Pearson Edexcel GCSE (9-1) History: Medicine in Britain, c1250–present Revision Guide & Workbook PDF

Pearson Edexcel GCSE (9–1) Pearson Edexcel GCSE (9–1) DOWNLO AD NOW FOR...

Pearson Edexcel GCSE (9–1) Pearson Edexcel GCSE (9–1) DOWNLO AD NOW FOR History REVISION ON THE Medicine in Britain, GO! c1250–present History Revision Guide & Workbook + App Including the PEARSON REVISE APP Pearson Edexcel GCSE (9–1) Medicine in Britain, c1250–present The revision series for Pearson Edexcel GCSE (9–1) Take control of your revision and History from Pearson. confidently prepare for exams: This book will help you to: Quick quizzes for every topic Track your revision progress Organise your revision with the one-topic-per-page in the app format Revise on the go with links Check your understanding with worked examples to Revision Guide pages. Medicine in Britain, Develop your exam technique with exam-style practice questions and full answers c1250–present Revision Guide & Workbook + App Speed up your revision with helpful hints and tips Track your revision progress with at-a-glance Revision Guide & Workbook + App check boxes. Pearson Revise is the only series that includes a Revision Guide & Workbook for all 16 topics of the Pearson Edexcel GCSE (9–1) History specification. The series also includes Revision Cards and Practice Papers Plus+ for seven key GCSE History topics. www.pearsonschools.co.uk [email protected] CVR_ED_GCSE_RGRW_HISTORY_MEDICINE_9729_CVR.indd 1 30/06/2020 12:58  Pearson Edexcel GCSE (9–1) History Medicine in Britain, c1250–present Revision Guide & Workbook + App Series Consultant: Harry Smith Author: Kirsty Taylor A note from the publisher In order to ensure that this resource offers high-quality is accurate, the official specification and associated support for the associated Pearson qualification, it has assessment guidance materials are the only authoritative been through a review process by the awarding body. source of information and should always be referred to This process confirms that this resource fully covers for definitive guidance. the teaching and learning content of the specification Pearson examiners have not contributed to any sections or part of a specification at which it is aimed. It also in this resource relevant to examination papers for which confirms that it demonstrates an appropriate balance they have responsibility. between the development of subject skills, knowledge and understanding, in addition to preparation Examiners will not use endorsed resources as a source for assessment. of material for any assessment set by Pearson. Endorsement does not cover any guidance on Endorsement of a resource does not mean that the assessment activities or processes (e.g. practise resource is required to achieve this Pearson qualification, questions or advice on how to answer assessment nor does it mean that it is the only suitable material questions), included in the resource nor does it available to support the qualification, and any resource prescribe any particular approach to the teaching or lists produced by the awarding body shall include this delivery of a related course. and other appropriate resources. While the publishers have made every attempt to ensure that advice on the qualification and its assessment For the full range of Pearson revision titles across KS2,11+, KS3, GCSE, Functional Skills, AS/A Level and BTEC visit: www.pearsonschools.co.uk/revise A01_ED_GCSE_RGRW_HISTORY_MEDICINE_9729_TP.indd 1 29/06/2020 09:54  Contents SUBJECT CONTENT The British sector of the Western Front, Medicine in Britain, c1250–present 1914–18: injuries, treatment and the trenches c1250–c1500: The Middle Ages The historic environment 1 Ideas: supernatural and religious 24 The Western Front – the trenches 2 Rational explanations for disease 25 Injuries and illnesses 3 Approaches to prevention and treatment 26 RAMC and FANY 4 Approaches to caring for the sick 27 Medicine in the early 20th century 5 The Black Death 1348–9 28 Medical advances c1500–c1700: The Renaissance SKILLS 6 Ideas: a scientific approach 29 Exam overview 7 Transmission of ideas 30 Question 1: Describing features 8 Continuity in prevention, treatment 31 Source skills 1 and care 32 Source skills 2 9 Change in care and treatment 33 Question 2(a): Usefulness of sources 10 The Great Plague, 1665 34 Question 2(b): Following up sources 11 William Harvey 35 Question 3: Making comparisons 36 Question 4: Explaining why c1700–c1900 18th and 19th Century 37 Question 5/6: Making a judgement 12 Germ Theory and microbes 13 Improvements in hospital care PRACTICE 14 Anaesthetics and antiseptics 38 Practice questions 15 Approaches to prevention of disease 55 Practice sources booklet 16 Jenner and vaccination 56 ANSWERS 17 Fighting cholera in London, 1854 c1900–present: Modern Britain A small bit of small print 18 Ideas: genetics and lifestyles Pearson Edexcel publishes Sample Assessment 19 Improvements in diagnosis Material and the Specification on its website. 20 Change in care and treatment This is the official content and this book should be 21 Preventing disease used in conjunction with it. The questions in Now try this have been written to help you practise 22 The development of penicillin every topic in the book. Remember: the real exam 23 The fight against lung cancer questions may not look like this.  c1250–c1500: The Middle Had a look Nearly there Nailed it! Ages Ideas: supernatural and religious The Christian Church was dominant in medieval society. Belief in religious and supernatural causes of illness were common. God and the cause of disease Astrology The Church taught, and people believed, that God made them ill because He was either   The alignment of planets and stars was displeased with them or was testing thought to cause some diseases. their faith. For most people this was an   Astrology was used to help diagnose acceptable explanation for the cause what was wrong with a patient. of illness. This belief, and trust in ancient   Use of astrology wasn’t new in 1250 medical practices, held back medical research but it increased through this period, and meant that few new ideas about the especially after the Black Death. causes of disease appeared in medieval times. The Church’s control of ideas Most of what ordinary people learned was taught by the Church. The Church was also the centre of formal learning; it set up and ran universities where physicians were trained. Unlike most people, monks and priests could read and write. Most large collections of books were in monasteries. This meant the monasteries had a lot of influence over what books were written and read. The Church approved of traditional, rational explanations for disease. In particular, it promoted the ideas of Galen as his theories fitted Christian beliefs that the body had a soul and that all parts had been created by God to work together. easingly Abbeys and monasteries were incr Dissections were usually performed at Mid dle Age s and dominated important during the icine. universities, but they were not common many aspects of life including med in this period. Dissections were often used to teach Galen’s theories about anatomy and anything that was found that contradicted Galen might be ignored. This meant that knowledge of anatomy did not advance a great deal. The Church also taught that people should follow Jesus’ example and care for theories the sick. Many hospitals were housed in See page 2 for details on Galen’s on med ieva l hospitals. and page 4 for details monasteries and nunneries. Now try this In what ways did the Christian Church (a) help and (b) hinder medicine in the Middle Ages? 1  c1250–c1500: The Middle Ages Had a look Nearly there Nailed it! Rational explanations for disease Rational explanations for disease in Medieval England were still based on ideas from the Ancient world, in particular those of Hippocrates and Galen. Spring The Four Humours The Ancient Greeks thought everyone had a mix of four humours in their body. They believed people became ill when this mix was Blood ET HO unbalanced, so to make people better they W Air T tried to put this balance right. These ideas continued well into the Middle Ages. Theory of Opposites Summer Winter Water Fire Phlegm Yellow In the 2nd century AD, a doctor called Galen bile developed the idea of the Four Humours further. Besides bleeding and purging to get rid of excess humours, treatment based on Earth his Theory of Opposites aimed to balance the CO Y DR LD humours by giving the patient the ‘opposite’ Black bile of their symptoms. For example, if you had too much phlegm (linked to water and cold) you should eat hot peppers. The Four Humours Autumn Galen Hippocrates a Greek Claudius Galen was Hippocrates was an Ancient rk ed in as and doctor who wo Greek doctor. His ide ote Ancient Rome. He wr books were very infl uential d hi s ide as es and many books an well into me die va l tim of m ed ica l the were the basis beyond. He dismissed M idd le Ag es. He disease training in the ly idea that go ds ca us ed tes’ ideas and main was a physical reas on developed Hippocra to pr ev en t – he believed there. purging, ys ica l cu re used bloodletting, or s ow n for illness, which ne eded a ph well as hi nts were based on and treat illness, as Most of his treatme se d on his Theory of st but he also used treatments ba s diet, exercise and re ew detailed diagram to get rid of excess Opposites. He also dr ow led ge he bleeding and purging , of human anatomy using kn the Hippocratic Oath g on wounded humours. He wrote gained from op er at in e to respect life and ying out dissections where doctors swor gladiators and carr thod of clinical imals’) bodies. prevent harm. His me g on dead (mostly an ing symptoms, makin observation – study th similar cases, then notes, comparing wi ing – is the basis of diagnosing and treat ay. the approach used tod Miasma Another theory about the cause of disease was that it was transmitted by ‘bad air’. This was related to God Now try this because bad smells indicated sin. The theory originated in the Ancient world Give four reasons why Ancient explanations but continued into the Middle Ages and and ideas for disease dominated medicine in the well into the 19th century. Middle Ages. 2  c1250–c1500: The Middle Had a look Nearly there Nailed it! Ages Approaches to prevention and treatment Prevention and treatment of disease in the Middle Ages was based on rational and religious methods as well as traditional remedies. Rational treatments in connection with the Four Humours 1  loodletting was the most common B 2  urging was another treatment used P treatment for an imbalance of humours. to re-balance the humours. It either It was either done by cutting a vein, using involved making a patient vomit or go leeches or by cupping. Different points in to the toilet to remove food from the body were used for different illnesses. the body. Emetics and laxatives were Occasionally bloodletting was performed mixed by apothecaries, wise women or, by physicians but, more usually, it was at the patient’s home, physicians done by barber-surgeons or non-medical prescribed treatments and sometimes persons. gave enemas themselves. Methods to prevent illness Traditional remedies The most common remedies were traditional Living a Christian life – e.g. ones made with herbs, which were drunk, praying, going to church, and sniffed or bathed in. Remedies also included obeying the Commandments different foods to rebalance the humours and ointments to apply to the skin. They were made at home or mixed and sold Carrying Religious and by an apothecary. lucky Chanting charms or supernatural incantations amulets methods Religious treatments Self-punishment, such Praying as flagellation – punishing Fasting yourself so God wouldn’t Going on pilgrimage Trying to keep streets clean Paying for a special Mass to be said Bathing and washing Purifying Rational Supernatural treatments the air methods Supernatural treatments included specific Exercising ideas for certain illnesses, such as hanging a magpie’s beak around your neck to cure toothache. Bleeding and purging Not overeating Now try this For each of the six rational prevention methods above, explain why people believed each method would help them stay healthy. 3  c1250–c1500: The Middle Ages Had a look Nearly there Nailed it! Approaches to caring for the sick There were different people who treated the sick in the Middle Ages. Barber-surgeons Care in the home No training. Most ill people throughout this period were treated Carried out bloodletting, pulling teeth and lancing at home by a female family member. boils. Also cut hair! The village ‘wise woman’, often the Lady of the Manor, Did basic surgery such as amputating limbs (very would also tend to people in their homes for free. low success rate). Cost less than a physician. Who treated the sick? Apothecaries Physicians Received training but no medical qualifications. Medically trained at university and passed exams. Mixed medicines and ointments based on their Diagnosed illnesses and gave treatments, or sent own knowledge or directions of a physician. patients to the apothecary or barber-surgeon. Cost money (but less than a physician). Expensive, so mainly used by the wealthy. Very few of them, with women physicians incredibly rare. What physicians did 1  ommonly, physicians observed a patient’s symptoms and checked their pulse, skin colour C and urine (for both colour and taste!). 2 They consulted urine charts in their vademecum (handbook). 3  hey then consulted zodiac charts to help diagnose the illness and to work out the best time T to treat the patient. 4  hey then either treated patients themselves (though this was rare), or sent them to a T barber-surgeon or apothecary. Hospitals Usually, people with infectious diseases or Many hospitals incurable conditions were not admitted. were places where travellers and pilgrims stayed on Patients and their their journeys. surroundings were kept very clean. Hospitals were places of recuperation rather The number than places where increased during patients were treated the Middle Ages. for disease. Patients were given fresh food and plenty of rest. Many were run by the Church, so the Some hospitals were built for emphasis was on God and healing souls. specific infectious diseases. Now try this List examples of people and conditions that would have been treated by each of the following: physicians, barber-surgeons, apothecaries, hospitals and the home. 4  c1250–c1500: The Middle Had a look Nearly there Nailed it! Ages The Black Death, 1348–9 Case The Black Death reached Britain in 1348, killing about one-third of the population. study Ideas about what caused the Black Death and how it could be treated tell us a lot about how people in Late Medieval England thought about illness and disease. What was it? Most historians today think this disease was bubonic plague, carried by fleas living on black rats, which brought the disease to different countries on trading ships. Bubonic plague is passed to humans when an infected flea bites them and the disease enters their blood. Causes and avoidance How people thought the Black Death How people tried to avoid catching it was caused Religion: God sent the plague as a Praying and fasting: because people punishment for people’s sins. believed that God had sent the disease, it Astrology: the position of Mars, Jupiter made sense to show God they were sorry and Saturn was unusual at this time. by punishing themselves. Miasma: bad air or smells caused by Clearing up rubbish in the streets. decaying rubbish. Smelling their toilets or other bad smells, in Volcanoes: poisonous gases from the belief this would overcome the plague. European volcanoes and earthquakes Lighting a fire in the room, ringing bells or carried in the air. having birds flying around the room to keep Four Humours: most physicians believed air moving. that disease was caused by an Carrying herbs and spices to avoid imbalance in the Four Humours. breathing in ‘bad air’. Outsiders: strangers or witches had Not letting unknown people enter the town caused the disease. or village. Symptoms Treatments Symptoms of the Black Death included: Treatments for the Black Death included: swelling of the lymph glands into large lumps praying and holding lucky charms filled with pus (known as buboes) cutting open buboes to drain the pus fever and chills holding bread against the buboes, then headache burying it in the ground vomiting, diarrhoea and abdominal pain. eating cool things and taking cold baths. Now try this Medieval people tried to prevent and cure the Black Death in many different ways. What does this tell us about what they thought caused disease? 5  c1500–c1700: The Renaissance Had a look Nearly there Nailed it! Ideas: a scientific approach In the Renaissance period there was further investigation into Ancient Greek and Roman theories on disease and anatomy. More and more, the old ways were challenged and existing assumptions were tested. However, some things stayed the same. Change in ideas on causes of disease Continuity in ideas on causes Gradually, throughout the Renaissance period, of disease fewer people believed in supernatural or The theory of miasma continued to be religious causes of disease. Various new rational believed by many to be the cause explanations for disease were suggested, such of disease. It was a particularly popular as seeds in the air spreading disease. A major theory during epidemics. change in this period was the decline in the influence of the Church, and with it the focus on The Theory of the Four Humours continued God as a cause of illness. There was a shift to a to be an accepted explanation for disease, more scientific approach to diagnosing illness. although by 1700 very few physicians still believed in it. The changing influence of the Church Thomas Sydenham During this time new religious ideas challenged Sydenham worked as a doctor in London the authority of the Catholic Church, weakening during the 1660s and 70s. His book its influence. People were still very religious Observationes Medicae (1676) outlined his but they began to look for new explanations for theories and observations. the cause of disease, rather than believing that   He didn’t rely on medical books when disease was caused by God. Also, the ideas making a diagnosis, but observed patients of Galen, which were supported by the Church, and recorded symptoms in detail. were relied upon less.   He was instrumental in the ‘new’ idea that a disease had nothing to do with Change in the work of physicians the nature of the person who had it. and scientists   He based treatment on the disease During this period, as a new scientific approach as a whole and didn’t treat was adopted, the way in which disease was individual symptoms. diagnosed by physicians gradually began to improve. This was largely influenced by people like Thomas Sydenham. As fewer people believed that astrology He became caused disease, physicians stopped using known as astrology charts for diagnosis and the ‘English timing treatment. Hippocrates’ due to his Due to improved knowledge of digestion, influence physicians realised that urine was not a good on doctors indicator of disease and stopped using urine (mostly after charts for diagnosis. his death). Physicians carried out more direct observations and examinations of their patients, rather than relying on the patient explaining their symptoms. Now try this Write a sentence explaining what happened to belief in each of the following as a cause of disease during the Renaissance: Miasma, Theory of the Four Humours, God. 6  c1500–c1700: The Had a look Nearly there Nailed it! Renaissance Transmission of ideas One of the major changes in the Renaissance period was in the communication and transmission of medical ideas. The development of the printing press ess It meant that many uce the The printing pr ound exact copies of texts It helped red ol of ar ’s co n tr was invented could be produced Church uld no berg. it co 1440 by Guten e in a short amount of id ea s, as ve n t the of th longer p re By the start time. f ideas it 1500 publication o Renaissance in reds p ro ve of. hu nd did no t ap there were esses of printing pr pe. across Euro The books, and therefore the ideas and discoveries of scientists and doctors contained within those books, could be shared more effectively and much faster across a wider area. The printing press, invented in 1440. The setting up of the Royal Society The Royal Society aimed to further scientific understanding by carrying out and recording the results of experiments, sharing scientific knowledge and encouraging new theories and ideas. Most significantly, it sponsored scientists to enable them to carry out research. From 1665 the Royal Society published a journal called Philosophical Transactions, in which scientists could share their work and ideas. This meant that doctors and scientists could study, challenge and build on each other’s research. In this way, theories could be confirmed or dismissed and news of the findings could spread through the medical community quickly. King Charles II granted a Royal Charter to the society. He was very inte rested in science and his approval of the society helped it to gain credibilit y. Now try this Explain how the invention of the printing press led to developments in medicine. 7  c1500–c1700: The Renaissance Had a look Nearly there Nailed it! Continuity in prevention, treatment and care Although there were some changes in hospital care, most treatment and preventions during the Renaissance remained the same. Hospitals 1  y 1500, hospitals were treating more B sick people and were being used less by travellers and pilgrims. Most had their own apothecary to mix medicines and physicians frequently visited patients. 2 In 1536, the dissolution of the monasteries in England by Henry VIII caused most hospitals to close. 3 Some free, charity-funded hospitals were set up but it wasn’t until well into the 1700s that the number of hospitals returned to pre-dissolution levels. 4 More pest houses began to appear, where people suffering from a particular contagious disease could go for care. St Bartholomew's Hospital 5 When hospitals did re-appear, they were run by physicians focused on treating the sick rather than by religion. Traditional herbal remedies Community care As in medieval times, most people who became ill Continuing Bleeding and were cared for at home, usually by a female relative. Healthy Physicians were still too expensive for the majority. living treatments and purging Members of the community (again, usually women) preventions helped with advice and remedies. Some were paid for their services. Superstitions and prayer Cleanliness Changes in prevention and treatments More emphasis on removing miasma through draining Lack of change swamps, and removing sewage and rubbish. The improved knowledge and discoveries People regularly changed their clothes to keep clean of the Renaissance had a limited impact rather than just bathing. at the time because: New herbal remedies from newly discovered countries the ideas were slow to be accepted appeared in England, and some were effective.   they had no direct use in improving The theory of transference led people to try and treatment or preventing disease rub objects on themselves to transfer the disease   their discoveries did not improve to the object. understanding of the cause Alchemy caused chemical cures using metals or of disease. minerals to become popular. Now try this Explain why there were few totally new treatments for disease in the period 1500–1700. 8  c1500–c1700: The Had a look Nearly there Nailed it! Renaissance Change in care and treatment Although there was little practical change in medicine during the Renaissance, there were important changes in medical training and new discoveries made by Vesalius that led to changes in care and treatment after 1700. Training for apothecaries, surgeons and physicians Apothecaries and surgeons Physicians Continuity They were still not given They were still trained at universities and university training and were still the training lasted for many years. considered inferior to physicians Training was still based on learning and they were cheaper. from textbooks rather than practical experience. Change Both were better trained There was better access to a wider through being in guild systems, variety of medical books and detailed where they were apprentices, drawings due to the printing press. then journeymen, before Gradually, new ideas about anatomy becoming masters. (led by Vesalius) and causes of disease A licence was now needed inspired some physicians to become more to work as an apothecary or practical and experimental. surgeon and these were only Dissection was legalised but took time to issued after completing training. become commonplace. Vesalius The importance of Vesalius Andreas Vesalius He improved understanding of the studied medicine in human body. Paris in 1533, then He made the study of anatomy became a professor fashionable. It became central to of surgery in Padua, the study of medicine. Italy. He carried out a large number of He proved that some of Galen’s dissections on human work was incorrect, which helped bodies and made many encourage others to question discoveries about how Galen’s theories. the body worked. He encouraged and inspired other medical professionals to carry out dissections and make This drawing is taken further discoveries. from his most famous book, On the Fabric of His work was widely published in the Human Body, which England and throughout Europe, and was published in 1543. included detailed illustrations of the human body, which were copied into other medical textbooks. Now try this List ways in which the work of Vesalius shows the differences between medicine in the Renaissance and Medieval times. 9  c1500–c1700: The Renaissance Had a look Nearly there Nailed it! The Great Plague, 1665 Case The Great Plague of 1665 was the first serious outbreak of plague in England since the study Black Death. There were many similarities and some differences in how people tried to treat and prevent it. Causes The Black Death and Great Plague People’s beliefs about the causes of the These two diseases were the same, so Great Plague were mostly the same as their comparing the methods used to treat beliefs about the causes of the Black Death. and prevent them is a useful guide to There were a few differences: understanding what changed and what stayed miasma was by far the most commonly the same in over 300 years of medicine. believed cause Remember to use examples from both far fewer people believed it was caused by outbreaks to show how much or how little an imbalance in the Four Humours change there had been in understanding and people knew that disease could be passed treating disease. from person to person. ut the See page 5 for more details abo disease and its symptoms. Treatments Government action Like its causes, many treatments for the A real difference between 1665 and 1348 was Great Plague were similar to those for the a far greater reaction by local councils, who Black Death. As most people with the disease were ordered by the King to try and stop the were quarantined, little is known about plague from spreading. treatments, though many used herbal remedies, Theatres were closed and large gatherings either mixed in the home or by apothecaries, were banned. and ‘quack’ doctors. There were some new Dogs and cats were killed. treatments for disease that had an impact: Streets were regularly cleaned. The theory of transference meant that Barrels of tar were burned in the streets. people tried to ‘transfer’ the disease to something else, especially birds, such Every day, carts collected the dead who as chickens. were then buried in deep mass graves. It was thought that people could sweat A household was boarded into its home for disease out, so sufferers were wrapped up 28 days or taken to the pest house if a in thick blankets and put by a fire. member caught the plague. Days of fasting and public prayers were ordered. Plague doctors wore co stumes to prevent them catching the disea se. The masks included sweet-smellin g herbs to ward off miasma and the cloak wa s waxed so that nothing from the patie nt could be absorbed into it. Birds were belie ved to attract disease so the mask was in the shape of a bird’s beak in the hope that it would cause the plague to leave the patient. Now try this Use the image to help you n me thods. remember preventio List six prevention methods used to try and stop people from catching the Great Plague. For each one, explain why they did this. 10  c1500–c1700: The Had a look Nearly there Nailed it! Renaissance William Harvey Case William Harvey was one of the most important individuals of the Medical Renaissance. study He was influenced by Vesalius and went on to influence many others, including Sydenham. William Harvey William Harvey, 1578-1657 Studied medicine at Cambridge, then Padua. Became a lecturer of anatomy in London at the College of Physicians. Was one of James I’s doctors. Carried out public dissections. Harvey published his findings in An Anatomical Mot ion of the Hea rt and Blood Account of the Taught the importance of doctors observing in Animals in 1628, which contain ed detailed and recording patients’ symptoms, rather diagrams like this one. than relying on textbooks for diagnosis and treatment. Discovered the process of blood circulation. Discovering the circulation of The importance of Harvey the blood He proved that some of Galen’s theories Harvey researched Vesalius’ theory that were wrong, bringing into question Galen’s blood flowed towards the heart, which other theories. contradicted Galen’s theory. He proved He improved knowledge about how the body Vesalius was right using dissected bodies worked and passed this knowledge on. and pumps that showed blood only flowed By 1700 his work was being taught in one way. medical schools. He then proved that blood could not be As a royal physician, Harvey’s work gained produced by the liver and absorbed into the publicity and credibility, and inspired others body, as Galen had thought. to find out more. He was influenced by new technology, such His scientific methods of observation and as mechanical water pumps, which made use of dissection had brought results, and him think the human body worked in the so were copied by others. same way. His discoveries left many unanswered He discovered that arteries and veins were questions, which encouraged part of one system and that blood was further experiments. pumped around the body by the heart. Now try this List the factors that were important in leading Harvey to make his discovery. 11  c1700–c1900: 18th and 19th Century Had a look Nearly there Nailed it! Germ Theory and microbes Although this period began with little change in ideas about the cause of disease, by 1900, huge breakthroughs had been made in the discovery of the true cause of many diseases. Continuity in theory of Microscopes causes of disease By 1700, microscopes had developed so There were few new ideas about that cloudy images of what would become the cause of disease in the 18th known as bacteria or germs could century, though some scientists be seen. By 1850, microscopes had thought that germs were produced further improved so that extremely by decaying matter – this was tiny images could be seen clearly. called spontaneous generation. This was essential in enabling the scientific Most people still thought breakthroughs of the later 19th century. miasma was a cause of disease, s science were but this was becoming a less Social attitudes toward an increasing popular theory than it was in changing – there was for rational the Renaissance. awareness of the need use of disease. explanations for the ca Change in theory of causes of disease: Germ Theory In 1861, Louis Pasteur (a French chemist) published his Germ Theory, which showed that spontaneous generation was incorrect. He proved that microbes (bacteria or germs) in the air cause decay (he discovered this when investigating why liquids turned sour for the brewing industry). He theorised that germs also caused disease but was unable to prove this. Robert Koch (a German doctor and scientist) read Pasteur’s work and began to study microbes himself. He proved that Pasteur’s theory was right, that microbes caused disease as well as decay. He identified the specific microbes that caused TB in 1882, and cholera in 1883. Koch developed a new, easier way of growing bacteria on agar jelly, and also discovered that chemical dyes stained bacteria, which made them easier to see under a microscope. Other scientists used these methods to identify the microbes that caused other diseases. Eventually, these discoveries were to have a direct impact on the prevention and cure of many diseases. The influence of Pasteur and Koch Pasteur’s Germ Theory had very little impact on medicine in Britain to begin with as he was not a doctor and his work focused on food and drink, not disease. Most doctors still believed in the spontaneous generation theory, but there were some (e.g. Joseph Lister) who did make the link between microbes and disease. Koch’s work had more of an impact in Britain than Pasteur’s had, and he inspired others to research other microbes. However, it took time for most doctors and the British government to accept the Germ Theory of disease. Even though the real cause of many diseases had been discovered, it didn’t yet have an impact on their medical treatment and prevention. Now try this Explain three factors that led to the development of the Germ Theory. 12  c1700–c1900: 18th and 19th Had a look Nearly there Nailed it! Century Improvements in hospital care Florence Nightingale was significant in influencing improvements in hospital care. Reports of her changes to hospital conditions after witnessing high death rates in military hospitals in the field had a significant impact on public opinion. Florence Nightingale 1  ursing wasn’t seen as a N 4  he believed that miasma S respectable job for women caused disease, so emphasised and there was little training. hygiene, fresh air, good 2 Florence Nightingale supplies and training for nurses. attended the first nurses’ Her approach greatly improved training school in Kaiserwerth conditions in the hospital. hospital, Germany. 5 Her work was widely reported 3 She was asked to lead a in newspapers in Britain. team of nurses at the military She published books on nursing hospital in Scutari during the and hospital organisation and Crimean War (1854–56). set up a training school for nurses / midwives. Changes in hospital care 1856 New hospitals (financed by Great Ormond Street Hospital, charities and local councils) opened during the 19th The elderly, sick or disabled century to look after the sick. poor were forced to enter workhouses. First cottage hospital (small buildings where nurses gave Most hospitals tried to care and GPs prescribed to create a home atmosphere. create a home treatment) Parents and visitors had to opened in 1859. help nurses look after Middle and upper classes the patients. could afford doctors to treat them at home. Great Ormond Street Hospital, 1875 Due to the work of reformers Public pressure led to like Florence Nightingale, infirmaries (separate from hospital cleanliness and workhouses) being set up organisation improved, and for the poorest in society. nurses were better trained. Pasteur’s germ theory led to improved hygiene. Specialist hospitals (such as Nurses were given a more asylums for the mentally ill and central role caring for patients fever houses for infectious and assisting doctors. diseases) developed. Now try this Give three examples of ways in which hospitals had improved by the end of the 19th century. 13  c1700–c1900: 18th and 19th Century Had a look Nearly there Nailed it! Anaesthetics and antiseptics The three main problems that made surgery so dangerous were blood loss, pain and infection. The 19th century saw important developments in the management of pain and the reduction in infection. Search for an anaesthetic Development of antiseptics Joseph Lister was a surgeon who worked at Before 1800, alcohol and opium had little Glasgow Royal Infirmary. success in easing pain during operations. Laughing gas was used in 1844 in dentistry Timeline 1861 Half the patients in in the USA, but failed to ease all pain and surgery die from patients remained conscious. postoperative infections. 1864 Lister reads Lister starts work as a Pasteur’s Germ Theory surgeon. Ether (used from 1846) made patients totally and learns that carbolic unconscious and lasted a long time. However, acid kills parasites in 1865 Lister soaks it could make patients cough during operations sewage. bandages in carbolic and sick afterwards. It was highly flammable acid to avoid wounds and was transported in heavy glass bottles. 1866 Lister uses carbolic getting infected. acid to clean wounds and equipment and 1867 Lister states that Chloroform (used from 1847) was very effective invents a spray to kill his wards have been free with few side effects. However, it was difficult germs in the air. from infection (sepsis) to get the dose right and could kill some for 9 months. people because of the effect on their heart. An He publishes his ideas. inhaler helped to regulate the dosage. 1877 Lister becomes Professor of Surgery at King’s College Hospital, Cocaine was used as the first local anaesthetic London. in 1884. In 1905 a less addictive version – novocaine – was used as a general anaesthetic. Aseptic surgery red chloroform James Simpson discove Lister’s work inspired others to search for solutions to pain when he was looking for methods to prevent the spread of infection lectures and wrote during surgery. He gave in hospitals. By 1900, operating theatres use for surgery and articles to promote its and wards were thoroughly cleaned using the first person to aseptic techniques, and surgeons and for childbirth. He was s to medicine. nurses wore sterilised clothing and used be knighted for service sterilised instruments. Opposition The impact of anaesthetics People worried about the long-term effects and antiseptics of using anaesthetics and thought that being Surgery became pain free and patients didn’t unconscious made patients more likely to die. struggle, so surgeons could take more time The Victorians were very religious and thought and be more careful. Deeper, more complex that God inflicted pain for a reason, so it was surgery became possible and the death rate wrong to interfere with His plan. Also, it took a dramatically decreased as surgery was long time for doctors and surgeons to believe more successful. Aseptic surgery was in the Germ Theory and therefore accept possible because antiseptics were used to Lister’s discoveries. clean wounds and operating theatres. Now try this Give three reasons why surgery was more successful by 1900. 14  c1700–c1900: 18th and 19th Had a look Nearly there Nailed it! Century Approaches to prevention of disease The 19th century saw some important developments in disease prevention as the Germ Theory was used to create vaccines for some diseases. Also, the government began to play more of a role in public health and increased prevention rates by reducing the conditions that fostered disease. The development of vaccinations 1. Pasteur carried out experiments to observe microbes and published his results in 1861. He called his discovery Germ Theory. 2. Pasteur’s team of scientists discovered that a weakened version of a disease-causing microbe could be used to create immunity from that disease. For more on 3. Pasteur admired Jenner and called his new discovery ‘vaccination’ Jenner see in tribute to Jenner. page 16. 4. Pasteur developed vaccines against anthrax and chicken cholera for animals, and against rabies for humans. 5. Pasteur’s work inspired other scientists to develop vaccines for human diseases. Reasons for the 1875 Public Health Act Public Health Act, 1875 Previously the government did not believe City authorities must provide: it was its role to improve living conditions 1. clean water and saw it as interfering in people’s lives. 2. sewers It preferred a ‘hands off’, laissez-faire policy. 3. public toilets During the 19th century, the attitude 4. street lighting of government began to change due to 5. public parks. several epidemics (especially cholera) and As well as: the increasing scientific evidence that 1. inspect lodging houses for cleanliness these diseases were caused by poor 2. monitor the building of new houses to living conditions. Also, the increasing number prevent damp and overcrowding of men who could vote influenced politicians. 3. check the quality of food sold in shops By 1875, people recognised that it was the 4. employ a public officer of health to monitor disease. government’s responsibility to improve living conditions in the cities. Now try this Explain two reasons why the Public Health Act of 1875 was important. 15  c1700–c1900: 18th and 19th Century Had a look Nearly there Nailed it! Jenner and vaccination Case Edward Jenner was the first to make a discovery that successfully prevented people study from catching the deadly disease, smallpox. Smallpox Jenner In the 18th century, smallpox killed more Edward Jenner was born in 1749. He trained children than any other disease. Thousands of in London as a surgeon and apothecary before adults died, too, and survivors were often left working at St George’s Hospital. He then with terrible scars. The disease spread quickly returned to his birthplace in Gloucestershire and easily from person to person. to work as a GP, where he made his great discovery. Vaccination and smallpox Jenner’s importance Since the 1720s, doctors had been inoculating Jenner’s work proved that scientific methods people against smallpox by infecting them with a could lead to a disease being wiped out. mild version of the disease. This could still kill and He saved the lives of millions! However: only the very rich could afford it. he didn’t know why it worked the link between cowpox and smallpox was unique, so it didn’t lead to Jenner collected evidence of the success and other vaccinations failure of smallpox inoculations. He regularly other diseases were still killing people. treated people for the mild disease, cowpox, and noticed that these people never caught smallpox. In the 1790s, Jenner used scientific methods for carrying out experiments to test his theory and observe and record the results. He infected local people with cowpox and then tried to infect them with smallpox. None of them caught smallpox. In 1798, the Royal Society refused to publish Jenner’s ideas, so he paid to print his findings in An Enquiry into the Causes and Effects of the Variola Vaccinae. He included detailed instructions Opposition to Jenner so that others could follow them. Many people opposed Jenner’s work because: they thought it was wrong to give people By 1800, around 100 000 people worldwide had an animal’s disease been vaccinated, but the practice took time to it interfered with God’s plan become popular in Britain. doctors lost money when the government offered vaccination free In 1802, the Royal Jennerian Society was set up some doctors didn’t vaccinate people to promote vaccination and, by 1804, over properly so it didn’t work. 12 000 British people had been vaccinated. In 1840, vaccinations were provided free of charge for the poor. Vaccinations were made compulsory in 1853. Now try this In 1979, WHO, the World Health Organisation, Explain the factors that led to the success of the announced that smallpox had been wiped out. smallpox vaccination in reducing cases of the disease. 16  c1700–c1900: 18th and 19th Had a look Nearly there Nailed it! Century Fighting cholera in London, 1854 Case The first cholera epidemic in Britain occurred in 1831 and was followed by another in study 1848–49, and another in 1854. Then a London doctor, John Snow, found what was causing the disease. Attempts to prevent the spread What do we know about cholera? of cholera It was known as the ‘blue death’ as Most people, including the government, believed dehydration turns the skin blue. cholera was caused by miasma and spontaneous It mostly affected the poorest, slum areas generation. Therefore, people tried to keep of cities, although wealthier parts were their homes as clean as possible and some local affected too. councils tried to clean the streets and clear It causes severe diarrhoea and vomiting away rubbish. The government’s Public Health Act leading to dehydration. of 1848 suggested that cities should provide In the early 19th century there was no clean water supplies, but the Act was not treatment and most people who caught compulsory so few complied. it died. The work of John Snow The significance of John Snow’s work Snow was a popular and well-respected Many cholera deaths in Soho were prevented doctor and surgeon in London. after Snow stopped people using the Broad He observed the cholera epidemic of Street pump. 1848–49 and began Many did not believe work on his theory that Snow’s theory. He had cholera was spread no scientific evidence through contaminated to prove cholera was drinking water, not transmitted in water – by miasma. the Germ Theory wouldn’t When cholera broke out emerge until 1861. again in 1854 in Soho, Therefore, the where Snow lived, he government didn’t act on mapped all the deaths Snow’s recommendation and found a strong link to build a new sewer to one water pump on system for London. Broad Street. In the longer-term, He removed the handle Snow’s work combined from the pump so with other evidence people couldn’t collect (e.g. The Great Stink) water from it and the and a new London sewer number of deaths system was completed fell dramatically. in 1875. Later it was discovered Also, in the longer-term, that a cesspit close by Snow’s work helped was leaking waste into make the link between the well. dirty water and disease, In 1855, Snow leading to the Public presented his findings Health Act in 1875 when to the government. cities’ authorities were finally forced to provide clean water. Now try this Give two ways in which John Snow was significant and two ways in which his significance was limited. 17 c1900–present: Modern Britain Had a look Nearly there Nailed it! Ideas: genetics and lifestyles By 1900, the correct cause of many diseases had been discovered and the knowledge had been used to produce effective vaccines to prevent certain diseases. The 20th century witnessed a search for the cause of other conditions and greater understanding of other reasons for poor health. Understanding genetics During the 19th century, Mendel showed how human characteristics could be passed between generations. In the 20th century new technology (electron microscopes, X-rays) let scientists analyse human cells in greater detail. They found that every cell in the body contains DNA – codes controlling the genes of each person. James Watson and Francis Crick worked together on how the genetic codes of DNA fitted together. They analysed X-ray crystallography by Maurice Wilkins and Rosalind Franklin at King’s College Hospital (London) and eventually worked out the double helix structure of DNA (1953). In 1990 James Watson led the Human Genome Project and started identifying and mapping every gene in human DNA. New possibilities Discovering the structure of DNA and the work of the Human Genome Project has led to:  a better understanding of some genetic conditions, such as Down’s syndrome  predicting whether individuals are at higher risk of developing some cancers  the discovery that stem cells can be grown into different cells. However, there is not yet a:  cure or effective treatment for most genetic conditions  way of preventing most genetic diseases. Understanding of lifestyle factors Since 1900, people have discovered that some lifestyle factors can negatively affect health and increase the chance of contracting disease. Smoking Drinking Diet Research now alcohol Scientific research has links smoking with Research now confirmed that eating a many diseases, such as links drinking too much balance of different foods and emphysema, high blood alcohol to many cancers, limiting sugar and fat reduces the pressure, heart disease as well as liver and kidney chances of getting certain types and many cancers. disease. of cancer or heart disease. Now try this The discovery of DNA is important for medicine. Give three reasons why. 18  c1900–present: Modern Had a look Nearly there Nailed it! Britain Improvements in diagnosis Developments in science and technology in the 20th century have improved the diagnosis of illness and the cause of disease. Improvements in diagnosis The 20th century saw huge changes in the ways that doctors diagnosed illness. Although doctors today still use their own knowledge and medical books, they combine this with medical testing, using science and technology to discover what is wrong. This includes the use of: laboratories to test skin or blood x-rays, scans and endoscopes to ‘see’ inside the body with more clarity than ever before monitors to see what is going on over a Blood samples are taken and test ed by a period of time. rato ry. Ana lysin g blood pathologist in a labo a huge num ber of dise ases are Improved scientific understanding and means that ed with out the now diagnosed and monitor technology has made diagnosing disease far need for surgical investigation. more accurate. Medical technological advances Incubators X-rays Prosthetic Microscopes limbs Hypodermic needles MRI, CT and Examples of technology ultrasound scans used in 20th and 21st Blood pressure and blood sugar century medicine monitors Endoscopes Insulin pumps Dialysis machines Pacemakers Now try this Give three methods used to diagnose illness in the period 1900 to the present day. 19 c1900–present: Modern Britain Had a look Nearly there Nailed it! Change in care and treatment The 20th century saw major advances in treatments from new ‘miracle’ drugs that cured diseases to advanced surgical treatments, which solved other problems. Magic bullets Antibiotics Koch discovered Behring discovered the Antibiotics destroy bacteria or prevent that different body manufactures its growth. The first to be discovered chemical dyes antitoxins that only attack was penicillin. stained specific the microbe causing a See page 22 for more microbes. disease. about penicillin. Scientists, inspired by the discovery of Paul Ehrlich and his team of researchers searched for a ‘magic bullet’ – a chemical penicillin, experimented with other moulds and compound that would attack and kill the found more antibiotics that were effective microbe causing a specific disease. against different diseases throughout the 1940s, 50s and 60s. Once the chemical structure of different The team, helped by German government antibiotics was discovered, scientists were funding, worked for many years. They tested able to make antibiotics, which solved the many compounds of Salvarsan to find one to problem of having to grow them first in order cure syphilis. to amend them to treat further diseases. Antibiotics have saved and extended millions of In 1909, Dr Hata joined the team and lives but due to overuse, super-bacteria, which discovered they had rejected a compound are resistant to antibiotics, have evolved. that worked – the 606th! Using examples Where possible, always use specific In 1932, Gerhard Domagk developed the examples to demonstrate your knowledge. second magic bullet, Prontosil, which cured Examples of high-tech medical and surgical some types of blood poisoning. treatments include: radiotherapy and chemotherapy Other scientists checking Domagk’s work kidney dialysis found that the key ingredient in Prontosil, fitting pacemakers sulphonamide, also cured pneumonia, scarlet fever and meningitis. organ transplants. Advances: keyhole and microsurgery Advances: robotic surgery With the development of tiny cameras and Some surgery can now be carried out surgical instruments, surgeons can use small remotely, with surgeons controlling robots incisions instead of large cuts to access the through computers. This has also made surgery body, which reduces patients’ recovery time. more precise. The small instruments also make it possible to reattach nerves and blood vessels. The final major problem of surgery, blood loss, had also been solved, which led to success ful blood transfusions. See page 27 for more on blood transfusions. Now try this Describe the factors that made the advances in treatments since 1900 possible. 20