought to be God’s will as
to protect these people
ideas or allow the experimentation needed to develop the mentally ill, like Bedlam in punishment for sin. Later,
from the wrath of the
them. London. They focused on ‘care, this view caused opposition
Church.
not cure’. to anaesthetics.
The 18th century saw a shift

to hospitals being founded
During the Great Plague
and supported by the When the Black Death hit England
(1665), people still The Church supported the
charitable gifts of private in 1348, people looked to religion
didn’t understand the ideas of Galen because he
people, with a focus on for answers. Some thought God For the medieval Church,
causes of disease. Those believed in a single
treatment rather than just was punishing them for their sins prayers were the most
houses with plague creator, and this fitted
care. Guy’s Hospital was set and sought to punish themselves important treatment for the
victims were with monotheistic
up in 1721 by the merchant (flagellants), thus showing sick. The Church also
quarantined (locked up) Christian ideas about God.
Thomas Guy. This still fitted penance. Monks and nuns suffered encouraged the belief in
and had a red cross This made it difficult to
with the Christian need to do higher death rates due to their miraculous healing. There
painted on the door with challenge anything Galen
good works. There was also a roles as healers and because were many shrines with relics
the words ‘Lord have wrote as it would be seen
recognition of the issue of travellers visited them. Clergy (such as bones or the blood
mercy on us’. The bodies as a criticism of the
child mortality rates. This suffered similarly due to their role of a holy person) that people
of the dead were too Church. Roger Bacon was
century saw fewer conflicts in the Catholic beliefs around could pilgrimage to for cures.
many for the arrested for suggesting
based around religion, and death and burial. Some people There was a strong belief
cemeteries, so plague doctors do their own
there was a growing feeling turned away from religion and set that illness came from God.
pits were dug to place research rather than trust
that faith was shown more up communes which lived ‘in the
them in. Dead bodies the old books.
through good works in the moment’.
were picked up at night.
community than specific
ceremonies.

The Islamic empires

valued learning, and
Monasteries and nunneries In the modern period, there
many caliphs were Islamic ideas reached the
tended to be cleaner and have been religious Religious ideas from the East
interested in science and West through trade links and
healthier places than towns. objections to a number of have fed into a renewed
supported Islamic due to the contact between
Their inhabitants were new medical discoveries, interest in alternative
medicine. Central to this the two religions during the
generally well educated and including gene therapy, medicines, including
was the statement by Crusades. Gerard of
disciplined, with access to cloning and transplants. homeopathy and
the Prophet Muhammad Cremona, an Italian
medical books and infirmaries. Jehovah's Witnesses reject acupuncture. Acupuncture
that ‘For every disease, translator, brought
Water was also cleaner, and blood transfusions. There has been successfully used as
Allah has given a cure.’ Avicenna’s Canon of Medicine
water for cooking and drinking have also been arguments an anaesthetic during major
Islamic hospitals sought to the West through his Latin
was kept away from the toilets over issues such as surgery.
to treat people, not just translation.
and wash places. euthanasia and abortion.
care for them, and
doctors were present.
The King’s Touch was Many of the social reformers

thought to cure people During both world wars, some calling for change in the 19th
of diseases such as people refused to fight for century were motivated by
scrofula. This came from religious reasons. Some of their religious convictions. An The Reformation saw an intellectual climate in which it
the view that the King these conscientious objectors example is Thomas Barnardo, became more common to question accepted beliefs and to
was God’s anointed worked in non-combatant whose Lutheran conversion conduct original research.
representative on earth. roles as ambulance men, influenced his decision to set
This continued in caring for the wounded. up homes and schools to help
England until 1714. Britain’s orphans.

Task 2c: Essay–plan table: Factor = Chance


Task 2c: Information for the factor of chance
Koch’s discovery of a way to

During WW2, an
grow batches of a specific Roentgen's discovery of the Jenner heard stories about
examination by Dr Ridley
bacterium followed the properties of X-rays occurred by milkmaids who caught Paré ran out of oil for
of an RAF pilot’s eyes
chance discovery of a chance when he noticed a cowpox and then seemed to cauterisation in 1536. He
(damaged by plastic
different-coloured growth mysterious green glow while be protected against had to use a mixture
shards) found that they
on a slice of potato left in experimenting on cathode rays in smallpox. This convinced him including eggs, rose oil
had not reacted to the
the lab. This led to the a vacuum in the presence of a to conduct experiments to and turpentine, which
presence of plastic. This
development of the use of photosensitive plate. He took an test this, leading to the proved far more effective
paved the way for cataract
agar in Petri dishes rather X-ray of his wife’s hand to show development of his than boiling oil!
surgery using implanted
than the liquid broths used his discovery. vaccination.
plastic lenses.
before this.
In 1880, Charles Early experiments with The chance meeting of

John Hunter infected
Chamberland (Pasteur's chemicals to develop Oskar Minkowski and
himself with gonorrhoea and
assistant) injected Pasteur only got to test his rabies anaesthetics were largely Joseph von Mering at the
syphilis at the same time by
chickens with a weakened vaccine because a boy who had trial and error. What swung university of Strasbourg in
accident. However, he did
strain of chicken cholera been bitten by a dog was brought the argument to use them 1889 led to a conversation
show that the two infections
by mistake. He thus to him on death’s door. Pasteur was Dr John Snow convincing which established the role
could be present in the
discovered by chance that decided to go ahead and test the Prince Albert (Queen of the pancreas in
same organ of a body at the
the weakened (or vaccine, and thus developed the Victoria’s husband) to allow diabetes. This paved the
same time – something
attenuated) culture had rabies vaccination in 1885. the use of chloroform in her way for the discovery of
which had not been thought
made the chickens next childbirth. Her support insulin and how to manage
possible prior to this.
immune. then made it acceptable. diabetes.
Originally marketed as a ‘mood enhancer’ and peddled in Fleming noticed by chance the
country sideshows, nitrous oxide was, and still is, known bacteria–killing qualities of the Penicillin actually causes a
Chance could influence
as laughing gas. In 1863, Englishman Joseph Priestley, who mould Penicillin notatum by severe reaction in guinea
medicine because it
had already discovered oxygen in its gaseous form, chance in 1928. Although this pigs, leading to death. Had it
enabled leaps to be made
combined iron filings with nitric acid and discovered that had been discovered previously, been tested on actual guinea
in the understanding of
it produced a tingling, numbing effect when inhaled. it was Fleming’s work that pigs, it might never have
illnesses, cures,
Dentists, doctors and surgeons then began to explore the inspired Florey and Chain to take been judged suitable for
techniques and tools.
drug as an anaesthetic, improving the outcomes of up the challenge to develop the human trials.
thousands of surgical procedures. mass production of penicillin.

Task 2d: Essay–plan table: Factor = Government

Task 2d: Information for the factor of government
During both the Black

Penicillin’s widespread use While dissection was allowed,
Death and the Great
was held back by the there were never enough
Plague, local councils Following the dissolution of Laissez–faire attitudes to
problems in producing bodies available for research.
tried to quarantine the monasteries, the government meant that
enough of it. The British Scientists like John Hunter
infected places. However, monarchy was forced to governments were reluctant to
government and then the were reduced to using other
efforts to combat disease legislate to try to deal with act to force change in public
USA funded the research means to get bodies for their
were hampered by the the problem of poverty. health.
needed, due to its life– studies, and a thriving illegal
lack of understanding of
saving potential in WW2. trade developed.
what caused it.
1388 – Parliament passed a law

Governments can have an impact as they typically have the which fined people £20 for
Quarantine laws were Kings like Edward I
finances and organisation necessary to make change throwing ‘dung, garbage and
introduced from 1666 to encouraged the growth of
happen. They can also hinder progress, though, particularly entrails’ into ‘ditches, ponds
prevent epidemic diseases towns as a way of increasing
when the government is influenced by a religion that does and rivers’. However, it proved
coming into the country on the amount of taxes they
not support development, or if the government is conscious difficult to enforce as there was
ships. could extract.
of the high cost of implementing change. no police force to catch those
who disobeyed.
Caliph al-Ma’mun (813–33)

Competition between
developed his father’s In 1853, the British
rulers and countries 1298 – Edward I complained of
library into the ‘House of government made the From 1906, the Liberal
during the Renaissance unhygienic conditions in York
Wisdom’: the world’s smallpox vaccination government introduced a raft of
provided patrons for that were endangering his
largest library at the time compulsory. This was partly reforms to improve the health
people who would soldiers’ health. He ordered
and a centre of study for in reaction to the use of the of the nation. This included free
develop theories to the building of public latrines
scholars. The Islamic vaccine in France on school meals for children.
challenge the ideas of in the city.
empires encouraged Napoleon’s troops.
Galen – like da Vinci.
medical learning.

The Beveridge Report (1942)

The French and German The treatment Charles II Government sponsorship of
identified ‘five giants’ that
Queen Victoria’s use of governments helped received showed the ‘voyages of discovery’, and
needed to be tackled: idleness,
chloroform made the use Pasteur and Koch. From continuing belief in the four then colonisation, from the
ignorance, disease, squalor and
of anaesthetics acceptable the 1860s to the 1880s, humours and the bloodletting 1400s brought new
want. The start of the NHS in
and even fashionable. The tremendous progress was associated with it. An average discoveries in the form of
1948 was partially a result of
conquest of pain made made in the development of 3,000 people came to new foods and medicines.
this report and gave free
further developments in of vaccinations, including London each year in the hope Many believed (wrongly)
healthcare to all. Hospitals also
surgery possible. chicken cholera, rabies of being cured by the King’s that tobacco had curative
came under government control
and anthrax. Touch. properties.
and scrutiny.
The need to address the Modern politicians have

cholera epidemic led to been far more aware of the The NHS has meant that
The death of Prince Albert
the 1848 Public Health In 1858, the Great Stink saw government’s role in helping surgeries are now available to
(Queen Victoria’s husband)
Act giving local town Joseph Bazalgette being given to protect the people they the British population as a
from typhoid raised public
councils the power to £3 million by MPs to install a serve. Recent years have whole – not just a privileged
awareness of the issue and
spend money on cleaning sewage system in the capital. seen the introduction of few. However, there is still the
helped lead to the
up their towns. This was This would provide a blueprint health warnings on tobacco option of private healthcare for
acceptance of germ theory
improved on in 1875 by for other towns and cities. products, including images those who can afford it, or as
in Britain.
the Second Public Health to show their effects, and a part of a salary package.
Act. healthy schools campaign.

Task 2e: Essay–plan table: Factor = Communication

Task 2e: Information for the factor of communication
Universities were key centres for

Leonardo da Vinci and Hugh of Lucca and his son
medical training. In the
Andreas Vesalius produced Theodoric wrote a book
The invention of the medieval period, they had been
Wise women and other detailed sketches of the criticising the idea that pus
printing press in the mid places where the works of Galen
healers did not write down human body. The more was needed for a wound to
1400s meant works could and other accepted texts were
their cures but passed them realistic style of painting heal. In 1316, Mondino
now be printed in larger read to students, while
on by word of mouth to the in the Renaissance wrote Anathomia, which
quantities and ideas shared assistants did any dissection. If
next generation. encouraged painters to became the standard
more quickly. the body disagreed with Galen’s
look more closely at how dissection manual for over
ideas, then it was the body that
the body worked. 200 years.
was wrong.
Vesalius was a gifted

teacher, and his lectures (in Before the printing press, books
Charts were used in the
which he demonstrated were handwritten – usually by From the invention of the Guy de Chauliac wrote
Middle Ages and later to help
dissections himself) were monks. This gave the Church a printing press onwards, against Hugh de Lucca and
diagnose illnesses from a
very popular and high degree of control over what most discoveries and his son in his famous
patient’s urine. Illustrations
encouraged others to do was produced. The Church developments were textbook Great Surgery
such as the ‘zodiac man’ also
their own original research. approved of Galen, so his books published and so could be (1363) and was a major
showed barber surgeons
He also published his ideas were reproduced. Books were used and improved by reason why their ideas did
where to bleed patients from
in an illustrated textbook available, but they were other doctors. not catch on.
and where to avoid.
On the Fabric of the Human expensive.
Body (1543).
John Hunter saw the need to

Ibn Sina’s (Avincenna) work The invention of the printing Government campaigns
educate the public about
The Canon of Medicine was press came at a time when aimed at promoting
medical progress to address the The Islamic world
translated into Latin by a scholars were looking back to healthier living and early
fear felt by many. He developed encouraged the
merchant named the classical world for ideas, identification of diseases
a massive collection of development of medical
Constantine of Africa in the and so old books previously like cancer have been a
specimens which he allowed to ideas, with the caliphs
12th century and became lost to the West started to be future of modern medicine.
be shown to the public. This creating great libraries of
the standard European rediscovered, especially with Tobacco products now show
included the skeleton of Charles works.
medical textbook until the the fall of Constantinople in pictures of the results of
Byrne, who was at least 2.3
17th century. 1453. their use.
metres tall.

Harvey was reluctant to

Cartoons were used as a
publish his ideas on the
Fleming’s published findings on Societies such as the Royal way of poking fun at
circulation of blood because
penicillin prompted the further College of Surgeons (created Increasingly detailed doctors and their
he could not fully explain
development of this antibiotic in 1800 out of the old drawings based on actual discoveries, and to suggest
all aspects of his theory. It
by Florey and Chain. They had Company of Surgeons) first–hand experience of that they were wrong or
took him 12 years to decide
been compiling a list of natural encouraged the sharing of dissection improved the dangerous. For example, a
to publish. Publishing had
substances that could kill germs new ideas and promoted understanding of the famous cartoon about the
also opened up the
and happened to read Fleming’s further research and human body. smallpox vaccine shows
possibility of criticising
article. developments. cows erupting from people
people’s work and ideas in
injected with the vaccine.
print.
Communication can impact

The development of
medical progress because of
In the modern age, the internet individual wards for different
the way ideas can be spread Social reformers used the
and television have types of disease in hospitals Newspapers reported on
or controlled. Over time, media to attract attention
revolutionised the ability to in the 18th century, and the the use of chloroform by
the ability to reach larger to their cause. Galt
diagnose illnesses, check development of medical Queen Victoria, thus
and larger audiences and to produced photos of slums in
symptoms and access medical schools attached to hospitals, encouraging the use of the
share research has an effort to call for a
advice – not always for the allowed doctors to new technique.
improved, although the change in conditions.
better. collaborate to develop new
effect is not always
treatments.
positive.

Task 2f: Essay–plan table: Factor = Science and technology

Task 2f: Information for the factor of science and technology
Paré developed artificial

limbs for patients to use In Harvey’s lifetime, there
New technology like
following amputations. He The use of the scientific was no microscope good
gunpowder resulted in new
designed these to be method can clearly be seen enough to see the tiny
injuries for surgeons to deal The first British surgeon to
functional, with moving in the work of Jenner and capillaries that connect the
with. Surgeons first thought use rubber gloves was
parts, as well as to look the experiments he veins to the arteries. In
gunpowder wounds were Berkeley Moynihan in the
realistic. conducted to test his theory 1661, Professor Marcello
poisonous and used boiling 1890s. Soon face masks,
Paré developed the bec de on cowpox. We can also see Malpighi used one of the first
oil on them. Paré used rubber gloves and surgical
corbin or ‘crow’s beak it in the work of Pasteur and effective microscopes to
cream when he ran out of gowns became the norm.
clamp’ to halt bleeding Koch in the development of prove Harvey’s work was
oil, finding that it worked
while a blood vessel was germ theory. correct, four years after
better.
being tied off with a Harvey’s death.
ligature.
New techniques were

Lister looked to Professor of
developed in WW1 to repair
The printing press saw a The Renaissance saw the Chemistry Thomas Anderson
broken bones, e.g. the army MRI machines and CAT
major change in how development of the for a suggestion of a
leg splint (or Keller–Blake scanners have allowed
accessible books would be, scientific method. This chemical that could kill
splint). This extended and doctors to see inside the
and thus in the ability of involved observation, bacteria. Anderson
elevated the leg ‘in traction’ human body in detail in a
doctors and surgeons to hypothesis and suggested carbolic acid, and
to help bones knit together non-invasive way.
share their findings. experimentation. so Lister developed the use
more securely. It is still used
of this in his surgery.
today.
Television, videos or DVDs,

The development of In the modern age, the
and sites on the internet like
Science and technology photography allowed social internet and television have
YouTube have spawned a Keyhole surgery has been
could influence change by reformers to take emotive revolutionised the ability to
craze for exercise of various developed to reduce risk to
providing new instruments pictures of the ‘real’ diagnose illnesses, check
types in an attempt to get patients, scarring and
and methods for researchers conditions of Victorian symptoms and access
fit, develop muscle or recovery time.
to use. Britain in an attempt to medical advice – not always
achieve what is perceived as
effect change. for the better.
the ‘perfect body’.

John Hunter saw the need to

educate the public about Blood transfusions were
The Islamic world saw the
The ability to take detailed medical progress and the developed. In 1914, Albert
development of The development of germ
photographs and footage of scientific method to address Hustin discovered that
anaesthetics, with patients theory as a proven scientific
surgery and medical the fear felt by many. He glucose and sodium citrate
holding sponges soaked with theory forced a change in
conditions has been a useful developed a massive stopped blood clotting. The
drugs against their noses. In public health as governments
tool in the teaching of collection of specimens British National Blood
the West, mandrake root, could no longer ignore the
medical students and the which he allowed to be Transfusion Service opened
opium and hemlock were link between poor sanitary
development of new shown to the public. This in 1938, and large blood
used (but an overdose could conditions and disease.
techniques and cures. included the skeleton of banks developed were in
kill).
Charles Byrne, who was at WW2.
least 2.3 metres tall.
The discovery of DNA by

Some towns in the medieval After Ehrlich’s discovery of Chemical giants like Pfizer
Crick and Watson (1953) has
period had systems for their the chemical cure for have allowed for the mass
The Industrial Revolution opened up new avenues for
water left by the Romans, syphilis (Salvarsan or 606), production of new drugs like
saw the development of research into causes and
but as towns grew these other ‘magic bullets’ were penicillin, but they have also
methods to mass-produce cures, leading to such
were no longer enough. invented by scientists over been accused of keeping
medical tools and research developments as gene
Towns like Exeter and the next 20 years, including prices artificially high,
equipment, although some therapy, genetic screening
London then used new prontosil, which worked taking ideas from their
would still be made by hand. and genetic engineering. Not
technology with pipes made against the germs that original inventors and not
everyone sees these as
of wood or lead. caused blood poisoning. sharing research.
positive steps forwards.

Task 2g: Essay–plan table: Factor = Role of individuals

Task 2g: Information for the factor of the role of individuals
Paré developed artificial

In 1865, Elizabeth Garrett William Harvey (1578-1657)
limbs for patients to use
Anderson became the first was a careful scientist who
In the medieval period and following amputations. He
female doctor. Although she came up with the idea that John Hunter saw the need to
beyond, the ideas of Galen designed these to be
had no degree (no university blood circulates. He waited educate the public about
held sway. These set out functional, with moving
in Britain would accept her), 12 years before publishing, medical progress and the
that illness was caused by an parts, as well as to loo–
she gained qualification though, as he could not fully scientific method to address
imbalance of the four realistic.
through experience and explain his findings. In the fear felt by many. He
humours – blood, yellow Paré developed the bec de
taking the Society of Harvey’s lifetime, there was developed a massive
bile, black bile and phlegm - corbin or ‘crow’s beak
Apothecaries exam. She set no microscope good enough collection of specimens
and so treatments looked for clamp’ to halt bleeding
up her own practice, which to see the tiny capillaries which he allowed to be
ways to readjust that while a blood vessel was
evolved into the New that connect the veins to the shown to the public. Thus
balance. These ideas also being tied off with a
Hospital for Women and arteries. In 1661, Professor included the skeleton of
had the backing of the ligature. He also moved
Children by 1872. She Marcello Malpighi used one Charles Byrne, who was at
Church and so were difficult away from the use of
established the London of the first effective least 2.3 metres tall.
to question successfully. cauterisation – using cream
School of Medicine for microscopes to prove
instead to sooth the area
Women in 1874. Harvey’s work was correct.
and promote healing.
Roentgen's discovery of the

Leonardo da Vinci was a Al-Razi (c.865–c.925), aka The 18th century saw the
properties of X-rays occurred
Guy de Chauliac wrote Renaissance scientist, Rhazes, stressed the need development of hospitals
by chance when he noticed a
against Hugh de Lucca and painter and inventor who for careful observation of funded by private individuals
mysterious green glow while
his son in his famous made over 30 human the patient, and for the first and groups. Westminster
experimenting on cathode
textbook Great Surgery dissections and carefully time told smallpox and Hospital (1719) was founded
rays in a vacuum in the
(1363) and was a major recorded his findings in measles apart. He followed by a private bank and Guy’s
presence of a photosensitive
reason why their ideas did highly detailed sketches. He Galen but thought all Hospital (1721) by a
plate. He took an X-ray of
not catch on. had to understand the body students should improve on merchant called Thomas
his wife’s hand to show his
for his artwork. the work of their tutor. Guy.
discovery.

The Bristol physician Thomas Edwin Chadwick was lawyer Ibn Sina (980–1037), aka Joseph Bazalgette was the
Beddoes and his assistant who dedicated his life to Avicenna, wrote The Canon man responsible for the
Pasteur and Koch developed
Humphry Davy experimented pushing for health and social of Medicine, which was to designing and building of the
Germ Theory, while people
with inhaling nitrous oxide reform, publishing a report become the standard London sewer system
like Lister, John Tyndall,
as an anaesthetic, but the in 1842 on conditions in medical textbook in Europe following the Great Stink.
William Roberts and William
breakthrough came when Britain. However, he still for the next 700 years. It The project was finally
Cheyne championed the
James Simpson discovered believed in miasma. Dr John listed the properties of 760 completed in 1866 and
theory in Britain, helping it
chloroform and Dr John Snow’s work would show the different drugs and had became a blueprint for other
to become accepted.
Snow got Queen Victoria to cause of cholera to be dirty chapters on anorexia and similar projects across the
use it. water. obesity. country.
John of Arderne was the The discovery of DNA by Vesalius used his own
most famous surgeon in Hugh of Lucca and his son Crick and Watson (1953) has experiments to challenge
medieval England. His Theodoric wrote a book British scientist Godfrey opened up new avenues for the work of Galen, and his
surgical manual Practica criticising the idea that pus Hounsfield invented the CAT research into causes and lectures, during which he
(1376) contained was needed for a wound to scanner in 1973. This used cures, leading to such carried out dissections
illustrations of his operations heal. In 1316, Mondino wrote X-ray images from many developments as gene himself, were extremely
and instruments. He tried to Anathomia, which became angles to build up a 3D therapy, genetic screening popular. He published an
separate surgeons from the the standard dissection image of the body. and genetic engineering. Not illustrated textbook, On the
lower-class barber surgeons manual for over 200 years. everyone sees these as Fabric of the Human Body,
by forming a guild for them. positive steps forwards. in 1543.
Individuals could effect

Florey and Chain took up the Aneurin Bevan was the change as they came up with
Edward Jenner (1749–1823)
challenge of mass-producing champion of the NHS, new ideas and ways of
The First World War inspired developed the smallpox
penicillin, using the ensuring that its setting–up treating or conducting
Fleming to develop a better vaccine. Others had made
outbreak of WW2 to gain (following the 1942 surgery. These were often
way to treat infected the link between smallpox
funding from the British Beveridge Report that built on by later work. They
wounds. He stumbled upon and cowpox, but Jenner
government and, in 1941, recommended it) went could also hold medicine
penicillin. published his and so was
from the American ahead despite stiff criticism back, though, if they
credited with the discovery.
government. and concern about the cost. thought the ideas were too
radical.

Task 3: Read through this master table of model paragraphs for each factor and theme. You can also use this to check whether you have put
the correct examples in the correct boxes in task 2, though note that some information may apply to more than one factor or theme.
Challenge: Where the same examples are used across different themes (areas of medicine), notice how the analysis of each example has been
tailored to that specific theme.
Focus of question
Factors
Medical knowledge in general Causes and cures Public health Surgery
War War could help drive medical War helped to promote knowledge of War has helped improve public War helped in the development of
knowledge forwards as it gave the causes of illness and cures as it health throughout history. In 1298, surgery because it provided
opportunities to test new ideas and provided opportunities for doctors to we see Edward I ordering new opportunities for surgeons to try new
practise skills. Paré was able to try new things. Paré found by latrines in York as he felt the ideas, like Hugh of Lucca and his son
perfect his use of ligatures on the accident that using a cream to conditions there were endangering Theodoric developing new ways of
amputations which were common on soothe open wounds and amputation his troops. Paré saw many removing arrows. Paré found by
the battlefield. The need to keep sites was more effective than amputations on the battlefield, and accident that using a cream to sooth
troops healthy could also motivate cauterisation, which had been he worked to develop artificial limbs open wounds and amputation sites
people to make new discoveries and commonly used in the medieval which would be functional, with was more effective than
to tackle public health issues. period. The medieval period had moving parts, and allow amputees to cauterisation, which had been
Edward I ordered new public latrines seen contact with the Islamic world, have a better standard of life. The commonly used in the medieval
in York in 1298 since the conditions though, which benefited the West. Crimean War of 1853–56 saw leaps period. He also had a steady stream
there endangered his troops. War Avicenna’s book The Canon of forwards in the development of of patients to practise his method of
could also encourage competition. Medicine was to be the standard nursing, and an understanding of the using ligatures instead of
The Franco-Prussian war in 1871 fed textbook for the next 700 years. The importance of good-quality care to cauterisation. The Crimean War
the competition between Pasteur and Crimean War of 1853–56 saw leaps recovery. Florence Nightingale and helped to highlight the importance of
Koch and helped to promote the forwards in the development of Mary Seacole worked to try to good hygiene following surgery, with
development of germ theory. The nursing, and an understanding of the improve nursing and conditions, first Florence Nightingale and Mary
two world wars had a massive impact importance of good-quality care to in military hospitals and then in Seacole pushing for improvements in
on medical progress. Plastic surgery recovery. Florence Nightingale and hospitals in general. Rivalry with military hospitals and better
was developed to deal with the Mary Seacole worked to try to Napoleon’s France led to the British standards of nursing. The ability to
horrendous injuries caused, improve nursing and conditions, first government making the smallpox fight infection was also inspired by
especially the burns. Continued. in military hospitals and then in vaccination compulsory in 1852, after and driven forwards by war. The First
hospitals in general. Continued. Napoleon had all his soldiers World War inspired Fleming to
vaccinated. Continued. develop a better way to treat
infected wounds. Continued.

Factors Medical knowledge in general Causes and cures Public health Surgery
War The Second World War in particular The First World War saw the In the Boer War, alarmed army chiefs He stumbled across penicillin. Florey
was a driver in the creation of the recognition of the psychological found that 40% of young men who and Chain took up the challenge of
cont.
NHS as a consequence of the poor impact of war on soldiers through the volunteered were unfit to be mass-producing it, using the outbreak
conditions people saw in the condition identified as shellshock. In soldiers. At the same time, people of WW2 to gain funding from the
evacuees and that the Beveridge terms of cures, one of the major such as Charles Booth (who reported British government, and then in 1941
Report then confirmed. The NHS contributions of war was the role it that 40% of people living in London from the American government. It is
opened for business in 1948 and was played in the development of were so poor they did not have estimated that 15% of wounded
the single most important penicillin and antibiotics. It is a enough money to eat properly, British and American soldiers would
development in medicine, based as it measure of how important these despite having a full-time job) and have died without it. More antibiotics
was on the need to keep Britain drugs are that there is such concern Seebohm Rowntree (who reported would follow. World War Two also
healthy and provide free healthcare today that some infections are that, at some point in their lives, 28% led to the development of the NHS,
for all. becoming resistant to them. of people living in York did not have which would open up the availability
the minimum amount of money of surgery to all and is perhaps the
needed to live) showed the most important change of all in the
government it needed to do history of surgery.
something to improve the welfare of
the country. This helped lead to the
Liberal Reforms from 1906. The
Second World War in particular was a
driver in the creation of the NHS as a
consequence of the poor conditions
people saw in the evacuees, and that
the Beveridge Report then
confirmed. The NHS opened for
business in 1948 and was the single
most important development in
medicine, based as it was on the
need to keep Britain healthy and
provide free healthcare for all.

Superstition Religion and superstition could Religion and superstition could both Religion and superstition could both Religion and superstition could both
and religion both help and hinder medicine. help and hinder medicine. Many help and hinder medicine. Many help and hinder medicine. Contact
Many religions include a religions include a requirement to religions include a requirement to with the Islamic empires through the
requirement to care for the sick. In care for the sick. In the medieval care for the sick. In the medieval Crusades benefited the West. The
the medieval world, we see this in world, we see this in the hospitals world, we see this in the hospitals Islamic world saw the development of
the hospitals and infirmaries and infirmaries staffed by monks and and infirmaries staffed by monks and anaesthetics, with patients holding
staffed by monks and nuns. There, nuns. There, the emphasis was very nuns. There, the emphasis was very sponges soaked with drugs against
the emphasis was very much on much on care rather than cure, and much on care rather than cure, and their noses. In the West, mandrake
care rather than cure, and indeed indeed the sickest patients might be indeed the sickest patients might be root, opium and hemlock might be
the sickest patients might be turned away if they disturbed the turned away if they disturbed the used (but an overdose could kill). The
turned away if they disturbed the prayer of others. Islamic hospitals in prayer of others. Islamic hospitals in design of scissors, syringes and
prayer of others. Islamic hospitals the same period had the opposite the same period had the opposite forceps was also improved. The work
in the same period had the focus; central to this was the focus; central to this was the of people like Vesalius and Leonardo
opposite focus; central to this was statement by the Prophet Muhammad statement by the Prophet Muhammad da Vinci in developing a better
the statement by the Prophet that ‘For every disease, Allah has that ‘For every disease, Allah has understanding of anatomy was crucial
Muhammad that ‘For every given a cure.’ However, it was not given a cure.’ However, it was not in improving surgery, but the Church
disease, Allah has given a cure.’ until the 18th century that this view until the 18th century that this view was not pleased with theories that
However, it was not until the 18th was common in the West. The Church was common in the West. The idea of criticised the accepted ideas based on
century that this view was common supported the ideas of Galen and the doing good works in order to get into the work of Galen. The 18th century
in the West. The idea of doing four humours, seeing illness as due to heaven was a feature of Christianity saw a shift to hospitals founded and
good works in order to get into an imbalance of the humours and which helped drive improvements in supported by the charitable gifts of
heaven was a feature of cures as an attempt to balance them. public health. The 18th century saw a private people, with a focus on
Christianity which helped drive During the Renaissance, people like shift to hospitals founded and treatment rather than just care.
improvements in public health. An Vesalius began to question the work supported by the charitable gifts of Guy’s Hospital was set up in 1721 by
example is Thomas Barnardo, of Galen, and the Church reacted to private people, with a focus on the merchant Thomas Guy. This fitted
whose Lutheran conversion try to stop this. Vesalius was forced treatment rather than just care. with the Christian need to do good
influenced his decision to set up to leave his job at Padua. It took Guy’s Hospital was set up in 1721 by works, and the teaching schools
homes and schools to help Britain’s powerful patrons to protect these the merchant Thomas Guy. Many of attached to many of these hospitals
orphans. Continued. people from the wrath of the Church. the social reformers calling for allowed surgery to develop. In
The 18th century saw a shift to change in the 19th century were surgery, some patients had religious
hospitals founded and supported by motivated by their religious objections to using alcohol as a
the charitable gifts of private people, convictions. Continued. painkiller, preferring to sing hymns
with a focus on treatment rather than and cope with the pain. Continued.
just care. Continued.

Superstition However, conflict between Guy’s Hospital was set up in 1721 by An example would be Thomas There was also a belief that women
and religion religions could lead to ideas from the merchant Thomas Guy. Many of Barnardo, whose Lutheran conversion should suffer during childbirth since
opposing religions being ignored, these new hospitals were teaching influenced his decision to set up this was thought to be God’s will as
cont.
which would lessen the influence hospitals and so helped medical homes and schools to help Britain’s punishment for original sin. Later,
of Islamic medicine on the West. progress. This fitted with the orphans. During both world wars, this caused opposition to
Organised religion could also hold Christian need to do good works. In some people refused to fight for anaesthetics. In the modern period,
back medical progress by refusing the modern period, there have been religious reasons. Some of these there have been religious objections
to accept new ideas or allow the religious objections to a number of conscientious objectors worked in to a number of new medical
experimentation needed to new medical discoveries, including non-combatant roles as ambulance discoveries, including gene therapy,
develop them. Vesalius was not gene therapy, cloning and men, caring for the wounded. Modern cloning and transplants. Jehovah’s
popular in the Church as his ideas transplants. Jehovah’s Witnesses hospitals and hospices also retain a Witnesses reject blood transfusions.
on the human anatomy challenged reject blood transfusions. There have link to organised religion. Therefore, religion can both help and
Galen’s teaching, which the Church also been arguments over issues such hinder progress in surgery.
supported. Bacon had been as euthanasia and abortion. We can
arrested for suggesting doctors do see religion continuing to act as a
their own research. In surgery, balance on medicine, attempting to
some patients had religious ensure that the moral element is not
objections to using alcohol as a lost in the pursuit of progress.
painkiller, preferring to sing hymns
and cope with the pain. There was
also a belief that women should
suffer during childbirth since this
was thought to be God’s will as
punishment for sin. Later, this
view caused opposition to
anaesthetics. In the modern world,
religious ideas from the East have
fed into a renewed interest in
alternative medicines, including
homeopathy and acupuncture.
Acupuncture has been successfully
used as an anaesthetic during
major surgery.

Chance Chance could influence medicine Chance could influence medicine There is nothing for this factor Chance could influence medicine because
because it enabled leaps to be made because it enabled leaps to be made and theme combination! it enabled leaps to be made in the
in the understanding of illnesses, in the understanding of illnesses, understanding of illness, cures, techniques
Challenge: could you research
cures, techniques and tools. Paré ran cures, techniques and tools. Paré ran and tools. Paré ran out of oil for
something?
out of oil for cauterising in 1536 and out of oil for cauterising in 1536 and cauterising in 1536 and had to use a
had to use a mixture including eggs, had to use a mixture including eggs, mixture including eggs, rose oil and
rose oil and turpentine, which proved rose oil and turpentine, which proved turpentine, which proved far more
far more effective than boiling oil. far more effective than boiling oil. effective than boiling oil. Perhaps one of
Perhaps one of the most famous Perhaps one of the most famous the most famous chance discoveries is
chance discoveries is Roentgen’s chance discoveries is Roentgen’s Roentgen’s discovery of the properties of
discovery of the properties of discovery of the properties of X-rays. X-rays. He noticed a mysterious green glow
X-rays. He noticed a mysterious green He noticed a mysterious green glow when experimenting on cathode rays in a
glow when experimenting on cathode when experimenting on cathode rays vacuum in the presence of a photosensitive
rays in a vacuum in the presence of a in a vacuum in the presence of a plate. He took an X-ray of his wife’s hand
photosensitive plate. He took an X-ray photosensitive plate. He took an X-ray to show his discovery. X-rays would go on
of his wife’s hand to show his of his wife’s hand to show his to revolutionise diagnosis by allowing
discovery. X-rays would go on to discovery. X-rays would go on to doctors to see inside a patient without
revolutionise diagnosis by allowing revolutionise diagnosis by allowing cutting. This would then feed into further
doctors to see inside a patient doctors to see inside a patient development in this field with the
without cutting. This would then feed without cutting. This would then feed invention of the MRI and CAT scanners. In
into further development in this field into further development in this field the field of anaesthetics, nitrous oxide was
with the invention of the MRI and CAT with the invention of the MRI and CAT originally marketed as a ‘mood enhancer’
scanners. Perhaps a key ‘what if’ scanners. Perhaps a key ‘what if’ and peddled in country sideshows; nitrous
comes from the discovery of comes from the discovery of oxide was, and still is, known as laughing
penicillin. Not only does it kill guinea penicillin. Not only does it kill guinea gas. In 1863, the Englishman Joseph
pigs, and so might never have got to pigs, and so might never have got to Priestley, who had already discovered
human trials if solely tested on these human trials if solely tested on these oxygen in its gaseous form, combined iron
animals, but it was only by chance animals, but it was only by chance filings with nitric acid and discovered that
that Florey and Chain came across that Florey and Chain came across it produced a tingling, numbing effect
Fleming’s paper and so decided to Fleming’s paper and so decided to when inhaled. Dentists, doctors and
look into human trials and then look into human trials and then surgeons then began to explore the drug as
research ways of mass-producing the research ways of mass-producing the an anaesthetic, improving the outcomes of
antibiotic. antibiotic. thousands of surgical procedures.
Therefore, nitrous oxide was developed
due to chance.

Government Governments can have an impact as Governments can have an impact as Governments can have an impact as Governments can have an impact as
they typically have the finances and they typically have the finances and they typically have the finances and they typically have the finances and
organisation necessary to make change organisation necessary to make change organisation necessary to make change organisation necessary to make change
happen. Early government action happen. While early governments might happen. Early government action happen. In the field of surgery,
proved difficult to enforce, though, have recognised a link between poor proved difficult to enforce, though, ultimately it is governments and
such as in 1388 when Parliament sanitation and disease (as with Edward I such as in 1388 when Parliament monarchs that decide whether a country
passed a law which fined people £20 ordering public latrines to be built in passed a law which fined people £20 goes to war. Since surgery was initially
for throwing ‘dung, garbage and York as the filth endangered his troops), for throwing ‘dung, garbage and done on the battlefield, this provided
entrails’ into ‘ditches, ponds and they did not always have the ability to entrails’ into ‘ditches, ponds,and opportunities for surgeons to try out
rivers’. Few fines were issued as there enforce action due to local corruption rivers’. Few fines were issued as there new techniques – like Hugh of Lucca and
was no police force to catch those who and a lack of policing. Since ideas about was no police force to catch those who his son Theodoric, who would develop
disobeyed. During the Great Plague the causes of disease were based on disobeyed. During the Great Plague new methods for removing arrows.
(1665), government action would be Galen, there was also not a clear (1665), government action would be Competition between rulers and
more decisive, with houses of the sick understanding of how to cure disease. more decisive, with houses of the sick countries during the Renaissance
boarded up for 40 days and guarded to Both the Black Death and the Great boarded up for 40 days and guarded to provided patrons for people who would
ensure people did not infect their Plague saw government attempts to ensure people did not infect their develop theories to challenge the ideas
neighbours. New quarantine laws were quarantine infected areas, but they neighbours. New quarantine laws were of Galen – like da Vinci. The improved
introduced in 1666 which aimed to were unable to cure the disease introduced in 1666 which aimed to understanding of human anatomy that
prevent contagious diseases being effectively as they did not understand prevent contagious diseases being followed would benefit surgeons. In the
brought in on ships. In the Victorian its cause. Key to an understanding of brought in on ships. In the Victorian industrial age, Queen Victoria’s use of
era, acceptance of germ theory meant disease was a better understanding of era, acceptance of germ theory meant chloroform made the use of
that the government was pushed to the human body. While dissection was that the government was pushed to anaesthetics acceptable and even
act to clean up the cities. In 1858, allowed, there were never enough act to clean up the cities. In 1858, fashionable. The conquest of pain made
Joseph Bazalgette was given £3 million bodies available for research. Scientists Joseph Bazalgette was given £3 million further developments in surgery
to install a sewage system in London like John Hunter were reduced to using to install a sewage system in London possible. The Second World War saw
that was to become a blueprint for other means to get bodies for their that was to become a blueprint for maybe the biggest change influenced by
other towns and cities. The Second studies, and a thriving illegal trade other towns and cities. The Second government. Not only did the British
World War saw maybe the biggest developed. However, competition could World War saw maybe the biggest and American governments fund the
change influenced by government. Not also spark improvements. Jenner was change influenced by government. Not mass development of penicillin, which
only did the British and American given £10,000 to fund his research into only did the British and American was to revolutionise the ability to
governments fund the mass smallpox, and in 1853 vaccination governments fund the mass control infections, which had been a
development of penicillin, which was against smallpox was made compulsory development of penicillin, which was major problem in surgery, but the 1942
to revolutionise the ability to control in Britain, after Napoleon (who Britain to revolutionise the ability to control Beveridge Report led to the introduction
infections, but the 1942 Beveridge was fighting) vaccinated his soldiers. infections, but the 1942 Beveridge in 1948 of a National Health Service
Report led to the introduction in 1948 Report led to the introduction in 1948 providing free healthcare for all. This
of a National Health Service providing of a National Health Service providing included the possibility of surgery for all
free healthcare for all. free healthcare for all. needing it, and funding to develop new
surgical methods like keyhole surgery.

Communication Communication can impact medical Communication can impact medical Communication can impact medical Communication can impact medical
progress because of the way ideas progress because of the way ideas progress because of the way ideas progress because of the way ideas
can be spread or controlled. can be spread or controlled. can be spread or controlled. In the can be spread or controlled. Hugh of
Universities were key centres for Universities were key centres for Islamic world, hospitals focused on Lucca and his son Theodoric wrote a
medical training. In the medieval medical training. In the medieval trying to cure patients, rather than book criticising the idea that pus
period, they had been places where period, they had been places where just caring for the sick as they did in was needed for a wound to heal. In
the works of Galen and other the works of Galen and other the West. However, these ideas 1316, Mondino wrote Anathomia,
accepted texts were read to accepted texts were read to were not taken on in the West, even which became the standard
students, while assistants did any students, while assistants did any though some of the works of Islamic dissection manual for over
dissection. If the body disagreed dissection. If the body disagreed doctors like Avicenna were to 200 years. Guy de Chauliac wrote
with Galen’s ideas, then it was the with Galen’s ideas, then it was the become key medical texts in the against Hugh de Lucca and his son in
body that was wrong. Before the body that was wrong. Before the West. The development of individual his famous textbook Great Surgery
printing press, books were printing press, books were wards for different types of disease (1363) and was a major reason why
handwritten, usually by monks. This handwritten, usually by monks. This in hospitals in the 18th century, and their ideas did not catch on.
gave the Church a high degree of gave the Church a high degree of the development of medical schools However, the increased emphasis on
control over what was produced. control over what was produced. attached to hospitals, allowed correct anatomical detail in books
The Church approved of Galen, so The Church approved of Galen, so doctors to collaborate to develop was a feature of the Renaissance
his books were reproduced. Books his books were reproduced. Books new treatments. In the modern that benefited surgery greatly.
were available, but they were were available, but they were world, especially since the Second These books were based on first–
expensive. The invention of the expensive. The invention of the World War, government campaigns hand experiences of dissection. One
printing press changed this. Vesalius printing press changed this. Vesalius aimed at promoting healthier living of the people who were a part of
was a gifted teacher, and his was a gifted teacher, and his and early identification of diseases this movement was Vesalius, who
lectures (in which he demonstrated lectures (in which he demonstrated like cancer have been a feature of gave lectures at which he did his
dissections himself) were very dissections himself) were very modern medicine. Tobacco products own dissections, encouraging other
popular and encouraged others to do popular and encouraged others to do now show pictures of the results of doctors and trainees to do the same.
their own original research. He also their own original research. He also their use. In the Victorian age, societies like
published his ideas in an illustrated published his ideas in an illustrated the Royal College of Surgeons
textbook, On the Fabric of the textbook, On the Fabric of the further encouraged the sharing of
Human Body (1543). The key Human Body (1543). The key ideas, promoting further
development of the 19th century – development of the 19th century – development in surgery. Newspapers
the development of germ theory – the development of germ theory – publicised the use of chloroform by
was pushed forwards by competition was pushed forwards by competition Queen Victoria, helping to gain
but also because of teamwork and but also because of teamwork and public acceptance of the use of
communication. Continued. communication. Continued. anaesthetics. Continued.

Communication The success of Pasteur’s The success of Pasteur’s In the modern age, government
demonstration of vaccination demonstration of vaccination campaigns promoting healthier
cont.
against anthrax in 1881 was quickly against anthrax in 1881 was quickly living (such as putting pictures of
sent around Europe by electric sent around Europe by electric the issues caused by tobacco on
telegraph. A key development in the telegraph. A key development in the cigarette packets) have tried to
modern age was Fleming’s modern age was Fleming’s limit the amount of surgery needed.
development of penicillin. He development of penicillin. He The internet has also made it easier
published his findings on penicillin, published his findings on penicillin, for people to access certain types of
which prompted the further which prompted the further surgery, like plastic surgery.
development of this antibiotic by development of this antibiotic by
Florey and Chain. They had been Florey and Chain. They had been
compiling a list of natural compiling a list of natural
substances that could kill germs and substances that could kill germs and
happened to read Fleming’s article. happened to read Fleming’s article.
In the modern age, the internet and
television have revolutionised the
ability to diagnose illnesses, check
symptoms and access medical advice
– not always for the better.
Science and Science and technology could Science and technology could Science and technology could Science and technology could
technology influence change by providing new influence change by providing new influence change by providing new influence change by providing new
instruments and methods for instruments and methods for instruments and methods for instruments and methods for
researchers to use. The influence of researchers to use. The influence of researchers to use, but it could also researchers to use. The influence of
science and technology was limited science and technology was limited have a negative impact on public science and technology was limited
in the Middle Ages, but there were in the Middle Ages, but there were health. Some towns in the medieval in the Middle Ages, but there were
pockets of development. The Islamic pockets of development – for period had systems for their water pockets of development. The Islamic
world saw the development of example, in the Islamic world. left by the Romans, but as towns world saw the development of
anaesthetics, with patients holding Avicenna produced The Canon of grew these were no longer enough. anaesthetics, with patients holding
sponges soaked with drugs against Medicine, which listed the Towns like Exeter and London then sponges soaked with drugs against
their noses. In the West, mandrake properties of 760 different drugs. used new technology with pipes their noses. In the West, mandrake
root, opium and hemlock might be Continued. made of wood or lead. Continued. root, opium and hemlock might be
used (but an overdose could kill). used (but an overdose could kill).
Continued. Continued.

Science and The design of scissors, syringes and The situation would improve Clean water was crucial to health. The design of scissors, syringes and
technology forceps was improved. The situation drastically with the introduction of The use of the scientific method can forceps was improved. In the early
would improve drastically with the the scientific method, with its use clearly be seen in the work of modern period, Paré developed
cont.
introduction of the scientific of observation, hypothesis, and Pasteur and Koch. The development artificial limbs for patients to use
method, with its use of observation, experimentation. In Harvey’s of germ theory as a proven scientific following amputations. He designed
hypothesis and experimentation. lifetime there was no microscope theory forced a change in public these to be functional, with moving
Better tools were developed that good enough to see the tiny health, as governments could no parts, as well as to look realistic.
could further research. In Harvey’s capillaries that connect the veins to longer ignore the link between poor Paré also developed the bec de
lifetime there was no microscope the arteries. In 1661, Professor sanitary conditions and disease. The corbin, or ‘crow’s beak clamp’, to
good enough to see the tiny Marcello Malpighi used one of the Second Public Health Act in 1875 halt bleeding while a blood vessel
capillaries that connect the veins to first effective microscopes to prove was to come out of this, setting out was being tied off with a ligature.
the arteries. In 1661, Professor Harvey’s work was correct. The use that all councils must appoint Surgery was also affected by the
Marcello Malpighi used one of the of the scientific method can clearly medical officers responsible for development of germ theory, which
first effective microscopes to prove be seen in the work of Jenner and public health. In the modern age, saw the production of an
Harvey’s work was correct. The use the experiments he conducted to television, videos or DVDs, and sites increasingly specialist ‘kit’ for
of the scientific method can clearly test his theory on cowpox. We can on the internet like YouTube have surgeons. The first British surgeon to
be seen in the work of Jenner and also see it in the work of Pasteur spawned a craze for exercise of use rubber gloves was Berkeley
the experiments he conducted to and Koch in the development of various types in an attempt to get Moynihan in the 1890s. Soon face
test his theory on cowpox. We can germ theory. In the modern age, fit, develop muscle or achieve what masks, rubber gloves and surgical
also see it in the work of Pasteur chemical giants like Pfizer have is perceived as the ‘perfect body’, gowns became the norm. In the
and Koch in the development of allowed for the mass production of with people increasingly taking their modern age, massive advances have
germ theory. In the modern age, new drugs like penicillin, bringing health into their own hands due this been made in surgery and diagnosis.
massive advances have been made the possibility of cure to more and increased access to information. MRI machines and CAT scanners
in surgery and diagnosis. MRI more of the world. have allowed doctors to see inside
machines and CAT scanners have the human body in detail, in a non–
allowed doctors to see inside the invasive way. This has allowed for a
human body in detail in a non– more considered method of surgery,
invasive way. This has allowed for a which is now as non–invasive as
more considered method of surgery, possible thanks to the development
which is now as non–invasive as of keyhole surgery.
possible thanks to the development
of keyhole surgery.

Individuals could effect change as they Individuals could effect change as they Individuals could effect change Individuals could effect change as they
Role of
came up with new ideas and ways of came up with new ideas and ways of as they came up with new ideas came up with new ideas and ways of
the
treating or conducting surgery. These were treating or conducting surgery. These and ways of treating or treating or conducting surgery. These were
individual
often built on by later work. Ibn Sina were often built on by later work. Ibn conducting surgery. These were often built on by later work. John of
(Avicenna) wrote The Canon of Medicine, Sina (Avicenna) wrote The Canon of often built on by later work. In Arderne was the most famous surgeon in
which was to become the standard medical Medicine, which was to become the the medieval world, monarchs medieval England. His surgical manual,
textbook in Europe for the next 700 years. It standard medical textbook in Europe had an impact on public health, Practica (1376), contained illustrations of
listed the properties of 760 different drugs for the next 700 years. It listed the with Edward I demanding public his operations and instruments. He tried to
and had chapters on anorexia and obesity. properties of 760 different drugs and latrines for York in 1298. In the separate surgeons from the lower–class
The Renaissance would see an explosion of had chapters on anorexia and obesity. early modern period, Charles II’s barber surgeons by forming a guild for
ideas as people questioned the accepted The Renaissance would see an reign would see the Great them. In the early modern period, there
views of Galen and the four humours. explosion of ideas as people Plague. The King led the trend of was an emphasis on questioning and on
Vesalius used his own experiments to questioned the accepted views of the rich fleeing the affected city developing new ideas. Paré developed
challenge the work of Galen, and his Galen and the four humours, like of London. The Industrial artificial limbs for patients to use following
lectures (during which he carried out Vesalius and Harvey, who went against Revolution saw an increase in amputations. He designed these to be
dissections himself) were extremely Galen in suggesting that blood people concerned to show their functional, with moving parts, as well as to
popular. He published an illustrated circulated around the body rather Christianity through good works. look realistic. Paré also developed the bec
textbook, On the Fabric of Human Body, in than being constantly generated in the Edwin Chadwick was lawyer who de corbin, or ‘crow’s beak clamp’, to halt
1543. It was not just men that would liver and burnt as fuel in the body. In dedicated his life to pushing for bleeding while a blood vessel was being tied
contribute; in 1865, Elizabeth Garrett the development of germ theory, it health and social reform, off with a ligature. He also moved away
Anderson became the first female doctor. would take many minds for the publishing a report in 1842 on from the use of cauterisation, using cream
Although she had no degree (no university in discovery to be accepted in Britain: conditions in Britain. However, instead to sooth the area and promote
Britain would accept her), she gained Pasteur and Koch developed the he still believed in miasma. Dr healing. His approach considered the impact
qualification through experience and taking theory, while people like Lister, John John Snow’s work would show of surgery on the patient. Chance
the Society of Apothecaries exam. She set Tyndall, William Roberts and William the cause of cholera to be dirty discoveries also brought developments. In
up her own practice, which evolved into the Cheyne championed the theory in water, allowing action to be 1895, Roentgen's discovery of the properties
New Hospital for Women and Children by Britain, helping it to become taken to stop the contamination of X-rays occurred when he noticed a
1872. She established the London School of accepted. In the modern age, we have of water supplies. The 20th mysterious green glow while experimenting
Medicine for Women in 1874. In the modern giants of medicine like Florey and century saw possibly the key on cathode rays in a vacuum in the presence
age, we have giants of medicine like Florey Chain, who saw to it that penicillin development in public health - of a photosensitive plate. He took an X-ray
and Chain, who saw to it that penicillin was was developed to save countless lives, the opening of the NHS in 1948. of his wife’s hand to show his discovery.
developed to save countless lives, and Crick and Crick and Watson, who discovered Aneurin Bevan was its champion, This would be invaluable in the WW1 in
and Watson, who discovered DNA. This DNA. This discovery gave us a deeper ensuring that its setting up allowing surgeons to locate shrapnel before
discovery gave us a deeper understanding of understanding of the human body and (following the 1942 Beveridge surgery. The ability to look inside the body
the human body and opened up new opened up new avenues for research Report that recommended it) without cutting it open would also be
avenues for research into causes and cures, into causes and cures, leading to such went ahead despite stiff developed by British scientist Godfrey
leading to such developments as gene developments as gene therapy, criticism and concern about the Hounsfield, who invented the CAT scanner
therapy, genetic screening and genetic genetic screening and genetic cost. in 1973. This used X-ray images from many
engineering. engineering. angles to build up a 3D image of the body.

Teaching notes
This resource is suitable for supporting initial delivery or revision of the thematic 16–mark essay on AQA’s Britain: Health and the people exam.
The resource can be used in a more student–facing way or can be used to support a more teacher–led delivery.
If you want to put the onus onto students, then start by instructing them to work independently through task 1 and task 2 a–g. Then students
should self–assess their sorting by comparing the tables they have created with the master paragraphs sheet in task 3.
If you want to lead students through the tasks yourself, you may wish to propose an alternative task for task 3 – for example, you could test
students’ understanding by asking them to pick the most important example out of each model paragraph and explain why that example made the
greatest contribution to medicine within that theme and factor.
The pages for tasks 2a to 3 have been formatted with A3 printing in mind. If you print these onto A4 you may wish to increase the font size first.
Answers
Task 1:
Question 1: Government.
Question 2: Three paragraphs, plus a conclusion.
Question 3: True – you should start with the factor in the question.
Question 4: You should not make up your own factors – just use the ones AQA has set out.
Question 5: Public health.
Question 6: The exam board can ask about either medicine in general or one of the themes.
Question 7: False – while you can use examples from any time period, it does matter because you need to draw from all time periods across your
essay to access the highest marks.

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How to answer the 16-mark question (the ‘factors’ essay question) on AQA’s ‘Britain: Health and the people’

Every question uses the following formula:

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Task 2a: Essay–plan table: Factor = War

Causes and cures: Public health: Surgery and anatomy:

Paragraph to suggest it was the most important factor:

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Task 2a: Information for the factor of war

During WW1, Harold Gillies

The Crusades brought Blood transfusions were

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New techniques were

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Task 2b: Essay–plan table: Factor = Superstition and religion

Causes and cures: Public health: Surgery and anatomy:

Paragraph to suggest it was the most important factor:

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Task 2b: Information for the factor of superstition and religion

In the medieval period, between In surgery, some patients had

The 18th century saw a shift

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The Islamic empires

The King’s Touch was Many of the social reformers

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Task 2c: Essay–plan table: Factor = Chance

Causes and cures: Public health: Surgery and anatomy:

Paragraph to suggest it was the most important factor:

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Task 2c: Information for the factor of chance

Koch’s discovery of a way to

In 1880, Charles Early experiments with The chance meeting of

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Causes and cures: Public health: Surgery and anatomy:

Paragraph to suggest it was the most important factor:

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Task 2d: Information for the factor of government

During both the Black

1388 – Parliament passed a law

Caliph al-Ma’mun (813–33)

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The Beveridge Report (1942)

The need to address the Modern politicians have

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Causes and cures: Public health: Surgery and anatomy:

Paragraph to suggest it was the most important factor:

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Task 2e: Information for the factor of communication

Universities were key centres for

Vesalius was a gifted

John Hunter saw the need to

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Harvey was reluctant to

Communication can impact

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Causes and cures: Public health: Surgery and anatomy:

Paragraph to suggest it was the most important factor:

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