DTC History

Medicine Through
Time

Revision Notes

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effectively, you should not need lots of other
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Contents
Page
1-3
4
5-6
7-23
24-26
27-31
32-35
36-40
41-47
48-53

54-56
57
58-60
61-62
63-67
68
69
70
71

Need To Know
Timeline
In Depth Timeline
Section A - Nominated Topic Pack
Prehistoric
Egyptian
Greek
Roman
Middle Ages
Renaissance
18 & 19c
Modern
Factors That Helped Development Of Medicine
Factors That Hindered Development Of Medicine
Section C - Public Health
Cause & Cure Disease and Anatomy/Physiology Through The
Ages
Surgery Through The Ages/Public Health Through The Ages
Exam Words
Audio-Visual Materials

Medicine
What You Need To Know !
This comes straight from the exam and unfortunately everything on this list needs to be looked at
revised as the questions may be on any of this.
The Exam
There are 3 sections to the exam paper
Section A
This is the nominated topic and this year is : DISEASE AND INFECTION
There will be 4 questions all based on sources. It is out of 26.
Section B
There are two sections - you choose one. Each section has two questions. It is out of 12.
Section C
Public Health - same as above!
"In the section on Public Health, with a focus on Britain, the emphasis is on the changing role of
government, both local and national, in providing health facilities for the people."

What I need to know!

Do|!know
this?

Medicine in the Ancient World, clO 000 BC-c500 AD

Prehistoric societies: the role of magic, parallels with traditional
aboriginal societies
Ancient Egypt: supernatural and natural approaches to medicine;
priests and doctors
'
Ancient Greece: the cult of Asklepios; the development of the Theory ,
of the Four Humours; Hippocratic
!
medicine
Ancient Rome: the influence of Greek medicine.
Key individuals: Aristotle, Hippocrates, Galen
Medieval and Renaissance Medicine, c500-c!700
The impact of the fall of the Roman Empire on medicine
The nature and importance of Islamic medicine
The impact of superstition and Christianity on Medieval medicine
The medieval doctor: training and treatments
Continuing traditional methods: bleeding, wise women, response to
plagues.
Key individuals: Rhazes, Ibn Sina (Avicenna), Paracelsus
Medicine in the Industrial and Modern World, c!700-present day
Vaccination; the Germ Theory and its impact on the treatment of

j
|
i

diseases: magic bullets; Penicillin

The development of the medical and nursing professions; the role of
women in medicine
Role of the World Health Organisation in fighting disease and ill health
Modern issues in medicine: AIDS, the drugs revolution, problem drugs,
alternative medicines, superbugs,
genetic engineering.
Key individuals: Jenner, Seacole, Nightingale, Pasteur, Koch, Blackwell,
Garrett Anderson, Ehrlich, Fleming,
Florey and Chain, Crick and Watson
Part 2: Surgery and Anatomy
Surgery and Anatomy in the Ancient World, clO 000 BC-c500 AD
Prehistoric societies: surgery; parallels with traditional aboriginal
societies
Ancient Egypt: Egyptian anatomy and surgery, supernatural and
natural approaches
Ancient Greece: Greek surgery, Alexandria
Ancient Rome: the influence of Greek medical knowledge, surgery in
Roman times, medicine in the army.
Key individuals: Aristotle, Hippocrates, Galen
Medieval and Renaissance Surgery and Anatomy, c500-c!700
The impact of the fall of the Roman Empire on medicine
The nature and importance of Islamic knowledge
Medieval surgical techniques and knowledge
The impact of superstition and Christianity on Medieval medical
knowledge
The challenging of medical authority: improved knowledge of anatomy
and physiology
Continuing traditional methods: bleeding.
Key individuals: Rhazes, Ibn Sina (Avicenna), Ibn Nafis, Vesalius, Pare,
Harvey
Surgery in the Industrial Modern World, c!700-present day
Developments in anaesthetics, antiseptics, aseptic surgery
The impact of two world wars on surgery: plastic surgery, blood
transfusions
The impact of technology: X-rays, transplant surgery, radiation therapy,
keyhole surgery.
Key individuals: Simpson, Lister, Pasteur, Hoisted, Mclndoe, Barnard
Part 3: Public Health
Public Health in the pre-industrial world, pre-c!750

 Greek public health and the importance of healthy living

Public health facilities in the Roman period
Public health in the Middle Ages: attempts to improve and the reasons
for lack of development
Public health problems; plagues and their treatment in the later
Middle Ages and seventeenth century, particularly the Black Death and
Great Plague in London.
Public Health after the Industrial Revolution, cl750-c!900
Problems of public health in urban and industrial areas after c!750
The nature and impact of epidemics, e.g. cholera, and attempts to deal
with them
Changing local and national government involvement in public health;
measures, causes and consequences, including the 1848 and 1875 Public
Health Acts.
Key individuals: Chadwick, Snow, Octavio Hill
Public Health since c!900
The nature of poverty c!900
Liberal Social Reforms: measures, causes and consequences
The impact of two world wars on Public Health
Public health problems between the wars; social conditions, poverty
and housing; attempted solutions
The National Health Service: measures, causes and consequences
Improved Public Health in the late 20th Century: issues and actions.
Key individuals: Booth, Rowntree, Lloyd George, Beveridge, Bevan

Basic Timeline
Prehistoric Medicine
2.5 million BC-8000BC
health, herbs, spirits, trephining, aborigines

Ancient Egypt
6000 - 30 BC
gods, mummies, no dissection

Ancient Greece
800BC-500BC
Asclepios, Hippocrates, Hippocratic oath, Four Humours, Alexandria
Romans
510BC-400/500AD
Public health, army, Galen
Dark Ages/Middle Ages

400 - 1400
no new learning, faith and superstition, monasteries, medical schools, Galen, Four
Humours, planets, herbs, Black death, public health
&
Arabic medicine
Mohammed, learning, Rhazes, Avicenna
Renaissance

1500-1700
New ideas, science, Royal Society, printing, Paracelsus, Great Plague, Vesalius, Pare,
Harvey
18 & 19C Medicine (also called Enlightenment & Industrial Revolution)
Jenner, Nightingale, Germ Theory, Pasteur, Koch, anaesthetics = Simpson,
antiseptics = Lister, Chadwick, cholera, Snow.
Twentieth Century
Penicillin - Fleming, Florey and Chain, blood groups and transfusions, X-rays,
transplants, NHS, Bevan.

1. CHRONOLOGY
The following brief outline would be a very useful table to memorise:
Dates
(approx)
10,0003,OOOB.C.

Periods of
history
Prehistoric Times

400B.C.

Ancient Times:
Egyptians
Chinese
Indian
Babylonian
Greek
Roman

Important
individuals
None known because
of the lack of written
records

Imhotep

Asklepios/Hippocrates

Galen

400 A.D

Dark Ages and

Middle Ages

Avicenna
Rhazes
Albicasis

Overview
Supernatural
explanations of disease
(spirit world). Use of
charms and magic,
some herbal remedies
and some primitive
surgery e.g. trephining
Settled civilisation and
therefore some
important progress.
Examples: Egyptians
learnt about anatomy
through religious
practise of
mummification. Greeks
saw the first ever
natural explanation of
disease with
Hippocrates theory of
the Four Humours. The
Chinese developed
acupuncture, Babylon
developed public health
systems. The Romans
were able to develop
public health systems
across their huge
Empire. In all Ancient
civilisations however
natural and
supernatural
approaches went side
by side
Regress in Western
Europe as Roman
empire collapsed.
Power of RC Church
large barrier in the way
of medical progress.
In contrast Arab

medicine thrived with

successful medical
schools in Salerno and
Cairo
1500A.D.

Renaissance

Vesalius
Da Vinci
Pare
Harvey
Sydenham

Reawakening of
interest in learning and
knowledge. Improved
travel and reduction in
influence of Church
resulted in great
progress in some areas
of medicine, especially
anatomy and
physiology

Industrial
Revolution

Jenner
Pasteur
Koch
Simpson
Lister
Nightingale
Chadwick and many
many more!!

Significant public health

problems caused by
Industrial revolution.
But significant progress
in all areas of medicine
e.g. vaccinations, germ
theory, anaesthetics,
improvements in
nursing and hospitals

The Modern
World

Ehrlich
Fleming
Florey and Chain
Barnard

Use of high level

technology, elimination
of many diseases in
wealthy areas of world.
Rapid improvements in
drugs and surgery,
National Health
services, contrasted to
growing inequalities
with developing
countries

1700A.D.

1900A.D.

2008 A.D.

Section A
The nominated topic for this year is:

DISEASE AND INFECTION

There will be a 4 part question based on sources (these could be

pictures or writing)
It is out of 26

So what could be in this bit of the paper? Who knows but it will
be how people have thought disease was caused and the cures
and how people dealt with infection.
Look at the Mindmap for some general ideas.

'The ideal way to get rid of any infectious disease would be to shoot instantly every
person who comes down with it.' H L Mencken

Feet showing the effects of leprosy, c.1350.

Credits: Science Museum London
Humanity and disease share a long and eventful history. As we emerged and evolved, so
did the diseases that blight our lives. Diseases exist in the fossil record, but our ancestors
were actually less exposed to them. This changed around 10,000 years ago when they
began living in more settled agriculturally based communities. Animals were a major part
of this revolution. But settlement brought disease and epidemics. Close contact, often in
overcrowded and unsanitary conditions, allowed some animal diseases to jump species
and become deadly human infections.
What did early people think about disease?
Like their prehistoric ancestors, most Ancient Egyptians blamed evil spirits or angry
gods. Some Egyptian doctors had other ideas. They blamed blocked channels within the
body, a theory that has echoes in other medical traditions, particularly Traditional
Chinese Medicine. In Ancient Greece Hippocrates proposed a theory about the body
which centred on humours, a notion which has parallels elsewhere, most obviously
in Avurvedic medicine. This Greek medical philosophy eventually took root among
Greece's conquerors in Rome, from where the writings of Galen resonated across much
of the world and remained influential for hundreds of years.
The decline of the Roman Empire and rise of the Islamic Empire
As the East Roman Empire declined, an Islamic Empire expanded westwards. Muslim
scholars collected, translated and supplemented classical Greek works as well as texts
from India and Northern Africa. To this body of learning they added their own innovative
work, with physicians al-Razi and Ibn Sina among the most prolific and influential
scholars of this period. These texts were archived at the House of Wisdom in Baghdad
and other centres of study. Emerging from the early medieval period, Europe remained
ignorant of much of this knowledge.

Galen and the spread of disease

The plague of Florence in 1348.

C red its: Wellcome Library, London.
Galen coined the word 'plague' to describe a quickly spreading fatal disease. He had
lived through the Antonine Plague - one of the great epidemics of the ancient world.
The Black Death that devastated Europe in the 1340s was just that and more, the most
deadly pandemic in recorded history. As a recovering Europe enjoyed the cultural
Renaissance of the following century, the ancient texts were rediscovered and newer texts
from the Islamic world became accessible. But the older texts were not simply revered,
they were also questioned.
New empires and epidemics
Despite more research into the nature of disease, little could be done in the face of
frequent and deadly epidemics. New empires grew in this time of exploration and
discovery. But armies, colonisers and traders all imported and exported disease. As
citizens of a growing trading nation, thousands of British people succumbed to smallpox,
sweating sickness and bubonic plague - all epidemic in the 1500s and 1600s. Old
supernatural beliefs remained embedded, with thousands presenting themselves to
Charles II believing only his touch could cure them of'king's evil'.
Conquest and colonialism
But conquest and colonialism also brought exposure to new medical
knowledge. Smallpox inoculation was successfully imported to Britain and America in
the early 1700s, a procedure Edward Jenner would subsequently improve with his
safer vaccination technique.
Germ theory and industrialisation

A young man with tuberculosis, c. 1900.

C red its: Wellcome Library, London.

In the 1800s, laboratory research - notably by Pasteur, Koch and their pupils significantly advanced our understanding of disease. The resulting germ theory gradually
supplanted the prevailing miasma and contaRJon theories. Ironically, proponents
of miasma theory had greatly influenced public health reforms. Industrialised and
overcrowded, 19th-century cities were havens for diseases such as typhoid, tuberculosis
and, increasingly, cholera. It was while researching a cholera outbreak in 1854 that
London doctor John Snow produced his ground-breaking work on disease transmission.
Penicillin, the poor and the protection of the state

Despite some improvements, infant mortality rates in Britain in 1900 were actually
higher than in 1800. Diphtheria, measles and whooping cough all took a cruel toll on
poor and ill-nourished children. Fortunately, growing state intervention and the wider
fruits of biomedical research reversed this trend. Germ theory focused research onto the
newly identified disease pathogens and the results were new vaccines and 'magic bullet'
antibacterial drugs which revolutionised treatment. The pinnacle of these achievements
was the production of penicillin during the Second World War (1939-45).
The decline of disease in the developed world

The influenza virus claims another victim, a cartoon from 1918.

Credits:Wellcome Library* London.
The flu pandemic of 1918 was the last occasion a killer disease swept rapidly across the
world. At least 50 million people died. Since that notable blip, infectious diseases have
continued to decline in the developed world, although smaller epidemics have
occurred. Polio notably brought a decade of post-war panic and with it the wheezing
spectre of the iron lung. This machine helped patients to breath - a symbol of new lifesaving technologies but also of the helplessness of many of polio's victims.
Disease today
Elsewhere, improvements have been slower. While smallpox has been eradicated, ancient
diseases such as malaria still kill millions. And although AIDS causes fear and death in
the West, its strongholds are mainly among the world's poor. Because of limited access
to health education programmes and expensive Western drugs, it is now predominantly a
disease of poverty. Increasingly, the resources of rich nations have concentrated on
disease at a more individual level, targeting cancer, heart and circulatory diseases,
respiratory and nervous diseases, the faults of genes and heredity, the diseases of
affluence and, increasingly, the diseases of old age.

Ideas about illness and possible causes and cures

Prehistoric Times
We do not know what prehistoric people thought about causes of and cures for illness so we
look at the Australian Aborigines who lived as hunter-gatherers until quite recently.
Prehistoric people may have had different ideas. We just cannot be certain. Aborigines
thought that illness was caused either by an evil spirit entering the body or by the person's
own spirit being taken out of the body. An enemy could do either of these by pointing a bone
at another person and saying a special chant or spell. Charms could be worn to keep evil
spirits away. A Medicine Man could be brought in to deal with evil spirits possessing the ill
person. Herbs and plants which could deal with everyday problems such as stomach upsets,
burns and sprains were discovered and knowledge was passed down to others by word of
mouth.

Ancient Egypt
Like most early people they thought that disease was caused by gods and spirits. Special
prayers or spells could be said to make a person better. Charms could be worn to keep evil
spirits away. A priest could be brought in to deal with evil spirits possessing the ill person.
Later healing was done by people who were not priests. A class of doctors emerged. A belief
spread that some diseases had natural causes and came about when the internal channels of
the body became blocked. Medicines were given to unblock these channels e.g. substances to
make the patient sick or go to the toilet. Herbs and plants which could deal with everyday
problems such as stomach upsets, burns and sprains were discovered and knowledge was
passed down to others after a system of writing had developed.

Ancient Greece
The Greeks at first thought that things which they did not understand e.g. earthquakes and
diseases were caused by gods. Temples called Asceplia were dedicated to a legendary god or
healer called Ascepfios and were built all over Greece. Patients would sleep in these and
during the night they believed that Asceplios and his two daughters, Panacea and Hygea,
would treat the sick. Snakes would lick the affected parts. In the morning the patient would
wake up cured. These temples were so calm and peaceful that they became the Greek
equivalent of our health farms and convalescent homes. Patients whose illnesses were caused
by stress and worry could recover.
As in Egypt a belief later spread that illnesses had natural causes and cures. Hippocrates and
his followers put forward the Four Humour Theory. They noticed that whenever some one
was ill one or more of four liquids (or humours) was present. (BLOOD, PHLEGM, YELLOW
BILE AND BLACK BILE) They were confusing EFFECTS of the illness with the CAUSES of it.
Treatments were developed to remove the extra amount of humour or to encourage more of it
to be produced. Hippocrates also developed the writing down of symptoms. This was called
clinical observation and doctors could tell the patients how the disease would develop and give
medicines to treat each stage. They also thought that exercise and diet could help to maintain
a balance of humours and body temperature e.g. eating a lot and drinking little in winter and
eating less and drinking a lot in summer.

Ancient Rome
The Romans also thought that gods could cause and cure illness. They accepted Greek ideas
and believed in building temples to Asceplios. They also accepted the Four-Humour Theory.

12.

Galen reinforced the belief in this and prescribed the use of opposites e.g. Hot showers for
people suffering with colds and lettuce and cucumbers for those with fevers.
They were a very practical people and also saw the value of exercise in preserving health.
They built a temple to Febris, goddess of fever but showed the practical side of their nature by
draining the marshes which spread malaria. Their main contribution to the history of Public
Health is their recognition that diseases were spread by poor drinking water and poor disposal
of sewage. They built aqueducts to bring fresh wsaer into their settlements from springs and
latrines and sewers to take sewage into the rivers. They did not just build these in Rome.
Everywhere they settled they were ready to build aqueducts, latrines and sewers. There are
remains of aqueducts (the bridge-like structures which carried water across valleys) in Italy,
Spain and France. They also used herbs as medicines and we can read about these in books
that Doctors wrote.

The Middle Ages

There was a return to a belief in supernatural causes and cures for illness. Illness was thought
to be a punishment from God for sins. Touching holy objects, saying special prayers or
visiting the tomb of a saint could help to bring cures. (Remember the film "Indiana Jones and
the Last Crusade") After the fall of the Roman Empire there was about 700 years of confusion
and attacks. The Roman Catholic Church helped to keep alive the ideas of the Romans and
Greeks. The four-humour theory seemed sensible and doctors believed in this. Galen had set
out the ideas of the Greeks so well that he was thought to be right about everything. Anyone
who suggested new ideas would be attacked by the Church and possibly burned as a heretic.
The Great Plague which first reached Europe in 1347 inspired a number of theories about its
cause e.g. a punishment from God, bad smells, the close position of the three great planets,
Saturn, Jupiter and Mars. Herbs and flowers were carried to try to remove the bad smells.

Renaisance times
Many of the old ideas continued e.g. disease being a punishment from God, bad smells
spreading disease, the value of herbs, the position of the moon, stars and planets affecting
health and the four humour theory. Printing helped to spread new ideas very quickly.
Vesalius pointed out the mistakes that Galen had made. Pare suggested using cool lotions on
wounds instead of boiling oil and he sewed up cut blood vessels after amputations but
infection still killed many of his patients. The one important breakthrough was Harvey's
discovery of how the blood circulated. Knowledge of this rarely improved treatments and an
incorrect belief in the value of bleeding patients still continued.

By Mr Davies

www.SchoolHistory.co.uk

At end of the 18th century Edward Jenner discovered a method of preventing smallpox.
He called his method vaccination. (Look back at the section on the Renaissance to
remind yourself about Jenner's work) Smallpox was on the way to being defeated but:
NOBODY KNEW HOW VACCINE WORKED
It was to be another 80 years before another vaccine was discovered - Jenner's work
did not lead directly to other developments, because the cause of disease had yet to be
discovered.
Pasteur and the Germ Theory
Spontaneous Generation
By 1800 most scientists and doctors knew of the existence
of micro-organisms, called germs or bacteria. But they
thought that the germs were the result of disease not the
cause of it - in other words germs were spontaneously
generated by disease.
Some believed that disease was caused by gases, called
miasmas.
Others had different theories, but no-one thought that
germs were the cause.
Pasteur
Louis Pasteur was the scientist who first linked germs and
disease.
Why did the discovery happen when it did?
In 1857 Pasteur was asked to investigate a problem that
was costing the brewing industry money. The problem was
caused when the sugar beet, used to make alcohol, went
sour during fermentation.
What did he discover and how?
He examined samples of the sour liquid under a
microscope.
He thought that the souring was caused by germs in the
air, so he conducted experiments with water in a swanneck flask.
When the water was heated, the warm air was pushed
out of the flask around the bend in the neck.
The curved neck then trapped the air and the germs it
carried.
When the neck was broken, the air (and germs) rushed
in and decay set in.
This proved that germs were actually causing the decay.

LOUIS PASTEUR
(1822-95)
Louis Pasteur was a French
chemist. In 1849 he was made
Professor of Chemistry at
Strasbourg, and in 1854 he
moved to Lille. He was the
first person to prove the
connection between germs and
decay and then the connection
between germs and disease.
Pasteur made many of his
investigations for businesses
who had problems that were
losing them money. His
researches were not always
continuous. His work on
silkworm disease, begun in
1865, was interrupted by
deaths in his family. In 1868 a
brain haemorrhage left him
paralysed on one side. He
stopped working, but by 1877
he was back, investigating
anthrax.
His investigations of animal
diseases had good results. He
discovered vaccines for
chicken cholera (1880)
anthrax (1881) and rabies
(1885). The deaths of two of
his daughters from typhoid
fever moy have started his
investigations into human
disease. He tried to produce a
cholera vaccine as early as
1865, but failed. In 1888 the
French government set up the
Institute Pasteur, for Pasteur
and others to further medical
research.

Reaction
Some scientists refused to accept his findings and clung on to the spontaneous
generation theory.
Others realised that he had made a breakthrough.
Further developments
1867 P. showed that germs caused silkworm disease pebrine.

1880 P. discovered a vaccine against chicken cholera.

1881 a vaccine for anthrax.
1885 a vaccine for rabies.
[Robert Koch
This German scientist took Pasteur's work a stage further - he linked particular germs
to particular diseases. The advantage he had over Pasteur
was that he had the detailed medical knowledge that
ROBERT KOCH
Pasteur lacked.
(1843-1910)
His work
1872 - he began to study anthrax, a fatal disease in
sheep and cattle, which could be passed to humans. He
studied the blood of affected and unaffected animals.
1875 he identified the microbe causing anthrax.
Robert Koch was born near
Hanover He graduated in
He used new technology to identify the microbe that
medicine
from
(Sottingen
caused septicaemia and blood poisoning - a coloured dye University and went to work in
to stain the microbe and make it visible under the Hamburg in 1866. He joined the
Prussian army in the war against
microscope and photographs to prove that he had the
France in 1870, The French
right germ.
were beaten within six months.
After that he became the
He developed new experimental methods, including a
medical officer in Wollstein, a
solid culture to breed germs on.
town near the border with
1882 K. discovered the tuberculosis germ.
Poland. His wife bought him a
microscope for
his 29th
1883 K. discovered the cholera germ.
birthday. It was to affect his
Bacteriology
life greatly. He went on to be a
The work of Pasteur and Koch meant that the real cause of
pioneer of the new science of
disease was known at last. A new science called bacteriology bacteriology, proving that one
specific germ could cause a
was established - the microbe hunters became the stars of
particular disease in animals and
humans. He identified the
scientific research. The chart below lists some of the other
microbes, which caused TB
microbes and when they were found.
Year

Microbe discovered

Scientist

1879
1880
1882

Leprosy
Typhoid
Diphtheria
Tetanus
Pneumonia
Plague

Hansen
Eberth
Klebs
Nicholaier
Frankael
Kitasato & Yersin

1884
1884

1894

(1882) and cholera (1883). His

work caused the
Sermon
government to set up the
Institute
for
Infectious
Diseases in Berlin in 1891. Koch
won the Nobel Prize in 1905 for
his work.

Task 1
Explain how the work of Pasteur was helped by the demands of industry.

Task 2
Explain how the work of Koch was helped by new Developments in technology.

Louis Pasteur A Chicken Cholera

Why?
When Pasteur heard of his Sermon rival's discoveries, he became determined to
outshine him - France had bet land and face in their war with Germany in 1870. He
wanted to do something to restore French pride.
1880 French chicken farmers were losing a lot of money because chicken cholera
was killing thousands of chickens. Pasteur was asked to investigate.
How?
1. The research team devised a new liquid culture to grow the cholera germ in.
2. Pasteur asked one of his assistants (Charles Chamberland) to inject chickens with
the germ, but Chamberland forgot and left the culture uncovered on a laboratory
bench when he went on holiday.
3. On his return he injected the chickens with the old culture - they did not die.
4. Pasteur told him to inject the chickens again with a fresh strong culture - the
chickens still did not die.
5. The process was repeated - first injection with old culture then with new - a new
batch of chickens, which had not had the old culture, died but the original chickens
survived
6. Pasteur concluded that when the culture was exposed, it became weaker - not
strong enough to kill but enough to give immunity to a strong dose.
Pasteur had discovered how Tenner's cowpox prevented smallpox. He called his culture
"vaccine" in honour of Jenner.

Task 3
Explain the part played by chance in the discovery of the principle of vaccination in the
case of both Jenner's and Pasteur's work.
Pasteur and the Anthrax Vaccine
In 1877 Pasteur's research team had begun research into the anthrax germ.
Pasteur and his team, led by Dr. Emile Roux, now set to work on a prevention for

anthrax.
How?
An experiment, using the process that had led to the discovery of the chicken
cholera vaccine, was conducted.
Journalists, politicians and farmers attended the experiment, on a farm near Paris.
It was entirely successful - Pasteur had proved publicly that vaccination was an
effective way of preventing disease.
Reaction and results
Within days the discovery was known worldwide - journalists sent reports by
electric telegraph.

The discovery saved the French farming industry lots of money.

People realised that if vaccination worked on animals, there was no reason why it
should not work on humans, because the process would work in the same way.

Task 4
Explain how the rivalry between Pasteur and Koch helped progress in the treatment of
infectious.

Task 5
Explain how improvements in communications (railways, the press, electric telegraph)
helped medical progress. Add this to your Factors Summary booklet.
Pasteur and Rabies
1882 Pasteur and his team set out to produce an effective vaccine for the invariably
fatal disease of rabies.
He picked up on some work being carried out by Emile Roux, using dried spines from
rabid rabbits!
He gave a series of injections, using a stronger culture each time and ending with a
new, fresh one. This gradual increase of virulent genus resulted in immunity. They
were not confident about the process.
Once more chance intervened. In 1885, a mother arrived at the laboratory with her
son, who had been bitten by a rabid dog. Joseph Meister was doomed unless Pasteur
tried the untested vaccine. He tried it - it worked.
Task 6
Add this to your Factors Summary booklet as an example of chance affecting change
Diphtheria
In this case a combination of scientists worked out how diphtheria was caused and came
up with a prevention:

Edwin Klebs, a German doctor discovered the diphtheria bacillus.

Friedrich Loeffler bred them but could not work out how they killed - he guessed
that they produced a toxin (poison)
Emile Roux, one of Pasteur's team, proved that the toxin was fatal.

Emil von Behring, a former member of Koch's team, developed a serum from the
blood of animals that survived the toxin - he called it an "anti-toxin". Injected into
the body it prevented the germ from producing toxin within the body.
Tuberculosis
Koch, under pressure from the German government, announced a vaccine for TB at the
10th International Medical Congress in 1890. The vaccine, tuberculin, seemed to work
on animals - it did not work on humans. Koch was blamed - his career waned but his team
continued.
government help
The national prestige that scientists like Pasteur and Koch brought to their respective
countries, meant that their governments gave them help and funded their research
institutes to make their work easier.

Task 7
Add the work of Pasteur and Koch to the government section of your Factors Summary
booklet
Task 8
(a) Explain the germ theory of disease.
(b) Explain how the theory opened the way to further developments in medicine.
(c) Why did some doctors oppose the germ theory?
Task 9
Look at the diagram below. Which do you think was the most important factor behind
the success of Pasteur and Koch? Explain your conclusion.
SUMMARY
TM

In 1850 there were still several different ideas about what caused disease.
Pasteur was asked by Monsieur Bigo to explain why his alcohol fermentation had gone bad. His experiments
showed that germs caused decay.
Pasteur demonstrated that germs caused disease in animals.

TM

Robert Koch was able to prove that each type of germ caused a specific disease by his work on anthrax.

TM

A variety of factors enabled these pioneers to make their discoveries.

Both Pasteur and Koch built teams of scientists and doctors to help their developments.

Individual genius enabled them to recognise opportunities for progress.

Development did not happen in isolation - communications enabled pioneers to improve upon each other's
discoveries.

Results of research spread

quickly
by
telegraph,
newspapers & journals
Scientists can travel by rail
to meet each other

Much
improved
microscope
allowed
bacteria to be studied
Koch
used
industrial
chemical dyes to stain
bacteria

f
V^

Indus try,Science
& technology

PaS teu r & Koc h used

experiments
to prove
theories
Both had research teams

^
J~

Personal qualities

Both
men
were
intelligent, persistent
and determined
Both
were
brave
enough to speak in
public at the risk of
abuse from doubters

Chamber land's mistake during Pasteur's research into

chicken cholera
Arrival of Joseph Meister when Pasteur needed someone to
test his rabies vaccine on

Possibility
of
prestige
for
their
countries
encouraged
French < Sermon
governments
to
fund research

Pasteur (French) & Koch (Sermon)

were Spurred on by the tensions that
developed between their countries
after the French defeat in the
Franco-Prussian War 1870-1 - keen
to bring prestige to their countries

brugs and infectious disease

Pasteur, Koch and others discovered a means of

preventing disease.
The problem remained as to how to cure disease.
- Drugs made from natural substances had
been used in the treatment of illness for
centuries.
- But these drugs could not combat the
bacteria that caused disease.
- A surgeon, Joseph Lister, had successfully
used a chemical, carbolic acid, to kill germs
outside the body. His work was widely the
accepted by 1890. But the acid was too toxic
to use internally.
What was needed was something that could be used
safely to kill bacteria inside the body.

Paul Ehrlich and Magic Bullets

PAUL EHftLICH

Ehrlich was born in the town of

Streblen in Silesia, Germany, in
1854. He studied at
the
University of Leipzig, researching
in chemistry and bacteriology He
worked first as a doctor but, in
1886, caught tuberculosis (TB). It
took him three years to recover
completely. In 1889, he joined
Robert Koch's research team at
the Institute for Infectious
Diseases in Berlin, He helped Emit
Behring to find an anti-toxin that
cured diphtheria. From 1899,
until his death in 1915, he was the
Director of the Royal Institute
of Experimental Therapy i n
Frankfurt. It was here that he
carried out his research into
chemotherapy (the treatment of
disease by chemical drugs). In
1908 he shared the Nobel Prize
for medicine with the Russian
bacteriologist Elie Metchnikov.

Ehrlich was a German doctor, who joined Koch's research

team in 1889.
Working with Behring on the diphtheria anti-toxin, he
became fascinated by the fact that the body produced
antibodies to fight off specific germs inside the body
without damaging the rest of the body.
He called these anti-bodies "magic bullets", because they
sought out their target as a bullet from a gun did.
The anti-bodies did not always kill off invasive bacteria.
He began research to find a chemical that could be used
inside the body to kill specific bacteria - a synthetic
magic bullet.
When he got his own research institute, he and his team
concentrated on finding chemical cures for disease:
Initial work was done on developing dyes that would kill microbes - successful on
malaria and sleeping sickness.
1906 the microbe that caused syphilis was identified by Fritz Schaudin and Paul
Erich Hoffman.
1907 Ehrlich began the search for a chemical compound that would kill the syphilis
germ - 600 arsenic compounds were tried unsuccessfully.
1909 Sahachiro Hata, a Japanese bacteriologist, joined Ehrlich's team. He retested the compounds that had already been tried and found that compound 606
did in fact kill the syphilis germ. Ehrlich called this new drug Salvarsan 606.
1911 after many tests on animals Salvarsan 606 was used for the first lime on a
human being.

Opposition
Salvarsan was not very soluble and was difficult and painful to inject into veins.
Some doctors thought that people would become more promiscuous if they knew
that syphilis could be cured.
Many doctors did not like the idea of giving patients arsenic in any form.
Task 10
(a) What progress had been made in the fight against infectious disease by 1900?
(b) What new breakthrough was needed?

Task 11
Look at the diagram below. What factors enabled the discovery of Salvarsan 606 to be
made?
Was any one of these factors more important than the others? Explain your answer.

Industry
Progress in the chemical
industry provided Ehrlich with
the idea that chemicals (e.g.
synthetic dyes) might be able
to kill germs inside the body.

Personal Qualities
Ehrlich was determined and
skilful. He was inspired by
Koch and Behring.

Salvarsan
606

Science and Technology

Improved knowledge of
physics and skilled engineering
provided Ehrlich with
technical aids (e.g. the
microscooeV

Research Techniques
Teamwork and careful
observation were crucial.
Hata had the patience to recheck previous work

Gerhard Domaqk and sulphonomide drugs

Domagk worked for a large chemical firm in Germany. He was inspired by the work of
Ehrlich to carry out research looking for dyes that might destroy infecting microbes
within the body. His determination paid off and he made two key discoveries:
gcrmanin - a drug effective against sleeping sickness.
prontosil (1932) a red dye which stopped the streptococcus microbe (causes blood
poisoning) from multiplying in mice.
1935 Domagk's daughter pricked herself with an infected needle and bloodpoisoning set in. With nothing to lose, he injected her with a huge dose of prontosil
- she turned slightly red but made a rapid recovery.
French scientists carried out further research and found that the compound in the
dye, which acted on the germs, was sulphonamidc - a chemical derived from coal tar.

Other sulphonamide drugs were developed to fight

- tonsillitis
- puerperal fever (an infection often suffered by women who have just
given birth)
- scarlet fever
- pneumonia (1938 in the U.K.)
There were disadvantages to sulphonamide drugs:

sometimes damaged the liver and kidneys.

ineffective against more virulent microbes.

A more powerful magic bullet was needed if infectious disease was to be
conquered.
[Penicillin - the first antibiotic
An antibiotic is a drug derived from living organisms, such as fungi, which would kill or
prevent bacteria from growing - it works on a variety of germs. Three men contributed
to the development of penicillin:
1.
Alexander Fleming
2.
Howard Florey
3.
Ernest Chain
Stage 1 - Alexander Fleming
Early life
1881 - Born Lochf ield, Ayrshire.
1902 - Went to London to study medicine.
1908 - Became a research assistant at St Mary's Hospital, London. He worked for
Sir Almoth Wright, a doctor, who had discovered a vaccine against typhoid in 1886.
1914-18 - 1st World War. Worked in a military hospital in Boulogne, treating
wounded soldiers. He was horrified to see that antiseptics could not stop infection
in deep wounds.
1918- Returned to St Mary's determined to find a substance that would kill germs
more effectively.
1922- Discovered that lysozyme, a substance in tears, would kill some germs, but not
those that caused disease and infection.
A Chance Discovery?
1928 Fleming was carrying out research into staphylococci (the germs that turn
wounds septic). This involved growing germs on agar in culture dishes.
When he came to clean a pile of discarded dishes, he saw that a mould spore had
lodged itself on to one of the dishes and grown to a diameter of about one
centimetre.
He noticed that, around the mould germs had stopped growing. The mould, penicillin
notatum, produced a bacteria-killing juice, which Fleming called penicillin.
He carried out further experiments on a variety of germs and found that it killed
them.
When he injected it into animals it did not harm them.

But:
If it was to be of practical use in treating humans, some way had to be found of turning
the mould into a pure drug. Fleming and his colleagues could not get the specialist help
and money to do this. He published his findings in medical journals in 1929 and 1931 and
then did nothing more.

Stage 2 - Florey and Chain

1935 - Howard Florey, an Australian doctor, became the Head of the William Dunn
School of Pathology at Oxford. He built up a team of brilliant biochemists, including
Ernest Chain, a Jewish refugee from Germany.
1938 - Florey's team began research into germ killing substances. They came across
Fleming's articles on penicillin. They produced small quantities of pure penicillin from
mould juice in powder form and tested it on mice - it worked.
They developed a freeze-drying process, but they could not produce the pure
penicillin in large quantities.
1940 - the drug was tested for the first time on a human - Albert Alexander, a
policeman. He was dying of blood-poisoning. The penicillin worked, but supplies ran
out and he died.
The drug worked but mass production for commercial use was still a problem.
Stage 3- War and the U.S. Chemical Industry
The help of large chemical companies was essential, but they were reluctant to
commit themselves to the risk and, in any case, were fully occupied by 1940 in
producing explosives for the war against Germany.
Florey realised that the drug would be useful in the treatment of deep infections
caused by war wounds. He went to America to try to get American companies
interested. He was unsuccessful until the U.S.A. entered the war in December 1942.
Then the American government provided grants for the development of mass
production of penicillin - it began in 1943 and by 1944 enough penicillin was being
produced to supply all the needs of the Allied forces.
After the war more efficient methods were developed - the cost of the drug came
down and it was, and still is, used to treat a whole range of diseases
The Fleming "myth"
Following the use of the drug to treat a friend of Fleming's (he specially asked Florey
for help) in 1943, Sir Almoth Wright wrote a letter to the Times newspaper, claiming
that Fleming was responsible for developing the drug. People began to believe that
Fleming had developed Penicillin all on his own. Even after Florey and Chain got the
Nobel Prize in 1945, with Fleming, their part in the development of this medical
breakthrough was played down.

Has infectious disease been conquered?

The main killer diseases in the developed world today are non-infectious - cancer and
heart disease. But infectious disease has not been conquered completely:
some bacteria have become immune to antibiotics such as penicillin.
tuberculosis remains a major killer - 1 Smillion people in 1990 - the bacteria that
cause it have developed immunity to the antibiotics used against it - new ones are
having to be developed.
the search is on for a vaccine and cure for AlbS.
there have been problems with drugs not being properly tested and having horrific
side-effects e.g. thalidomide.
1964 the British government set up the Committee on Safety of Drugs to screen all
newly developed drugs.

SUMMARY
1891 Behring discovered that anti-toxin serum could be used to cure diphtheria in humans.
1909 Ehrlich and Hata discovered a new chemical drug, Salvarsan 606, which kills the syphilis germ. This
was the first chemical 'magic bullet'.
1932 bomagk discovered prontosil - the second magic bullet and first of the sulphonamide drugs.
1928 Fleming discovered penicillin - the first antibiotic. He did not go on to develop it further
1938 Florey and Chain began their research into the production of pure penicillin at Oxford.
1942 The US chemicals industry invested in the mass production of penicillin, so that it was readily
available to the Allied forces in the Second World War.

Task 12
Louis Pasteur once said, "chance favours the prepared mind". Consider this statement in
the light of the discovery of penicillin in 1928.
Task 13
What part did the following factors play in the penicillin story?
- The brilliance of individual scientists?
- Teamwork?
- War?
Which do you think was the most important? Explain your answer.
Task 14
a) What is the Fleming "myth"?
b) How did it come into existence?
c) Who do you think deserves the credit for penicillin: Fleming or Florey and
Chain? Explain your answer.
Task 15
Complete the relevant sections in your Factors Summary booklet.

Prehistoric
2.5 million BCE -8,OOOBCE
Key Facts

Prehistoric Britons believed that the spirits caused

illness and disease.
They were able to treat simple surface wounds and
there was much use of herbs and plants.
Medicine men provided medical care but women
were involved in treating illnesses as wives and
mothers.
Remember: no understanding of cause would result
in a spiritual cure - like trephining.
Key Words

Trephination
Prehistoric - prehistory
Aborigines

Prehistoric Medicine
The term "prehistoric" refers to the time before
recorded history. This means that we no
written evidence about this time. It is usually said to
be about 500,000 years ago.
Prehistoric people lived all over the world but they left
the prehistoric period at different times, depending on
when writing developed - Britain remained prehistoric
long after hgypt and the Middle East because writing
developed much later in Britain.
The earliest prehistoric people had the following
features in common:
They were nomads.
They were hunter-gatherers.
They lived in small groups with no complicated
political arrangements.
- They had very simple technology - spears, bows and arrows, axes, knives and scrapers
made from wood, bone and stone.
They had no system of writing

There is in fact some evidence that a form of surgery was performed. Skulls have been
found with holes deliberately drilled in them. This kind of operation is called trephinning
and is done on living people. The skulls have been found in burial sites with the
complete body of the person and the disc of bone alongside. The disc often has holes in
it, indicating that it could have had a thong threaded through it, so that it could be worn
around the neck. All of the skulls are from adults and most of them show signs of bone
growth around the hole, indicating that people lived, often for some time, after the
operation. It is, however, difficult to find out why this operation was performed.
Some Theories
- the holes were made in the skull so they could be used as drinking vessels.
1876 the operation was performed on children, and those who survived were
thought to have great magic power. When the person died the skull and the pieces of
bone taken out were used as powerful charms.
1930 they were performed on people who had skull injuries and, later on people with
other problems, perhaps epilepsy or very bad headaches.
1945 - it may have been performed to let evil spirits out of the body.

What facts do we know about prehistoric medicine?

W'o do not know what people thought about their illnesses so we cannot know exactly
how or why they treated illness.
In order to find out more about prehistoric medicine historians have looked at the
medical beliefs of people around the world, whose technology and lifestyle are similar
to prehistoric people.
At the end of the 19th century anthropologists studied Aborigines in central and
southern Australia, who had had virtually no contact with the European settlers, so their
lifestyle had been unchanged for centuries.
They discovered the following facts:
they obtained their food by hunting and gathering wild plants.
they moved from water hole to waterhole & did not settle in fixed places.
they had many spoken languages but no written one.
Ti addition they learned about their beliefs:
they believed thai the world started in the dreamtime when their spirit ancestors
iivfd.
i hey beheved that their spirit ancestors had shaped the world as it was e.g. placed
streams, waterholes, and plants etc. in particular places.
they believed that spirits caused all new life - human or animal.
In fact, anything, which did not have an obvious physical explanation, was explained as
the work of spirits.
Medical Beliefs
Their beliefs affected their medicine.
Where the cause was obvious, common sense cures were used.
e.g. 1. Broken arms - encased in clay, which set hard in the sun (like a plaster cast).
2. Cuts - covered with clay or animal fat and bound up with bark or animal skin.
Where there were no obvious cause two possible explanations were considered:
an evil spirit had entered the sick person's body.
the person's own spirit had left, or been taken from, his or her body.
The treatment of illnesses with spiritual causes:

drive the evil spirit out.

find the pointing bone used to extract the spirit - the spirit would be stuck on it.

Ancient Egypt
6,OOOBCE - 30BCE
Key Facts

The Nile gave doctors ideas as to the cause of

disease. They knew that the body had channels like
the Nile and if one got blocked then there were
problems. They believed in the afterlife (that's why
people were mummified) and thought that the heart
was the centre of everything - where the soul was
and thinking took place.

Key Words
Mummification
Imhotep (first recorded doctor)
Hieroglyphics

Factors affecting progress in Egyptian Medicine - progress

1) They had a
2) They developed a

living in one place within the community

and were able to write down ideas and

findings on papyrus scrolls

3) There ships
to other areas in Europe and North Africa
4) They devek

ability e.g. making tools and constructing.

/ Pfantt/Htrfa
Writing

No Egyptian medical equipment survived only some

Most important medical information is from
Knew about the anatomy of the body but had

Mummification: Process of preserving the body for the afterlife

Embalming: Another word for mummification
Afterlife: belief in a place to go to- life after death

RS

Anatomical
Knowledge

Physiologica
Knowledge
Knew very little
about nervous
system

Embalmerswere
skillful

Spinal Chord was

improtant-did
not know about
the brain

Good knowledge
of structure in

~\n dissection
not allowed

ftH,

HW

Knew about veins,

arteries, muscles

structure
&

Did not know

about circulation

Air was drawn in

through the nose
into lungs

Key Question

Who treated the sick?

Egypt

Priests and doctors

Family members, especially women

What did they know about

the body?

They could identify some parts of the body but

they did not understand what they did.

How did they prevent and

treat illness?

Herbal remedies
Simple surgery
Charms and spells
Personal hygiene

What did they think

caused disease?

Gods
Food rotting in the channels of the body

How healthy were

people?

The wealthy probably lived longer than the

poor because they ate more and lived in
cleaner conditions. This meant that women in
wealthier families were likely to have stronger
babies that were less vulnerable to infection.
People in Egypt and Greece had similar life
expectancy.

Ancient Greece
800BCE - 338BCE
Key Facts
The Asklepion was a temple of healing to the god
Askelpios. Temple snakes would crawl over the sick.
There were over 200 temples in Greece.
Hippocrates is vital to know. Came up with the 4
Humours but more importantly said that disease was
not caused by god but by natural causes.

Key Words
Hippocrates
4 Humours (black bile, yellow bile, blood, phlegm)
"Each disease has a natural cause...if we can find the
cause, we can find the cure." Hippocrates

Greek Medicine
Aseclepius - Greek God of Healing Snake/serpent symbol
Ascelpion -Temple of the Greek God Asclepius built in quiet places. It might have baths,
gymnasium and stadium as well as temples of worship
Panacea and Hygeia - Aseclepius' daughters who helped him heal the sick
Why visit an Asclepion? - To worship Asclepius and so to be heaied by God
in an Asclepion visitors would make offerings to god, pray and sieep. They believed that the
snake/his daughters would visit them at night and cure the patient. Natural treatments with
baths and gyms

Religion was important in Greek society

They did not know the real causes of illness

Greek Natura! Ideas

They were a rich society of traders, farmers and craftsmen.

Trading with other civilisations bought them new ideas.

Greek thinkers were called philosophers. Although they still believed in Gods and
spirits they also wanted to find out why the world was at it was.

Through observation of sick people, noticed that often liquids oozed out of their
bodies.

These liquids were called the 4 Humours 1) Phlegm 2) Blood 3) Black bile 4} Yellow
Bile

The 4 Humours
> Belief that the body was mad of 4 liquids called humours
> Humours were black bile, yellow bile, blood, and phlegm
> It was believed that if the humours got out of balance then the body would
become ill so the humours had to be kept in balance
> Linked to the Greek theories of the world ie. 4 elements and 4 seasons

Hippocrates
Father of modern medicine - very important
Questioned old superstitious ideas
Turned medicine more into a science
Wrote books on detailed lists of symptoms and treatments
Hippocratic Oath - code of conduct for doctors, high standard to benefit
patients not doctors
Clinical observation - encourages doctors to use natural causes.
Observing and examining patients very closely.
Natural theory - wrote down the theory of 4 humours
Believed in the importance of prevention of illness
Lifestyle could affect health
Improved health, medical knowledge, new ideas.
Why is Hippocrates important?

1. Believed in natural causes of iiiness/disease

iSS

Mt

;5B*
MM

2. Emphasised natural treatment

3, Encouraged

4, Hippocratic collection of writing

ic Oath - code of conduct

Treating iilness
Believed that the doctor should help nature restore balance
Purging to balance the humours e.g. laxatives, emetics, bloodletting

What weren't the Greeks Rood at?

Public health and hygiene - lived in cramped houses in narrow streets, poor water
and sewage facilities

Anatomy and physiology - no information in the Hippocratic writings other than the
main organs being describe; dissection was banned

Surgery regarded as an inferior trade, manual work rather than thinking

Roman
510BCE - 400AD
Key Facts
Romans conquered the majority of Europe. To do this they
needed an army. And a healthy army was a strong army.
'Prevention is better than cure' is a key phrase.
Religion is still important and they believed in gods like the
Greeks.
Roman Invention:
Town planning
Aqueducts
Public bathing
Public lavatories
Sewers
Galen, doctor to Roman centurions. Very important. Religion
stopped Galen cutting up people so he used apes and pigs. He
was very wrong about anatomy - pigs/bears are different to
humans.

Types of evidence historians use to find out about Roman Medicine

1. Writings of Roman Doctors
2. Instruments
3.

Sharing ideas
Investigation into illness/cures easier when more common

Knowledge/understanding of illness/remedies spreads

quickly
Movement of medical personnel

Effective methods
new methods to treat illness

Health of soilders important so medical issued valued which

bentifited all

Can afford specialists

prepared to investtigate illness
Pay for treatments

Similar/Different ideas that the Romans shared with the

Similar:
v

Natural and supernatural id

Supernatural causes and cures

lonssic

V Theory of Humours
S

Natural remedies

Taking exercise, Sivin

Different:
*

Interested in practical approach to medicine

Dtd not like to think about why people got ill

Did not like to use doctors

Natural theories developed - Theory of Opposites

Knew there was a connection between cleanliness

!us-

They used Opium as a weak anaesthetic and turpentine and pitch as antiseptics

Public Health

Clean water provided by aqueducts, reservoirs, public fountains, public baths

JC Safety rules for fires

^f Burying dead people
Health of Roman Army soldiers
**& Military hospitals - look after the army, important to defend empire
Best treatments provided
Campus located in healthy areas
Medical personnel provided with each group of soldiers

en -Theory of Qpposites (A treatment

Believed the body was well designed - Christian church supported his
because it fitted in with their Ideas about God/World
Wrote many books on medicine which were used for many centuries
that was made
an advance on

had gone before

on natural theories and remedies.

M
Si

;ine in the Roman Empire

Name:

Change
Continuity
The Roman Empire overlaps
chronologically with the Ancient
Greek period - the Romans
also had contact with Egyptians.
T^e Romans developed ideas
such as Regimen.
Roman medicine continued to
mix supernatural and natural
i"uims of medicine.

The Romans were more

practical in their approach to
medicine - it served a purpose.
Roman government was
centralised and wealthy.
Roman doctors, Galen in
particular, learnt new things
about human anatomy.
Public Health was prioritised.

The Army
The Army of the Roman empire
had to be kept fit and healthy.
The Army was stationed across
the whole of the Empire.
The army spent much of it's
time building roads and Public
Works.
The welfare of the army is a
major reason for investment in
Public Health.

Medicine in the Roman

Empire

Religion in Ancient Rome

Public health
Empirical Observation led the
Romans to realise that bad
smells were linked with poor
health.
i he Romans invested in Public
Health across the whole Empire.
r.v::it; had over a hundred
Sewers and Aquaducts
lso built by the Romans.

^N

Galen
Galen worked with Gladiators, in
an Asclepion and trained at the
best schools.
Galen became the physician to
the Emperor's son which
allowed him to write.
Galen developed the ideas of
Hippocrates
Galen described quite
accurately, the anatomy of the
Human body.

Romans visited temples such

as Asclepions.
The Roman Empire later
converted to Christianity.
Romans believed that many
things were signs from the gods.
Roman Medicine was based
more on practical, natural
considerations than Religious
beliefs.

Diagram created by Mr Moorhouse

www.SchoolHistory.co.uk/diagrams/

Middle Ages
476AD - 1445AD
The Roman Empire has collapsed and in Europe there was now
not one ruler. Groups fought for the right to rule the land. There
were numerous wars.
The beginning of the Middle Ages is sometimes called 'The Dark
Ages'. The things the Romans invented were left to break down,
key books from Greeks and Romans were lost or destroyed.
The Church took the place of doctors and hospitals. The emphasis
was on care and religion rather than medicine.
Generally very little progress medically in the Middle Ages.
Generally poor public health if you were poor. If wealthy you
would have regular baths.
1348 - Black Death - no understanding why. Superstition and god
blamed.
Medicine regressed in the Middle Ages.
BUT
In the Islamic World (Iraq, Saudi Arabia, Egypt) there WAS
progress.
Rhazes
Ibn Sina

Why was there no progress in the Middle Ages?

Causes of medical stagnation in the Middle Ages included:
> the loss of medical knowledge/ bad doctors the forbidding
by the Church of dissection, and its encouragement of
prayer and superstition)
> the encouragement by the Church of prayer and superstition
> the emphasis on 'authority1 rather than on observation and
investigation
> the lack of resources to build public health systems
> social disorder and war, which disrupted communication
and learning
The Church played a big part in medical stagnation in the Middle
Ages. It discouraged progress by:
> forbidding dissection of human corpses
> insisting that people agree with the writings of Galen
encouraging people to rely on prayers to the saints and
superstition to cure them of disease
> encouraging the belief that disease was a punishment from
God - this led to fatalism and prevented investigation into
cures

The Middle Ages

The period between the fall of the Roman Empire to the Renaissance
A closed society

Countries and tribes at war - instability

Public health systems not continued

Any spare money spent on army

Trade/ travel/communications difficult and disrupted

Education and technology disrupted

Increasing power of religion - Christianity & Islam

Increase in magic and superstition

Galen's books lost or hidden

Factors affecting medical developments

War

Religion

Government

Communications

Education

influence of the Catholic Church

Illness was caused by God so people had to persuade go to be merciful so turned to

prayer, healing shrines, worship relics, pilgrimage etc.

Controlled ideas in medicine supported Galen's ideas as they fitted in with their
beliefs.
Role of monasteries: preserved Greek and Roman writings, became medical centres,
developed public health systems
Hospitals - without church there would have been no hospitals, main function is to
provide assistance to the sick and poor; Christians believed it was their duty to help
the sick

Medicine in the Dark Ages -AD 400 -1100

The Roman Empire had fallen. Under constant attack
from barbarian tribes the Romans had been forced to
pull its armies back to defend Rome.
As the Romans left, many of their practices fell into
disuse. People returned to a tribal existence and the
Romans knowledge of public health was no longer
used.
Throughout Europe, there was little new learning. Books had been destroyed.
Those that had survived were scattered across Europe and not easily accessible.
Science was pushed into the background while Religion became more
prominent.
^
.

Faith and Superstition

Alcohol and opium were used to numb the senses
during operations and for pain relief. Other popular
remedies included mandrake and hemlock.
Mandrake was used for pain relief, wounds, gout,
sleeplessness and for love potions. Cures using
hemlock were problematic because the plant
changes according to weather and age and so often
the remedy would cause more problems including
death.
The church taught people that illness and disease
was a punishment from God and that they needed to
pray to be cured. The soul was considered more
important than the body. Medical treatments and
bodily, cleanliness were'of little importance.

Monasteries
St. Benedict, founder of the Benedictine monks
believed that the cure of the sick was one of the most
important duties of monks. During the dark ages,
monasteries were the only hospitals in Europe.
Patients were cared for in the hospitals until they
recovered or died. Their fate was God's will. Prayer
and/or pilgrimages to holy shrines were considered
the best methods of effecting a cure.

Medicine in the Middle Ages 1100-1400

During the Dark Ages (AD40O1100) there was little progress in medicine in
Europe. As Europe moved into the middle ages, however, this began to change.
Doctors in the Middle Ages
In AD 900 the first European medical school in Europe was
established at Salermo. Others followed. The works of
Galen and other ancient writers were rediscovered and
taught. By the late middle ages physicians (from the word
physic) could only practise medicine if they had trained at
one of the medical schools. The church oversaw medical
training. The ideas of Galen were encouraged because they
fitted in with religious ideas.
Knowledge of anatomy was gained by studying books and
through dissection of dead bodies.
Physicians were bound by the Hippocratic oath.
Women were not allowed to go to university or to become
physicians. Women did, however, continue to give day to
day care of the sick and continued to act as midwives.
Causes of illness
Many physicians believed that illness was due to common sense reasons (bad
smells etc.), imbalance of the four humours, position of the sun and planets,
punishment from God, or poisonous fumes.
Treatments
Physicians would often study a patient's urine and/or use
astrology before deciding on a suitable treatment. Due to
belief in maintaining the balance of the four humours,
bleeding was a very common treatment.
Surgery was not taught at universities, surgeons learnt
surgery by watching an established surgeon.
Physicians often worked as army doctors, treating those
injured during the many wars of this period.
Herbal concoctions such as hemlock, mandrake, wrne or
opium were used for pain relief. Herbal remedies were
widely used for many everyday illnesses. Preparation of
herbs improved due to the improvement in equipment made
by scholars interested in alchemy (trying to turn cheap
m?taisJ!lt? 9L4i
Hospitals
The Catholic church taught that it was a religious duty to care for the sick, but it
was not until the twelfth century that the church provided medical schools. Of the
hospitals that were in existence, only 10% actually provided medical care. They
were called hospitals because they provided hospitality (housing, food and
clothing) for the needy. Monks and nuns cared for people in hospitals. Physicians
were rarely seen in hospitals, they treated kings, nobles and wealthy merchants,
not ordinary people.

The Rise of Islam

Throughout Europe in the dark ages, learning and medical advancement fell into decline. Much
of what had been learned by the Greeks and Romans was transferred to Islam.
Muslims in cities such as Jerusalem, Damascus, Alexandria, Fez, Tunis, Cairo, and Baghdad
made advances in philosophy, science, medicine, literature, and art. Many classical Greek and
Roman works, including those of Hippocrates and Galen were translated into Arabic.
Background to Islam
In AD 570, a man was born who was to transform the Arab world. His name was
Mohammed. In AD 610 he founded a new religion - Islam. The new religion united
the warring Arab tribes and founded a strong nation that conquered the Persian
and Byzantian empires. Islam extended its boundaries from Spain in the West to
China in the East and conquered north Africa.

The prophet
Mohammed

Importance of Learning
The teachings of Islam stressed the importance of learning. The Koran, the holy book of Islam
states Those who know and those who do not are not equal". Mohammed himself said "One
hour of teaching is better than a night of praying".
Medicine in Islam
The teachings of Islam encouraged cleanliness and personal hygiene. They were not to pray until
their bodies and clothes were spotlessly clean.
Hospitals were run by the government. There were separate wards for each sex and often for
different diseases as well.
Only qualified physicians were allowed to practice medicine and hospitals were considered
places of learning as well as healing centres. Most hospitals also had libraries containing
translated medical texts including those of Galen and Hippocrates. Detailed records of patients,
their medical treatment and their progress were kept.
Patients were first treated with physiotherapy and diet. If this failed drugs would be used and
finally, surgery.
Islam teaches that God provides a cure for every illness and so physicians sought to find new
cures and remedies.
The science of Chemistry was considered very important in Islam and as a result many new
drugs were developed. The Islamic Materia Medica (substances used in medicine) grew due to
links with both the West and the East.
Dissection was forbidden by the Islamic religion and so Islamic doctors knowledge of anatomy
was not as advanced as their knowledge of physiology and remedies.
Individuals
Rhazes was a Persian physician and philosopher. He is important because he
wrote more than 150 books and translated Greek medical texts into Arabic. He
identified the difference between smallpox and measles. He built a teaching
hospital and encouraged recording of treatments and symptoms.
Avicenna was the most famous Arab doctor. He travelled around the Arab Empire
and spent time teaching and practising medicine in Cordoba, Spain. He was the
first surgeon to describe the different parts of the eye. He also recognised the link
between emotions and health as well as the link between nerves and muscles and
nerves and pain. He wrote the Canon of Medicine which brought together all
medical knowledge to date and was a standard medical text for over 600 years.

1
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Rhazes
(850923)
Writings copied #
based on |
Hip/Galen; i

IbnSinna

(9801037)
Copied and
Greek writings

I
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important to
*
works
Followed theory
of 4 humours ;i

Did criticise Galert

and imphasised
importance of
own observatuori
Recorded
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nt^c/*^ftt^rtf\n.c

tvi
ycscnpiions OF

smallpox and
measles

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Mainly
responsible for
bringing Greek
qritingsintQ
Europe

lbn a

The Renaissance
1492AD - 1642AD
Renaissance means 'rebirth'. This is a movement from Italy
where people began to question things.
The teachings of the Catholic Church were beginning to
become challenged.
Vesalius - first person to dissect a body and discover that
Galen was wrong on numerous points on anatomy.
Printing is invented so ideas spread quickly.
Pare - French army surgeon who invented the ligature.
Harvey - discovery of the circulation of blood and purpose
of heart.
1665 - The Plague. Mixture of religious reasons for it
(planets, god, Jews) but many thought there was a
sensible answer.

 Challenged
Galens ideas
about anatomy
- dissection

57

Galen and ancient

doctors were accurate
Their work contained al
knowledge
There was no need to
learn more about
anatomy

Galen was wrong in

some cases about
anatomy
Doctors should dissect
human bodies
Galens ideas had to be
tested and not accepted

Dissecting human
bodies
Recording information
Checking results
when they went
against Galen's ideas

Did not offer any new

theories about causes
of disease or cures so
his findings had little
impact on the
treatment of illness

Proved Galen wrong and

old ideas had to be
questioned
Doctors and scientists
would investigate and
eventually develop
understanding of real cause
nf i

Why is tils work

Born in
1514

Studied in Louvain, Paris and Padua

Medical family background

Died in
1564
Professor of surgery and
teacher of anatomy

Vesalius said that:

* Dissections should take place in public
* Doctors and lecturers should perform the
dissections
* Students should have the opportunity to view
dissections close-up

Vesalius worked as a doctor at

the court of the Holy Roman
Emperor Charles V

Tabulae Sex 1538

1) Sees some errors in Galen
2) Accurate drawings of animal and human anatomy
1) A complete human anatomy - map of the body
2) Corrected some of Galen's errors

Fabric of the Human Body 1543

3) Accurate illustrations were put alongside the text.

4) It showed what could be achieved when dissection
accurate description and illustration were all put
together

Letters on Venesection 1539

1) About the practice of bleeding patients
2) Vesalius provided scientific reasons for why some of
Galen's theories could be accepted.

5) Vesalius emphasised accuracy by overseeing each

stage of the publication of his work.

New ways of
treating
wounds eg,
ligatures.

Wounds treated by
pouring boiling oil on
them to help heal
wounds sealed to stop
them bleeding by
cauterising ie using a red
hot iron

He discovered wounds
healed quickly if boiling
oil was not used
Bandages were placed
on wounds - special mix.
Stopped cauterising,
tied ends of arteries -

* Forced to use an
alernative method
which worked when
oil ran out
* Knowledge of Ancient
Roman treatments

Developed new ways

of treating wounds
which surgeons
adopted
no antiseptics meant
wounds likly to go

First hand experience

New ideas used by others
ligatures were used
successfully when
antiseptics were
developed - paitent more
likly to survive.

Circulation of
blood +
proved Galen
wrong

Proved blood circulated

around the body
Blood carried away from
heart by arteries
Returned to heart by veins
Heat acted like a pump
Blood was not burnt up

Did not offer any new

theories about causes
or cures of disease so
his findings had little
impact on treatment of
illnessess at the time
>
a

I
8
K

* Galens ideas about

blood
* Galen said that new
blood was made in
the liver and burnt up
ike a fuel by the body

Dissected animals and

human bodies - observed
and recorded
Experimented with liquids
and rods
Measured and calculated
quanities of blood in body

* Proved Galen wrong so

again showed that old
ideas had to be questioned
* Provided further doctors
with the foundation to look
at blood and the
circulatory system,

Why is His work

So important ; ' :

18 & 19c Medicine

1700AD- 1899AD
New hospitals beginning to be set up.
Due to the Industrial Revolution (automated machines being
invented) British towns were overcrowded and unhealthy.
Numerous epidemics like the 1854 outbreak of cholera in London.
Edwin Chadwick in 1842 wrote a 'report of the sanitary conditions
of the labouring population/ He did not know how dirt caused
disease but knew there was a link.
In 1848 a Public Health Act was passed.
End of laissezfaire.
Average age increased from 30 in 1801 to 50 in 1901.
James Simpson used chloroform as an anaesthetic in 1847. Queen
Victoria used it and popularized it.
Edward Jenner - cowpox/smallpox
Louis Pasteur - published the Germ Theory and proved that germs
caused disease.
Robert Koch -took Pasteur's ideas and developed vaccines for
deadly diseases.

Edward Jenner- The Experiment

I
People with cowpox never get

Jenner puts puss into Him with

He had symptoms of cowpox

He injected him with small
pox, no symptoms

Bov survives Jenner has a new

luea, vaccinauon
!** W P W I W I W %***?* # i*l I I. if** I

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Factors affecting Jenner's breakthrough

Chance - If he wasn't in town full of people with cowpox he wouldn't have

1
5
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JJ

5
5
M

come to get this vaccination

Scientific Experiment - He did this on a few people and wrote down his
recordings, testing to see if cowpox really prevents small pox, questioned and
tested his ideas again
The Role of the individual - If he did not investigate this story, we might not
have a vaccination. He is so important, he wanted to think for himself and try
new things.

1
1
5

Why did vaccination work?

Cowpox is almost the same virus as smallpox so that when the body reacts to
cowpox it becomes immune to a very similar disease of smallpox.
Why was Jenner unable to explain why vaccination worked?
He did not know the smallpox was caused by a virus. He did not have a
powerful microscope which would have enabled him to examine smallpox and
see what it contained.
Why was Jenner's work important?
He was the first immunises He made use of the knowledge that recovering
from one disease makes it immune to another. Basis of science of immunology
by Pasteur in the 19th century.

germsare micro-organisms which cause disease

Germs are carried in the air
Germs are killed by heating
Germs are invisible to the naked eye
Germs are not distributed evenly

This stated that micro-organisms were the result of decay ie.

decaying matter turned into living organisms

Modern Medicine
1900AD - 2011AD
Alexander Fleming discovers penicillin kills disease.
Howard Florey & Ernst Chain mass produced it (it
was needed for WW2)
WW1 & WW2 are important as new technology was
invented to help those that were injured in the wars.
1914 - Marie Curie discovered X rays.
1917 - Harold Gillies - pioneer in plastic surgery at
Queens (Mary's), Sidcup.
th

5 July 1948 - formation of NHS. Offered free

treatment for all. Anuerin Bevan was the MP who
introduced the Bill that made the NHS.

FACTORS THAT HELPED THE

DEVELOPMENT OF MEDICINE
War

Communications

Building an Empire involved WAR. The

Romans needed fit soldiers so they
developed a good public health system.
Roman soldiers also provided the need for
progress in battlefield surgery
War wounds give surgeons like Pare (1510
1590) opportunities. Pare developed a
soothing lotion to replace cauterisation. Also
developed artificial limbs and new surgical
tools
Crimean War (1853 -56) helps the
development of nursing. Gave Florence
Nightingale the opportunity to conduct her
work in Scutari.
Franco - Prussian 1871 war helps rivalry
between Pasteur and Koch. Both men's work
fuelled by nationalist pride.
First World War (1914-18) and blood
transfusions. War created the impetus for the
application of Landsteiner's work on blood
groups and transfusions
Second World War helped to develop
penicillin and plastic surgery. Penicillin first
mass produced in 1942 in response to the
demand created by the casualties of War

Invention of the printing press by Johann

Gutenberg 1454 and its use by Caxton in
England in 1476 greatly speeded up the
spread of new "Renaissance" ideas
Industrial revolution 1750 onwards
Better transport; canals, roads, rail
Electric telegraph and greater and greater
communication stimulates debate.
Medical journals such as the "The Lancet"
allowed scientists to share and developed
idea. (e.g. Lister first read about Pasteur's
germ theory in The Lancet which led to his
development of carbolic spray in surgery in
the1860's)

Government

Romans had a strong government

organisation backed up by an extensive civil
service and were thus able to develop their
excellent public health system
French and German governments helped
Pasteur and Koch. In the 1860s-1880'stremendous progress in the development of
vaccinations e.g. Chicken cholera, rabies,
anthrax etc.
Liberal government in Britain (1906-1916) first social security reforms and National
Insurance for health care set up in 1911
British and American governments fund work
in penicillin - Florey and Chain 1938-1944
Labour government set up NHS 1948 - free
health care for all

Chance

Pare runs out of oil 1536 - had to use a

mixture including eggs, rose oil and turpentine
- proved far more effective than boiling oil!
Charles Chamberland (Pasteur's assistant)
injected chickens with weakened strain of
chicken cholera by mistake - discovered by
chance then the weakened or attenuated
culture had made the chickens immune 1880.
Pasteur and his meeting with the boy bitten
by a dog - developed rabies vaccination 1885
Fleming and Penicillin. Fleming noticed by
chance the bacteria killing qualities of the
mould penicillin notatum by chance in 1928

Religion

Egyptian religious belief in life after death

helps knowledge of the Human body. Bodies
were mummified by priests increasing
knowledge of anatomy. Surgical tools also
advanced.
Islamic belief in looking after the sick and the
elderly
Work of Christian monks in the Middle ages a Christian duty to look after the sick
Renaissance and reformation - questioning of
Roman Catholic belief by religious reformers
such as Luther, Calvin and Zwingli led to a
questioning atmosphere in which more
progress was possible

Science and
technology

Scientific observation and enthusiasm for

scientific enquiry during the Renaissance e.g.
The Royal Society founded 1660.
Science develops during the Industrial
Revolution allowing scientists and chemists to
use technologies like the microscope in the
mid Nineteenth century.
Use of science in research, chemicals
developed.
Scientific and technological advances lead to
machines and materials e.g. Wilhelm
Roentgen discovered X rays in 1895
Surgical technology and scientific progress
allowed for the first heart transplant operation
by Christian Barnard 1967

Individual Genius

Imhotep (2730BC)
Hippocrates (460-377BC)
Galen (129-199 AD)
Avicenna (980-1037AD)
Pare (1510-1590 AD)
Vesalius(1514-1564AD)
Harvey (1578-1657 AD)
Jenner (1749-1823 AD)
Pasteur (1822-1895 AD)
Koch (1843-1910)
Lister (1827-1912)
Chadwick (1800-1890)
Simpson (1811-1870)
Nightingale (1820-1910)
Beveridge (1879-1963)
Fleming (1881 -1955)
Florey (1898-1968) and Chain (1906-1979)
Barnard (1922-)

FACTORS THAT HINDERED THE

DEVELOPMENT OF MEDICINE
War

Barbarian tribes attacked Rome 410AD. The

Western Empire collapses and the Dark Ages
emerge. Knowledge of the ancients lost and public
health systems collapsed
Loss of medical learning in the destruction of war
Finance directed away from research and care in
all wars especially during 19th and 20th century
conflicts

Religion

Egyptians were not allowed to dissect over and

above the removal of soft organs. Lack of
experimental dissection for religious reasons
limited what they learnt about anatomy
Religious attitudes hindered Galen. He could only
base his work on anatomy on the wounds of
gladiators and the dissection of animals. He
therefore made mistakes - mistakes not rectified
until Vesalius in 1543 AD
Later religious groups including both medieval
Christians and Muslims prevented criticism of
Galen because Galen had rejected the polytheistic
Romans religion and had come to believe in one
god
Religious groups opposed the use of anaesthetics
in the 19th century as they believed pain was a
"natural" part of childbirth. They were almost
exclusively men!

Tradition

Conservative doctors opposed Galen.

Opposition to Fare's methods. Many battlefield
surgeons continued to use boiling oil because it
was what they knew.
Opposition to Jenner and his smallpox vaccination
1796 - because doctors feared that they would
lose money. The public at large also feared that by
being injected with cowpox they would develop the
features of cows - not until 1840 that the
vaccination was widely available
Christians opposed the use of chloroform
Opposition to nursing improvements (e.g. the male
doctors at Scutari 1854-56 originally objected most

strongly to the idea of Nightingale and other

female nurses being in the hospital)
Objections to welfare state (e.g. the British Medical
Association feared that doctors would become
poor)

Lack of
Science &
Technology

Government

Lack of anatomical knowledge.

People did not know about germs and blood
groups because of lack of technology e.g. powerful
microscopes not invented until the Nineteenth
century
Lack of technical knowledge prevented
manufacture of effective microscope before this.
Germ theory and the identification of blood groups
therefore not possible.

Lack of stability and organisation before the

modern period (with the exception of the Romans!)
prevented progress in public health.
Laissez faire prevented action on public health
problems such as cholera during the Industrial
Revolution in Britain
Opposition to increased spending during the
debate on the NHS in the 1940s.

Section C
THIS SECTION IS ALWAYS ABOUT PUBLIC HEALTH.

Section C has two questions from which candidates

choose one.
Each question has two parts and is
worth 12 marks.

Public Health Through The Ages

Egyptian times
The Egyptians developed a system of writing which meant that
knowledge could be used by later generations. They did pray to the
goddess who was thought to cause and cure epidemics and wore
scarab brooches to frighten away the evil spirits who caused disease.
They must have seen the connection between dirt and disease
because both rich and poor washed frequently. Simple toilets and
latrines have been found but it seems that the sewage was stored,
later dug out and removed. It does not seem that water was used to
flush it away.
Greek ideas
We know that the Greeks picked up many Egyptian ideas. They came
to believe that disease had natural causes and could be prevented.
They also believed in keeping themselves clean. They tried to eat the
correct food for the time of year and to exercise. They did not use
water for flushing away sewage. The Romans in turn were influenced
by the Greeks.
Other civilisations

We know that cities in India had sewers around 1500 B.C. Crete had an
elaborate system of sewers and water supply but volcanic eruptions
buried them. The Romans had to find their own answers to problems
which Cretan engineers had already solved.
Importance of the Romans
The Romans are important because they went much further than any
other people in the Ancient World. The Romans wanted clean water
and good drainage for people throughout their empire. In other words
the Romans were the first people to plan and carry out a programme
of public health on a large scale. An example of the practical nature is
how they tried to stop fevers. At first they tried praying to the goddess
Febris but later took the sensible step of draining the marshes. They did
not know that mosquitoes spread the fever but they found a way of
breaking the chain of infection. The Greek idea which most influenced
the Romans was the importance of staying healthy. To the Romans it
seemed much more practical to spend time keeping fit than to spend
money on doctors for the sick. "We must pray for a healthy mind in a
healthy body/1 wrote Juvenal, a Roman poet. The Romans believed it
was important to build their settlements - their cities, villas, villages and
army forts - in healthy places near good springs, rivers or wells. They
built conduits (channels) to bring water into their settlements. When the
water had to go over hills and valleys the Romans built the conduits
(channels) on top of arches. These looked like bridges and were called
aqueducts. They were so well built that a number are still standing
today 1700 or more years later. Besides clean drinking water, the

Romans the Romans also believed in the importance of personal

cleanliness. They set about making daily bathing a possibility for all
citizens. Wherever the Romans settled, they built public baths.
The Roman interest in public health also led to them building latrines.
They used water to flush away the waste products. Rome had huge
sewers which emptied into the River Tiber. Romans took their drinking
water from other rivers and springs. The building of sewers
stopped germs infecting drinking water. The Romans were able to
provide these facilities because they were well organised, could
enforce peace, could raise money through taxation and could use
slaves as a cheap labour force
AD450 - 1800 a period of little or no progress

The Roman Empire collapsed around 450 A.D. and there followed a
long period of great disorder. It was healthier to live in Arab-occupied
Europe than in the Christian-ruled areas because the Arabs believed in
cleanliness. No Christian ruler was powerful or rich enough to carry on
what the Romans had done. Public health conditions grew worse.
Rivers were used as dumping grounds for sewage and other waste and
also as sources of drinking water. As towns grew in size, the problem
became worse. Town governments passed laws against dumping
sewage and other waste but could not suggest ways of dealing with
the problems. The Black Death reached Europe in 1340 and spread
very quickly. The filthy streets and piles of rubbish encouraged rats and
they carried the fleas which spread the disease. Making travellers spent
40 days (quarantine) outside cities to help to keep infected people
away was a sensible method of preventing the plague as was advice
to keep away from infected people. The carrying of sweet-smelling
flowers and burning strong-smelling materials did not help stop the
plague spreading. There were other epidemics of the plague. The 1665
epidemic was the last major one in Britain. Problems of providing water
and taking away sewage lasted until the middle of the 1800s. The
development of steam-powered pumping engines made
improvements possible.
VERY POOR CONDITIONS IN THE TOWNS AFTER THE GROWTH OF
FACTORIES

As more and more people moved into the towns to work, houses were
built as close together as possible. Many of them were damp and
overcrowded. Many towns had no sewers and everywhere there were
stinking toilets and piles of filth which seeped into rivers from which
drinking water was taken. All this encouraged disease, especially
among the poor. Tuberculosis, Typhoid (spread by water and food)
and Smallpox attacked people already weakened by overcrowding,
poor diet and exhaustion. The average life expectancy for a poor
person born in Manchester in 1830 was only 19.

Public Health in Britain

Section C of Paper 1 will be on Public Health in Britain. You should choose one subject
from this section from a choice of two. You will answer three sub-questions on your chosen
subject. There will be at least one source to give you information
Roman Britain
The Romans had a huge empire that, at its height, covered most of Europe and parts of
Africa. The Romans were practical, well organised and had strong centralised government.
Wherever they went the Romans built roads so that they could move their army quickly and
communicate easily with other parts qfjtte Empire. They also built towns, carefully
choosing to build near fresh wateygipplies as^3mrnjgarshes. Romans followed the
teachings of Hippocrates and G^l^jind undersTocdlpjmportance of keeping clean and
healthy. Roman towns woukyhPs^e baths, latrines, sew^and aqueducts. The Roman
army was well looked after ajjrf each legion would have sewnl doctors. Towns and forts
would have army hospital^;' Ordinary people living in towns woyld have benefited from
these public health mea^ur&s. Most British people lived in the countryside, away from the
Romans, and therefore vfpuld not have benefited from tfWpubllcfliealth measures the
Romans introduced.
%
**
/
Britain in the Middle Ages and the
t

""

-"**,,,*

&H

* *f K .

When the Ron^fiijpjre tx)l(ipsecnftplout 50CfADt practical meaiCres for public health
disappeared. !Piere wng,no onb to repair thadoaths and aqusdu<&&, and medieval
governments cfi^not have'fl power or rnoj^jp do anythjpg fcboutjujblic hwth.
Medieval tow|s were teft to sorties outl&TOmselvgjis 'Town
(councils)
did not like towp^iirron^aQdfe!t fc$@snot their r^ponsjWIIy. As towns grew, rubbish
and sewage pileaiip in the streets. P0Spte ottgn goHheirjtfater from the same river they
emptied their latrine into. Medial monasteries and chupDh hospitals were the exception to
this rule. They wa$ftegyEdean, had a fresh water supply ap<J wereJbuilt of stone rather
than wattle an<Jp(tob/^pRli coukt^|^^pcorDtf^^d withDuring the Black Death in th^ 1340s,
Salted inlhe monlsterie^vere less likely
to get ill and monflikely tcjjfeijrvive if they"S91S6fabme poorly. Tiie gov^iment did very little
to stop the plagijijspre^ilng, partly because they blamed supefttitiou^puses for the
disease and partiyb^&ause they were not rich or powerful enou^|^^Ke the towns
healthier.
During the Great Plague 1666, when bubonic plague came back to London, there was
more of an understanding that poor hygiene caused poor health. The Lord Mayor ordered
the streets to be cleaned and although it made London a healthier place, it did little to stop
the Great Plague spreading.
Industrial Revolution 1750 - 1900
From 1750, Britain industrialised and population increased rapidly. Towns became
overcrowded, housing was poor and there were inadequate water supplies. There were
few proper sewers and no system for collecting rubbish. There were no planning and
building regulations as the government believed in laissez-faire. There was little
understanding of the true causes of disease. As a result there were real problems with
diseases such as typhoid and TB. In 1831 a new disease hit Britain and forced the
government to take action - cholera. The government asked Edwin Chadwick to look into
the links between poverty and bad health. His report, The Sanitary Conditions of the
Labouring Population of Great Britain', proved the links between poor living conditions and

bad health and recommended that government action should be taken. This resulted in the
Public Health Act of 1848. The 1848 law allowed towns to set up a Local Board of Health
but these boards could not force towns to take any action.
Further developments took place;
1848 & 1854 = Further cholera epidemics
1853
= Free vaccination for smallpox
1854
= John Snow proved a link between cholera and poor water supply.
1861
= Pasteur published his work on 'Germ Theory'
1867
= Working men got the right to vote.
These factors put pressure on the government to do something about public health and the
1875 Public Health Act was pass^ ^llitol^Jfimed (peal councils to take responsibility
for public health. Streets, sewQ^^j| water si^^^i to be kept clean and healthy and
all councils had to employ inspectors to enforce the laws. T
.[/* *
The 20th Century
fj# *
i1
By 1900 most governmertB in ri|h countries like Britain a epte&that it was part of their job
to organise a good public^healthjlystern with pure water
d effective sewers. However,
living conditions were stipoor |H between 1886 and 1
philanthropists like Rowntree
and Booth carried out sUKeys whichJpked poor
In 1902 the
nation was shocked to fimthat4(0(t>f|fA6 menTOVf|fn
r War were
suffering
^
government
and Lloyd
brotjgiht irf|sei11slaf refonri to Wppoor peopl
fame known as
the Liberal Social Refofurs; *
*i?&
!~
1906 ,- fecal authoriftftfjjiven the
provid
1907
.inspections*
*
1909 Age Pensf% AcT^^p^^^ige
up.
1911 - National Insurapjjp Act
tess &j$piemployment benefit to some.
1919 - Hl^^^q siMJpimPJannmg Acts.
The First and Second World Wars sF^^f^'tl^^sMS^TOthow irtfportaritlt was to keep
the working clasps healthy and 'fighting fif .^Evacuation brdittat man/social problems to
the attention of ^authorities. After the Second World War enfed in
the new Labour
government introcftji^eflthe National Health Service of NHS, this Free hospitals
Free Doctors
Free Dental services
Social Services - care of the elderly and children
Many people were against the idea of the NHS because it would cost a lot of money in
taxes. Although it was a success, it proved to be very expensive and not long after the
NHS began, charges had to be introduced for adult dental services and prescriptions.

Cause and Cures of Disease Through The Ages

Prehistoric Times
(Before 3000BQ

No written evidence. Ideas aboutfthe causes of disease were based on

superstition and the supernatural.

Ancient Egypt
(3000BC-400BC)

Still believed disease was caused by the gods. Some doctors, however,
started using natural ideas and diagnosed symptoms.
Had healing temples called Asklepions (supernatural). Hippocrates put
forward a natural theory (the Four Humours). It was wrong, but it set
medical development in the right direction.

The Romans
(500BC-500AD)

Little regard for doctors. More interested in preventing disease than

curing it. Illness was often treated with herbal medicines and opposites.

The Middle Ages

(500AD-1500)

Parts of Western Europe were in chaos. Many medical books were

destroyed. The ideas of Hippocrates and Galen were kept alive in the
Middle East Christian Church dominated people's lives. Many beliefs
about the cause and treatment of disease were stilt based on the
supernatural. Natural remedies based on the four humours also used.

The Renaissance
(1500-1750)

Hardly any change. Treatments still based on a mixture of the

supernatural and the four humours.

The Modern
Period (1750-1900s)

Jenner discovered a vaccine for smallpox. Louis Pasteur proved the

germ theory of disease. Koch identified specific germs which caused
disease in humans. Pasteur also discovered other vaccines to prevent
specific diseases. After 1900 chemical drugs which cured disease were
discovered. Penicillin, the first antibiotic, discovered by Fleming and
developed by Florey and Chain. A period of very rapid change.
But recently some germs have become immune to antibiotics.
Alternative treatments, such acupuncture and homeopathy, have
become popular again.

Anatomy & Physiology Through The Ages

Prehistoric Times
(Before 3000BQ

No written evidence so we have very little knowledge.

Ancient Egypt
(3000BC-400BC)

Some knowledge of the inside of the body. Preserved the organs in

special jars. Did not cut up the body to find out more, as this would
have prevented it from going to the after-life.

Ancient Greece
(800BC-400BQ

Dissected dead animals. Thought that the bone structure of the human
body was like that of an animal.

The Romans
(500BC-500AD)

Galen dissected apes and pigs. He thought that humans had the same
anatomy, which was only partly true. Supported by the Church and his
writings blindly followed for 1,500 years, even though he had made
many mistakes. No one challenged his ideas until the Renaissance.

The Middle Ages

(500AD-1500)

Galen's work was kept alive by Arab doctors. Islamic religion did not
allow dead bodies to be dissected, so little new knowledge was found.
In Western Europe In the late Middle Ages the Christian Church also
would not allow human dissection, Galen's work was still followed.

The Renaissance
(1500-1750)

Vesalius' The Fabric of the Human Body was a turning point. Vesalius
dissected human bodies and proved Galen wrong. The power of the
Church declined as old ideas proved wrong. In 1628 Harvey proved that
blood was pumped around the body by the heart.

The Modern
Period (1750-1900s)

X-rays were discovered by Roentgen in 1895. X-ray machines enable

doctors to see the bones and the internal organs of the body.

Surgery Through The Ages

(Before 3000BC)

Archaeologists have discovered Prehistoric skulls which have been

trephined to allow evil spirits to be released.

Ancient Egypt
(3000BC-400BC)

Carried out simple operations, such as the cutting aw.ay of tumours.

Descriptions recorded in papyrus medical books.

Ancient Greece

Carried out minor operations. Surgical tools have been found.

Prehistoric Times

(800BC-400BC)

(500BC-500AD)

Surgeons carried out operations on the battlefield. The remains of

military hospitals and surgical tools have been found.

The Middle Ages

(500AD-1500)

Military surgeons carried out simple operations on injured soldiers.

Wine and hot cauterising irons used.

The Renaissance

Par forced to use a lotion of oil of roses, egg yolks and turpentine (a
chance happening). Also used silk thread to tie up arteries, rather than
stop the bleeding by using a cauterising iron.

The Romans

(1500-1750)

The Modern
Period (1750-1900s)

Three major problems - pain, infection and bleeding. Pain overcome by

chloroform, infection by antiseptic and bleeding by the discovery of
blood groups. The 20th century has seen the development of aseptic
surgery and high-tech machinery. Period of rapid change in surgery.
Factors which brought this about included the growth of industry,
science, technology, communications, and the major wars.

Public Health Through The Ages

Prehistoric Times
(Before 3QOOBQ

There is no written evidence to inform us of ideas about public health

in this period.

Ancient Egypt

No public health systems were provided by the government. But rich

people were keen on personal hygiene.

(3000BC-400BC)

Minoan Crete
(2000BC-1380BC)

The Romans
(500BC-500AD)

The Middle Ages

(500AD-1500)

At Knossos in Crete there was an advanced system of drainage and

water supply at the royal palace.
Romans needed healthy army to defend the empire. Government built
public baths, latrines, sewers and aqueducts. First comprehensive public
health system. The Romans wanted to prevent disease.
Roman system fell into disrepair Time of regression. Medieval towns
were filthy. Governments refused to clean them up. Monasteries,
however; had washrooms and latrines. Many monks escaped the Black
Death of 1347-9.

The Renaissance
(1500-1750)

There was little improvement. Towns remained dirty. Rich people had
better hygiene than the poor.

The Modern
Period (1750-1900s)

The Industrial Revolution brought large towns, no sanitation and little

fresh drinking water. (Mo action because laissez-faire. Cholera epidemics
frightened the government into temporary action. Chadwick highlights
conditions of the towns. Discovery of the germ theory and extension of
vote led to Acts of Parliament to make the towns cleaner.
Liberal government introduced school meals and medical inspections,
old-age pensions and National Insurance, Beveridge Report fn 1942.
National Health Service (NHS) set up in 1948.

EXAM COMMAND WORDS

Make sure you understand what the question is asking you to do
Command word

What docs it mean?

Account for
Analyse

Explain why something is the way it is.

Explain your view of why the main points of an idea, text
or process are important. C)o not just describe.
Show the method and obtain a numerical answer.
Write about the differences and similarities.
Make a decision after thinking something through.
Show the differences between two things.
Analyses and make a judgement or give an opinion. Do not
just be negative, give a considered view.
Give a brief explanation of what something means.
Say what something or someone is like or give an account
of events.
Explain the advantages and disadvantages of something,
and give your opinion.
Make a judgement about the quality of something, taking
the evidence into account.
Give reason WHY something is as it is or HOW it
operates.
Explain using words like because to make clear WHY
things happen.
Point out the required features or reasons.
Explain what you understand to be the meaning, or what
someone else intended the meaning to be.
Give good reasons for.
Give the main points of an idea or an argument.

Calculate
Compare
Conclude

Contrast
Criticise
Define
Describe
Discuss
Evaluate
Explain
Give reasons for
Identify
Interpret
Justify
Summarise

Audio - Visual Resources

The BBC Bitesize is a good
website. Broken down into
bits, there are videos and audio
clips to download.
www.bbc.co.uk/bitesize

El

Another good website is this one. Loads of good Youtube clips for each
period of History.
http://www.medicinethroughtime.co.uk/Medicine_worksheets/videos.htm

Egyptian Medtcine - the factors

Prehistoric Medtcine - Egyptian Medrctne Greek Mediane Roman _Metjigng - Medieval Methane - Islamic Medjone - Medicine in the Renaissance - TTie Revolution m Surqgrv Infectious Disease ZOth Century Medicine Public Health Factors - Role of Women - Back to TOD ol Page