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Exam Guide

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The

American West

1840-1895

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Timeline of the American West.

 Date Summary Event

1823 Joseph Smith sees vision of

Moroni

Joseph Smith founded the Mormon religion. Smith claimed that, after seeing a vision of an angel called Moroni, he discovered some hidden gold plates bearing inscriptions. He secretly translated the plates four years later.

1830 Book of Mormon

published

The translation of the inscriptions was published in 1830 in the 'Book of Mormon'. The official name of the religion is The Church of Jesus Christ of the Latter Day Saints but they are more commonly known as Mormons.

1831 Mormons in Kirtland, Ohio

Within just a year, Joseph Smith had recruited a thousand new members to his religion. Smith chose Kirtland as the place to set up the Mormon ‘zion’ (holy city). They were constantly attacked.

1832 Permanent Indian Frontier

The US Government decreed that the Indian tribes could freely inhabit the Great Plains.

1837 Economic Depression

An economic depression caused the collapse of many banks in the East. People lost their savings, wages fell and unemployment rose. The Mroman Bank also collapsed and caused many non-Mormons to attack the religion. The Mormons were driven out of Kirtland.

1837 Mormons in Independence,

Missouri

The Mormons were not welcome from the beginning. As violence increased, the Mormons formed their own secret police force called the Danites.

1839 Nauvoo founded

The Mormons built their 'holy city' in Illinois. They called their city Nauvoo. By 1842, the Mormon army was 2,000 strong.

1843 Oregon Trail established

Jim Bridger, a former mountain man, built Fort Bridger on the Oregon Trail. Fort Bridger contained a store where travellers could purchase supplies as well as a workshop and forge where wagons could be repaired.

1843 Great Migration About a thousand people made the journey West to Oregon. This was the highest number of migrants to make this journey in one year so far and became known as the Great Migration.

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1844 Joseph Smith Killed

Joseph Smith, founder of the Mormon religion, and his brother were shot and killed while imprisoned for destroying a printing press.

1845 Manifest Destiny

John O'Sullivan, editor of the New York newspaper 'The Morning Post', first used this phrase to express the long held belief that white Americans had a God-given right to occupy the entire North American continent.

1846 - 1847

Mormons move to Salt Lake

Following the death of the Mormon leader, Joseph Smith, Brigham Young decided to take the Mormons away from the persecution they faced in the East and to build a new life for them at the Great Salt Lake. 

1848 Gold discovered in

California

James Marshall, a carpenter employed by John Sutter to build a mill at Sutter's Fort, discovered gold. Initially news of the discovery was kept secret but once it became known 90,000 people from the East flocked to California hoping to find gold and make their fortune. Those who arrived in 1849 became known as the 'Forty-niners'.

1849 Perpetual Emigration

Fund

The Mormons set this up to encourage Mormons from Britain, Europe and other parts of America to Salt Lake City.

1850 Stagecoach Wells Fargo established the stagecoach which allowed travellers to pay to be transported by stagecoach.

1850 “Pinkertonians” Private company set up by Allan Pinkerton hired by stagecoach and railroad companies to provide protection and hunt down notorious outlaws.

1851 1st Fort Laramie Treaty

This treaty between the US Government and the Indian tribes redefined the Indian homelands. The treaty stated that these lands would belong to the Indians and that they would not be entered by white settlers. The Indians were to be given provisions for a period of ten years as compensation for the loss of land.

1854 Homesteaders The first homesteaders began to move onto the Great Plains.

1857 Mountain Meadows Massacre

A wagon train of settlers from Missouri was massacred. The Mormons claimed it was the Indians, but the Government were convinced it was the Mormons. In order to avoid all-out war, the Mormon religion and practices were allowed. Utah could not become a State of the USA though until polygamy was scrapped.

1861- 65 US Civil War The Northern States fight the Southern States over various issues, including the abolition of slavery. The North would

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eventually be victorious. During the war, the Longhorn cattle in Texas would continue to breed.

1861 First Telegraph The first telegraph message was sent across America

1862 Pacific Railways Act

This Act established two companies whose purpose was to construct a railway across America. The Union Pacific Railway was established in the East to build the railway to Missouri and then continue west. The Central Pacific Railway would build the railway from Sacramento and then continue east.

1862 The Homestead Act

This Act offered anyone prepared to settle in the West 160 acres of land for free provided they built a home and farmed the land for five years.  

1864 Sand Creek Massacre

An armed force, led by Colonel Chivington, attacked Black Kettle's Cheyenne camp at Sand Creek. The motive for the attack was punishment for the raids on wagon trains. 163 Indians, including women and children, were killed and mutilated.

1866 The Long Drive Texas cattlemen used cowboys to drive cattle to the northern states. The Goodnight - Loving Trail was established.

1866 First Train Robbery

From this point on, gangs like Butch Cassidy and the Wild Bunch regularly stopped trains to steal the money they carried.

1867 Red Cloud's War

The Sioux chief, Red Cloud, was furious when white settlers began using the Bozeman Trail which passed through the Sioux hunting grounds and began attacking travellers. Red Cloud was further angered when a line of forts was constructed to protect the travellers and increased the attacks. By spring of 1868 the government was forced to withdraw the army and abandon the forts.

1867 Medicine Creek Treaty

Four Indian tribes, including the Cheyennes, agreed to give up their land and move to small reservations in the south-east of the Plains.

1867 Abilene founded

Joseph McCoy, a Chicago cattle dealer, founded the 'cow town' of Abilene.

1868 The Winter Campaign

Realising that the Indians never fought during the Winter months, the army decided to mount a Winter Campaign to try to catch them by surprise and force them into submission.

1868 2nd Fort Laramie This treaty defined the territory of the Sioux Indians. It gave

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Treaty them the Black Hills of Dakota and the Bighorn mountains.

1869 Completion of the Railway

 The transcontinental railway was completed. A ceremony, known as the 'golden spike ceremony' because a golden spike was used to join the East and West railways, was held at Promontory Point in Utah.

1872 Abilene bans Cowboys

Fed up with the lawlessness, drunkenness, brawls and gun fights, the people of Abilene banned cowboys.

1873 Timber Culture Act

This Act was an extension to the Homestead Act offering 160 acres of land for free provided that at least 40 acres was planted with trees.

1874 Gold in the Black Hills

Gold was discovered in the Black Hills of Dakota (the sacred land of the Sioux Indians).

1874 Barbed wire invented

J F Glidden invented barbed wire. This invention meant that large areas of land could be fenced relatively cheaply.

1876 Battle of the Little Bighorn

The army decided to attack the Indians camped in the valley of the Little Bighorn. The attack was to be made from three sides. General George Armstrong Custer who led one of the attacking forces decided to attack without waiting for the other two forces to arrive. Custer split his force into three and advanced on the Indians. At some point Custer's group were attacked. Custer and all his men were killed.

1877 Desert Land Act This Act allowed farmers to buy 640 acres of land at a cheap price in areas where there was little rainfall and irrigation schemes were needed to farm the land.

1877 Brigham Young dies

After the death of Young, the US Government launched more vigorous attacks on Polygamy.

1878 Lincoln County War

Billy the Kid become notorious as a gunfighter.

1880s and

1890s

Fence Cutting Many small ranchers and homesteaders resisted the controls of the Cattle Barons by cutting the barbed wire fences that restricted their access to water supplies.

1881 Death of Billy the Kid

He was tracked down and shot dead by Sheriff Pat Garrett at Fort Summer, New Mexico.

1886 – 1887

The “Big Freeze”

This winter was extremely harsh. Cattle and cowboys died in the snow, ice and freezing temperatures

1887 Dawes Act This Act split up most of the remaining Indian land into 160 acre plots. Some of the plots were given to Indians but much

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of the land was allocated to white settlers.

1889 Oklahoma Land Rush

In April, the US Government opened up 2 million acres in the former Indian territory of Oklahoma. Between 50,000 and 100,000 people dashed to stake a claim to the land. In 1893, a further 6 million acres were opened up.

1890 End of Polygamy

The Mormons finally abandoned their policy of polygamy. Utah becomes an official state of the USA by 1896.

1890 Wounded Knee Massacre

A group of soldiers opened fire on a group of Sioux at the Pine Ridge reservation in Wounded Knee Creek killing 153 Indian men, women and children.

1892 Johnson County War

The Johnson County war was a range war fought by rival ranchers over cattle and land.

Cattle ranching had been firmly established in Johnson County since the 1870s and many ranch owners had become wealthy and influential. During the 1880s they wanted more land and tried to buy-out small time ranchers and farmers. Those small-time ranchers and farmers who resisted were accused of cattle-rustling and some were hanged.

In 1892 the cattle barons had hired a vigilante group to get rid of the 'rustlers'. The small time ranchers and farmers formed their own army to counter the vigilante group. The army of small time ranchers and farmers managed to force the vigilante group back to their base and hold them under siege. The situation had to be resolved by the intervention of the US cavalry to free the vigilantes

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Using the information from the Timeline, create a simple overview chart that shows how the whole course fits together. Complete the table below with the key events for each:

Time Indians Settlers Cattle industry Conflicts Law & Order

1840s

1850s

1860s

1870s

1880s

1890s

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American West Revision NotesRemember, when you are revising for the American West unit, that it is best tackled by dividing it up into the various sections. However, remember that all these things happen at the same time, and this may be very important for certain question types.

The Indians

Why they were on the Plains They were originally forced onto the Plains by the rapid growth of the East of America in the

early 1800s The Plains were given to the Indians, and in 1832 the US government established the

Permanent Indian Frontier. The land was supposed to be protected for life; however the US government also hoped that by pushing the Indians onto the Plains that they would no longer be an irritation to “white society”

The whites brought with them many diseases and so threatened the Indians, they would be safer on the Plains

The Plains were empty of other people but full of Buffalo, which they would use to survive

The Buffalo The Indians used every part of the Buffalo – none was wasted

o The bones were used as arrowheads and kniveso The hide was used for clothes and tipi coverso The dung was used for fuelo The intestines were used as buckets!

The hunting of the Buffalo was very difficult – the Indians would have to follow the herds wherever they went. They could not kill too many at a time either, or else there would not be enough to sustain them

Homes The Indians did not believe you could own land – therefore being nomadic was part of their

lifestyle The Indians lived in tipis These were designed to withstand the extreme conditions of the Plains They were cool in the summer yet warm in the winter. They were shaped like a cone so

they would not fall over in the high winds Everything was done inside the tipi – sleeping, cooking and often the tipi would fill up with

very dense smoke due to the open fires

Religion and lifestyle The Indians believed in Polytheism – that there is more than one God The most famous religious ceremony was the Sun Dance – this was performed in order to

get help from the spirit world The Sun Dance was performed in a circle – the circle was sacred to the Indians

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Women were very important – they did most of the work, including all the food preparations and keeping of the homes. The men’s’ roles were simply to fight and hunt

They believed in Polygamy – you were allowed to have more than one wife. Many men had at least three or four wives

During battle, the Indians scalped their enemies – this was believed to be removing the spirit of his enemy so that he could not go into the afterlife.

It was considered braver to touch a live enemy in war than to kill him. This was called the counting coup.

Indian tribes had to follow the Buffalo to stay alive. When relatives got too old and frail to move with them, they left them to die. This custom was called exposure.

Problems they faced The gradual invasion of white settlers – trailblazers and homesteaders interrupted their

lifestyle and that of the buffalo The US government always wanted the principle of Manifest Destiny to be invoked one day The Indians and the government would never get along whilst their lifestyles were so

different – polygamy vs monogamy; polytheism vs monotheism; the right to own land, etc etc

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The First Settlers

Mountain Men and trappers These were the first adventurers and explorers – they relayed information about the Plains

back to the East – they made a good living out of selling the Beaver skins back in the East They helped set up the first Trails – for example what would later become the Santa Fe

Trail and the Oregon Trail The US government believed in Manifest Destiny – the idea that whites should own the

entire country and so regularly helped out the trailblazers

Farmers in California and Oregon 1830s-1840s These crossed the Plains and the Rocky Mountains in wagons drawn along by horses or

cattle. The journey was difficult and very dangerous. Some got lost due to the poor weather of the Rocky Mountains and froze to death.

The Gold Rush In 1848 gold was discovered in California – by the end

of the year 10 000 people were crossing the plains to dig for gold

Within a year, over 100 000 people had crossed the plains. These were known as the forty-niners

As the West developed there were many problems:o Racism – many different cultures and races

clashed over land rights and taxations placed on foreign miners

o Poor living conditions – so many people rushed to the area so quickly that conditions were very poor with many living in dirty tents. Diseases spread quickly

o Law and order – there was no proper system of law. Miners turned rapidly to heavy drinking and gambling. Murders and claim-jumping was very common

o Vigilantes – gangs developed that took the law into their own hands – many were as bad as the criminals they were attacking

The Gold Rush did help to “open up” the West – more and more industries were set up in the West, San Francisco became a financial centre that rivalled New York and it also paved the way for the increased development of the railroads.

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The Mormons

Who were they? A religious group started by JOSEPH SMITH in 1830

– aka The Church of Jesus Christ of the Latter Day Saints

He had seen a vision of the angel Moroni who told him to go and find some golden plates. He found and translated the plates to form the Book of Mormon. It said how Israel tribes migrated to America and that Jesus went to America after he rose from the dead. Eleven people were allowed to see the plates to prove that Smith was not lying

They were hated in the East because of their beliefs –o You are allowed Polygamy – it was the will of

God – Joseph Smith had ten wiveso The number of Mormons grew very quicklyo They had their own army – The Daniteso Smith ran for President – people were worried

that if they became too powerful they would enforce their beliefs on the people of America

o They believed that they were God’s chosen people

o They were very hard-working and became very successful – this made many jealous

What happened in the East? They were attacked in their first “holy city” Kirtland after the collapse of their bank in

1837 They moved to Missouri but stayed only one year as they were attacked and their leaders

were put in prison BRIGHAM YOUNG took the Mormons to Nauvoo but again they were persecuted. In 1844

Smith and his brother were arrested. Non-Mormons attacked the prison and killed the brothers

Young realised he had to take the Mormons away from the East and started leading them towards the Great Salt Lake in the West

Why Salt Lake City?

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The area was uninhabited, and so no one would attack them any more The land was almost entirely useless and so was not wanted by anyone else – this made it

safe for the Mormons The Salt Lake Valley was still owned by Mexico, so the US government should now leave

them aloneThe settlement

Every family was to build their own wagons Search parties were sent ahead to gather resources such as wood together before the bulk

of the people arrived Land was shared out equally An irrigation system was built to supply the people with fresh water Travellers who crossed the valley were charged taxes Taxes would be paid to the church

Was Brigham Young a good leader?

Yes No Successfully led the

Mormons 2250 km across the Plains to Salt Lake City

Wagons driven in parallel lines and then put into circles at night for safety

Strict discipline meant everybody worked for the benefit of the community

Divided out the land fairly

Arranged building of irrigation channels to bring water to the dry earth

Encouraged the emigration of Mormons with skills to SLC from other parts of America and Europe

Ruled as a dictator Became very rich as the

church got 10% of everyone’s earnings

Sent the Danites to intimidate non-Mormons

Mountain Meadows massacre in 1857

Had 23 wives and 49 children

The problems In 1848 the Salt Lake Valley was handed over to America by Mexico The US government wanted to make the Mormons submit to their laws The Mormons and the government clashed violently in 1857 – fearing a full scale war, the

US government allowed the Mormons to practice their own religion and live their own way but their territory (Utah) was not allowed to become a state whilst they still practiced polygamy

In 1890 the Mormons finally abandoned polygamy. Utah was admitted as a state by 1896

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Cattlemen and Cowboys

The Growth of the Industry The cattle were originally looked after by the Mexican vaqueros During the Civil War the cattle were left unattended, but they managed to survive and

breed greatly – by 1865 it was estimated that there were at least 5 million Texas Longhorns

By 1865 the construction of the railway was under progress – ranchers were promised ten times the local price if they could get their cattle up to the railway to supply the North, where there was an increasing demand for beef

The ranchers began driving their cattle up the Plains along the new trails that were being developed –

o The GOODNIGHT-LOVING Trail (1867)o The Shawnee Trailo The Chisholm Trailo The Western Trail

JOSEPH MCCOY set up “cow towns” along the railroad – towns that were specifically set up to receive the cattle herds from Texas – Abilene was the first of these in 1867

The Cattle Drive The drive could take up to two months Average herds were about 2-3000 head in size It was a great responsibility for the cowboys as the loss of

only a few cattle would cost the rancher a lot of money There were many threats to the safety of the herd:

o Stampedes were the biggest danger – they could stampede several times a night and would often travel miles before they could be stopped

o The weather and the landscape were very harsh – hot winds, torrential rain and hail storms

o The Indians posed a serious threat – in 1870 the Cheyenne Indians stampeded a valuable herd and drove them off

o Rustlers – they stole cattle and branded them with their own markso Settlers – there were constant clashes, especially with the Homesteaders

The changes in Cattle herding The open range – to save time and money, cowboys began herding and breeding the

cattle further North than Texas on the open ranges of the Plains JOHN ILIFF helped produce a more sturdy cattle by cross breeding

the Texas Longhorn with Herefordshire Friesian cows from England Towards the 1880s, there was dramatically less grass on the Plains

than was needed to sustain the number of cattle being reared there After 1885 the demand for beef began to fall and so did the prices In the winter of 1886-87 many cattle died due to the severe

weather conditions In 1874 barbed wire was invented – this would help keep control of

the herds on the Plains Soon after windpumps were invented which provided regular and

easy access to fresh water The role of the cowboys changed dramatically – they were no longer

needed in such great numbers and their jobs became little more than ranch handymen, fixing fences and such. The wild and free life of the cowboy had finally come to an end

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The Rise and Fall of the Cattle IndustryThe cattle trade was at its peak from 1867 until the early 1880s. The following factors contributed to this: Increased number of railway lines – able to transport

cattle to new markets Development of refrigerated rail carriages – cattle

could be slaughtered before transportation Removal of Indians from the Plains to reservations –

more land available for ranching.In the last twenty years of the nineteenth century the beef trade virtually collapsed. The following factors contributed to this: Farmers began to experiment with different breeds of

cattle that could not live on the open range. There was less grass available for grazing. In 1883 there

was a drought that ruined the grass. The demand for beef fell which meant that ranching

was less profitable. The winter of 1886/7 was very severe – cattle and

cowboys died in the freezing temperatures.

A New Approach The days of the open range were over. From the late nineteenth century cattle were kept on

enclosed ranches and farmed in much smaller quantities. Two inventions were particularly important in making this an option: Barbed Wire & the Wind pump

Barbed Wire

Barbed WireBarbed wire was invented by J F GLIDDEN in 1874. This invention meant that large areas could be fenced cheaply. Cattle were now enclosed on ranches and no longer roamed the Plains. As a result fewer cowboys were needed and the long drive was a thing of the past.

Wind PumpThe strong winds that blew across the Plains were an ideal source of energy. Windmills were used to drive pumps that could pump water from underground. This meant that cattle ranches did not need to be sited near a river or stream.

Wind Pump

The age of the wild and free cowboy was gone, they now spent much of their time mending fences and tending the cattle. However, the image of the wild and free cowboy

was dramatised in Wild West shows performed for eastern audiences and it is that image that became, and has remained, a feature of the legend of the wild, wild west.

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The Homesteaders

What was the attraction of the Plains? Some moved to the West to escape from poverty or religious persecution Letters home encouraged more and more people to follow onto the Plains People were attracted by the various articles in newspapers and magazines which

portrayed amazing images of the West The Plains were obviously habitable, this had already been proved by both the Indians and

the early settlers such as the mountain men and trappers The railway companies were anxious to attract settlers – they needed to sell the land to

finance the railroads The Homestead Act 1862 – this gave away land free of charge as long as you built a

house on the land and live there for five years. Each plot was 160 acres in size

Life on the

Plains The problems:

o Lack of water and very hard eartho Shortage of building materialso Extremes of weather – scorching hot summers and freezing winterso Prairie fires and plagues – these could both destroy crops in no time at allo Protecting the crops – especially against the cattle trails

The solutions:o New crops – they grew harder types of wheat such as Turkey Red Wheat which

could survive the harsh conditions bettero Better machinery – stronger ploughs were built that would churn the eartho Fencing the land – this protected it against any wild animalso Wimdpumps – these provided water to the land and homesteaderso Dry farming – this was a method by which they conserved the water in the soil

through ploughing soon after heavy rain

Law and Order

Nine problems of law and order in the West1. Distance (difficult to cover the large areas and isolated communities of the West)2. Poverty and harsh conditions (people were prepared to resort to desperate measures)3. More men than women (no calming influence; prostitution)

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4. Different races (differences of language and culture led to there being little sense of a united community)

5. Culture of violence (everyone carried guns, and sorted out problems by using violence)6. Land claims and gold (arguments over land ownership; greed, gamblers, criminals)7. Cattle barons (fear of reprisal; 'respectable' citizens were scared to speak out; juries

could be bribed and were often biased)8. Poor court system (judges often had poor knowledge of law; courts often gave unfair

verdicts; lack of convictions)9. Vigilantes (often as much a problem as the criminals)

How lawless was the West? Gold Miners – crime was a big problem because there were few police when the West

originally opened up. Gold was very valuable and the miners tended to be young men with no wives or families. Also, there was a lawless element of exploitation of the miners – prostitutes, gamblers, people who sold goods to them and then cheated them, etc.

o Law and Order was maintained by “Miners’ Courts”. These were vigilantes who would hang people suspected of crimes rather than giving them fair trials. This was often linked to racial and national prejudices.

o Claim jumping forced miners to leave productive claims (or murdering them)!

Cowboys and cattle ranchers – crimes included rustling cattle (stealing cattle) and lawlessness, drunkenness and fighting in the cow towns. Crime was common because cowboys were usually young single men. They only got paid when they delivered the head of cattle and so often spent a lot of their earnings in the cow towns getting drunk, gambling and on prostitutes. In 1872, fed up with the lawlessness, drunkenness, brawls and gun fights, the people of Abilene banned cowboys.

Police in the West from 1860s onwards – US Marshalls were in overall control of a state or territory. Judges were appointed by the President to hear cases and pass sentences – 3 per state or territory. Town Marshalls and Deputies were appointed by the people of the town on an annual basis. Sheriffs were elected by the people of a county every two years.

Famous Criminals – BILLY THE KID, Butch Cassidy and the Sun Dance Kid, etc.

The Johnson County War – This was between Cattle Barons (large scale ranchers) on the one hand and homesteaders supported by some small scale ranchers on the other. The Cattle Barons hired some gunfighters called the Regulators to get rid of the homesteaders who they accused of rustling cattle and taking their land. In the long run, the government supported the homesteaders because they wanted the Great Plains to be settled by American families.

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Conflict on the Plains

Why did the Indians and the Americans hate each other? The US government believed in Manifest Destiny, that whites should own all of America Ranchers grazed their cattle on the land where the buffalo used to graze – many buffalo

were wiped out because of the lack of food The US government usually supported the white settlers in any conflict with the Indians Miners were digging for gold in land that was owned by the Indians The homesteaders took a lot of land away from the Indian tribes – the government gave

them this land The Us government tried to destroy the Indian

culture by forcing them onto reservations and making them reliant upon handouts

The US army were often brought in to help the white settlers in conflicts with the Indians

Thousands of buffalo hunters invaded the Plains – by 1885 there were only 200 buffalo left on the Plains. In 1840 there were an estimated 13 million

Indian children were taken from their families and sent to boarding schools where they were taught life in the “white man’s world”. If parents tried to stop their children from going their rations were stopped

The railroads divided up the Plains and invited more settlers onto the Plains. They also helped supply the army and facilitate its fast deployments and movements

The Indian Wars 1842 : Permanent Indian Frontier - all land given to the Indians 1848 : gold rush 1851 : First Fort Laramie treaty 1857 : Gold rush 1861 : Fort Lyon treaty 1862 : Little crow’s war– revolt by Santee Sioux against bad conditions on reservations 1863 : Cheyenne Uprising– revolts against the conditions on the reservations. Wagon trains

attacked for food 1864 : Sand Creek Massacre– at least 163 killed of which at least 110 were women and

children – us army attacked despite white flag being raised 1867 : Red cloud’s war– Sioux attacked travellers on the Bozeman trail and forced the

withdrawal of army 1868 : The Second Fort Laramie treaty - US government abandon the Bozeman trail,

Sioux given permanent reservation in Dakota 1868 : The winter campaign. Sheridan and Custer attack black kettle’s winter camp –

the Battle of Washita this was exactly the same as the events at Sand Creek 1874 : Gold discovered in the Black Hills, Dakota 1876 : The Battle of Little Big Horn - Defeat of Custer and the 7th cavalry 1887 : The Dawes Act - divides land into 160 acre allotments, some of these given to

Indians. Now they were forced to learn to farm - completely destroys way of life 1890 : Wounded Knee - End of the Indians’ wars and they are finally defeated.

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The Battle of the Little Bighorn

The Battle of Little Bighorn--also called Custer's Last Stand--marked the most decisive Native American victory and the worst U.S. Army defeat in the long Plains Indian War. The gruesome fate of GENERAL CUSTER and his men outraged many white Americans and confirmed their image of the Indians as wild and bloodthirsty.

The Plan: In June of 1876, the government sent in troops under the command of General Terry to locate and rout the Indians. Custer and the 7th Cavalry were to travel up the Rosebud River and cross the Little Bighorn River, trapping the Indians between the two groups.

Change of Plan: Some three days into his march, Custer abandoned the plan when he rather suddenly encountered a large group of Sioux and Cheyenne encamped nearby. Envisioning a three-pronged attack, he ordered Captain Benteen and Major Reno to lead troops on either side of the river, while he would advance to the northwest and surprise the encampment from the north.

All going wrong: Reno, who attacked first (and long before Custer reached the northern edge of the camp), was clearly overwhelmed by the Indians, and he retreated across the river, losing his strategic edge. He was joined by Benteen’s fresh troops, and the combined forces dug in and continued to fight. At Reno’s retreat, however, the major force of Indians, by then alerted to Custer’s presence, rode to the attack and completely vanquished Custer and his men within an hour, leaving more than 200 dead.

Custer was widely criticised in the official investigation after for his reckless tactics:

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CAPTAIN BENTEEN: “Custer disobeyed orders because he did not want any other command … or body to have a finger in the pie … and thereby lost his life.”

MAJOR RENO: “I had no confidence in his ability as a soldier.”

US President Ulysses S. Grant: “I regard Custer’s massacre as a sacrifice of troops, brought on by Custer himself.”

After the defeat, the U.S. government increased its efforts to subdue the tribes. Within five years, almost all of the Sioux and Cheyenne tribes would be confined to reservations.

Why did the Indians lose the conflicts overall? The US army were greater in number than the Indians, especially in major battles The Indians did not work together as a collective unit – some tribes actually joined forces with

he US army against their “common enemy” The US army changed and manipulated their

tactics – they fought during the night and the morning and even mounted campaigns in the depths of winter when the Indians were not expecting it

The Indians kept attempting to sort things out peacefully through treaties but were then left open to attack when the treaties were not honoured

The Indians were less well armed than the US army and were unable to replace their losses in the same manner as the army

The Indians were never able to fight long campaigns – they had their families to look after and feed – their whole way of life depended on the males

The buffalo was hunted to near extinction. This meant that the Indians’ way of life had to change as they could no longer base their survival on the Buffalo.

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Medicine Through

Time

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Medicine Through Time TimelineTask – Colour in the various dates and events based upon which area of medicine they are. Remember Some of the dates may be important in more than one category:

Red = Public Health Green = Surgery Blue = Disease

3000 BC Pre-History – understanding is based on spirits and gods. No real medical care. People die very young, normally by the age of 30-35 for men, but only 15-25 for women due to the dangers of childbirth. Most people suffered osteoarthritis (painful swelling of the joints). Trephining is a popular form of surgery – designed to release the evil spirits from the sick person’s body through drilling a hole in their skull.

2000 BC Egyptian Empire – development of papyrus, trade and a greater understanding of the body (based on irrigation channels from the River Nile). They believed the body had 42 blood channels and that illness was caused by undigested food blocking these channels.

1500 – 300 BC

Greek Empire – Medicine still based on religion – Temple of Asclepius. By 200 BC there was a temple in every town. Here, patients would get better, but mainly through the standard of rest, relaxation and exercise (like a Greek health spa)

450 BC Hippocrates – founder of the Four Humours theory. This theory stated that there were four main elements in the body – blood, yellow bile, black bile and phlegm. Illness was caused by having too much of one of these humours inside of you. He also wrote the Hippocratic Collection, more than 60 books detailing symptoms and treatments of many diseases.

384-322 BC

Aristotle used ideas of other Greek philosophers and produced a clear statement and theory about cause and treatment of disease. He suggested that imbalance was cause and not a symptom of illness.

400 BC – 500 AD

Roman Empire – The Romans were renowned for excellent public health facilities. The Romans introduced aqueducts, public baths, sewers and drains, etc. In the citcy of Rome, water commissioners were appointed to ensure good supplies of clean water.

162 AD Galen – continues the four humours theory but extends it to have the humours in opposition to each other. This meant that an illness

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could be treated in one of two ways, either removing the “excess” humour or by adding more to its opposite. Galen also proves the brain is important in the body (operation on the pig). Galen’s books would become the foundation of medical treatment in Europe for the next 1500 years.

Dark Ages

Britain and Europe return almost back to pre-historic times under Saxons & Vikings

860-925 Al-Razi (Rhazes) – wrote over 200 books and was the first to use opium for anesthesia. He also highlighted the effect of psychological factors on a person’s health.

980-1037

Ibn Sina (Avicenna) – wrote “The Canon” – a complete medical encyclopaedia that was used for hundreds of years after to teach European physicians.

1100s – 1200s

When Europeans went on crusades to the Holy Land in the 12th and 13th centuries, their doctors gained first-hand knowledge of Arab medicine, which was advanced by Western standards.

1347-1348

Black Death – across Europe more than 25 million people die. Two main types of plague

1. Bubonic – 50-75% chance of death. Carried by fleas on rats. Death usually within 8 days

2. Pneumonic – airborne disease. 90-95% chance of death within only 2-3 days

People had no idea how to stop the plague. People thought it was caused by various factors, i.e. the Jews, the Planets, the Gods, etc etc etc

1400 By 1400 there were over 500 hospitals in England organised through the Christian Church.

1455 The Printing Press was invented. This allowed for the massive reproduction of books and writings without using the Church as a medium.

1517 Protestantism begins in Europe. This slowly decreases the power of the Catholic church over medicine.

1543 Andreus Vesalius – proved Galen wrong regarding the jawbone and that blood flows through the septum in the heart. He published “The Fabric of the Body” in 1543. His work encouraged other to question Galen’s theories.

1570s Ambroise Paré – developed ligatures to stop bleeding during and after surgery. This reduced the risk of infection. He also

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developed an ointment to use instead of cauterising wounds.

1628 William Harvey – Published his famous book “An Anatomical Accout of the Motion of the Heart and Blood”. This proved that blood flows around the body, is carried away from the heart by the arteries and is returned through the veins. He proved that the heart acts as a pump re-circulating the blood and that blood does not “burn up”.

1665 The Great Plague – little improvement since 1348 – still have no idea what is causing it and still no understanding of how to control or prevent it. In London, almost 69,000 people died that year.

1668 Antony van Leeuwenhoek creates a superior microscope that magnifies up to 200 times. This is a huge improvement on Robert Hooke’s original microscope.

1721 Inoculation first used in Europe, brought over from Turkey by Lady Montague.

1796 Edward Jenner – discovered vaccinations using cowpox to treat smallpox. Jenner published his findings in 1798. The impact was slow and sporadic. In 1805 Napoleon had all his soldiers vaccinated. However, vaccination was not made compulsory in Britain until 1852.

1799 Humphrey Davy discovers the pain-killing attributes of Nitrous Oxide (Laughing Gas). It would become the main anaesthetic used in Dentistry. Horace Wells would try and get the gas international recognition. He committed suicide the day before it got the recognition it deserved.

1830s Industrial Revolution. This had a dramatic effect on public health. As more and more families moved into town and cities, the standards of public health declined. Families often shared housing, and living and working conditions were poor. People worked 15 hour days and had very little money.

1831 Cholera Epidemic. People infected with cholera suffered muscle cramps, diarrhoea , dehydration and a fever. The patient would most likely be killed by dehydration. Cholera returned regularly throughout the century, with major outbreaks in 1848 and 1854.

1842 Edwin Chadwick reports on the state of health of the people in cities, towns and villages to the Poor Law Commission (fore-runner to the Public Health Reforms). He highlights the differences in life-expectancy caused by living and working conditions. He proposes that simple changes could extend the lives of the working class by an average of 13 years.

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1845 Horace Wells uses nitrous oxide as an anaesthetic for the first time.

1846 First successful use of Ether as an anaesthetic in surgery by William Morton. The anaesthetic had some very severe drawbacks. In particular, it irritated the lungs and was highly inflammable.

1847 James Simpson discovers Chloroform during an after dinner sampling session with friends. He struggles to get the medical world to accept the drug above Ether. Doctors were wary of how much to give patients. Only 11 weeks after its first use by Simpson, a patient died under chloroform in Newcastle. The patient was only having an in-growing toenail removed (non-life threatening). It took the backing of Queen Victoria when she was given chloroform during childbirth in 1853 for chloroform and Simpson to gain worldwide publicity.

1847 Ignaz Semmelweiss orders his students to wash their hands before surgery (but only after they had been in the morgue).

1847 Elizabeth Blackwell becomes the first woman doctor in USA

1848 First Public Health Act in Britain – It allowed local authorities to make improvements if they wanted to & if ratepayers gave them their support. It enabled local authorities to borrow money to pay for the improvements. It was largely ineffective as it was not made compulsory for Councils to enforce it. This was an element of the “Laissez-Faire” style of government.

1854 Crimean War – Florence Nightingale and Mary Seacole contribute majorly to the improvements in Hospitals. Florence Nightingale wrote two books that would have a worldwide influence, Notes on Nursing and Notes on Hospitals. She also set up nursing schools.

1854 John Snow proves the link between the cholera epidemic and the water pump in Broad Street, London. Unfortunately, he was unable to convince the government to make any substantial reforms.

1857 Queen Victoria publicly advocates use of Chloroform after birth of her eighth child.

1858 The Great Stink – the summer of 1858 was very hot and as river levels fell, the horrid smells spread across London and into the Houses of Parliament. This led to Joseph Bazalgette designing and building London’s sewer system.

1858 Doctors’ Qualifications had to be regulated through the General Medical Council.

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1861 Germ Theory developed by Louis Pasteur whilst he was working on a method to keep beer and wine fresh – changed the whole understanding of how illnesses are caused.

1865 Elizabeth Garrett-Anderson – first female doctor in the UK

1865 Octavia Hill begins buying slum houses and cleaning them up to provide better housing for workers. Her influence helped to persuade the government to pas the 1875 Artisans’ Dwelling Act, giving councils the power to knock down slums on health grounds.

1867 Joseph Lister begins using Carbolic Spray during surgery to fight infection. It reduces the casualty rate of his operations from 45.7% of deaths to just 15.0 % dying. Initially he received a lot of opposition as the spray was an irritant to the surgeons’ skin. Based on Lister’s work, surgery progressed towards Aseptic surgery (where there are no germs present during surgery). From 1887, all instrument were steam-sterilised.

1875 Second Public Health Act – now made compulsory. Major requirement is that sewers must be moved away from housing and that houses must be a certain distance apart.

1876 Public Health improvements – in the UK, the government introduced new laws against the pollution of rivers, the sale of poor quality food and new building regulations were enforced.

1880 Joseph Lister uses sterilised catgut for internal stitches.

1881 Robert Koch discovers the bacteria that causes anthrax. He establishes a new method of staining bacteria. Using Koch’s methods, the causes of many diseases were identified quickly:1880 – Typhus 1882 – Tuberculosis 1883 – Cholera1884 – Tetanus 1886 – Pneumonia 1887 – Meningitis1894 – Plague 1898 – Dysentery

1889 William Halstead introduced the wearing of sterilised rubber gloves and surgical masks to prevent further infection in surgery.

1895 X-Rays discovered by Wilhelm Röntgen. Though it is an important discovery, it is only WW1 and the treatment of soldiers that propels it into the medical spotlight.

1895 Marie Curie discovers radioactive elements radium and polonium. She will eventually win two nobel prizes for her work on X-Rays and on Radium.

1901 Karl Landsteiner discovers that there are different blood groups- 27

this leads to the first 100% successful blood transfusions.

1905 Paul Ehrlich discovers first “magic bullet” – Salvarsan 606 to treat Syphilis. The problem was it was based on arsenic and so could kill the patient too easily.

1906-1914

David Lloyd-George puts his Liberal Reforms into action. These were based on investigations by Seebohm Rowntree and Charles Booth that highlighted the state of poverty and its impact upon people’s health.

1911 National Health Insurance introduced in Britain – this entitled to medical treatment and sick pay. It worked by regular payments from:Government – 2d per weekEmployers – 3d per weekWorkers – 4d per week

1914-1918

World War One – This was a huge turning point in medicine as it created many patients requiring skin grafts, treatment for burns, gas inhalation, etc.

1916 Sodium citrate was added to blood to prevent it clotting. This meant that blood could now be stored for several weeks before being used.

1928 Alexander Fleming – discovers Penicillin. The mould had grown on a petri dish that was accidentally left out. Fleming writes articles about the properties of Penicillin, but was unable to properly develop the mould into a drug.

1930s Archie McIndoe begins using skin grafts to reconstruct faces and hands in WW2. He carried out more than 4000 operations on burns cases. This results in the Guinea Pig Club being set up to help all those who he had treated.

1932 Gerhardt Domagk discovers Prontosil (the second magic bullet). Slight problem is that it turns the patient red.

1937-45 Florey & Chain work on producing penicillin as a drug. Their success will make the drug the second most funded project by the USA in WW2. They fund it to the tune of $80 million and every soldier landing on D-Day in 1944 has Penicillin as part of his medical kit. (Over 2.3 million doses)

1942 William Beveridge publishes the Beveridge Report. The report was the blueprint for the NHS and brought in the process of everyone working paying National Insurance.

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1946 National Health Service Act – provides for a free and comprehensive health service. Aneurin Bevan convinces 90% of the private doctors to enrol.

1948 World Health Organisation set up by the United Nations. Its greatest success has been the wiping out in Europe of Smallpox. By 1980, this had been wiped out across the world.

1948 First day of the NHS. Hospitals were nationalised, health centres were set up and doctors were more evenly distributed around the country. This was mostly due to the work of Aneurin Bevan whose speeches in favour of the NHS won support. He compromised with private doctors and managed to persuade them to work in the NHS.However, the popularity and costs of the NHS would rapidly spiral out of control. The £2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks. The government had estimated that the NHS would cost £140 million a year by 1950. In fact, by 1950 the NHS was costing £358 million.

1950 The first open-heart surgery is performed to repair a 'hole' in a baby's heart, using hypothermia.  

1952 First kidney transplant (America)

1952 Charges introduced in NHS – 1 shilling for a prescription.

1953 Francis Crick and James Watson discover the structure of DNA. They proved that it was present in every human cell and showed how it passed on information from parents to children.

1961 Contraceptive pill introduced

1967 Christian Barnard (South African) performed the first heart transplant - the patient lived for 18 days

1978 First test tube baby

1986 The Human Genome Project began to identify the exact purpose of each of the genes in the human body, compiling a complete map of human DNA.

1990s Increasing use of keyhole surgery, using endoscopes and ultrasound scanning, allowed minimally invasive surgery.

1994 National Organ Donor register created

1998 NHS Direct begins – this is a 24 hour telephone advice service

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staffed by nurses.

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Medicine Through Time Revision NotesTo answer questions on medicine through time you need to know the dates of the different time periods and some details about their way of life. Remember, the history of medicine is divided into three themes – Disease, Surgery and Public Health:

Prehistoric Times: Before 3000BC:

They did not write, so much of our knowledge about their way of life comes from cave paintings and archaeology. We also study similar modern day tribes, such as the Aborigines to see how they lived.

Prehistoric people were nomads – they had temporary shelters and travelled in search of food and followed animals to survive.

The tools they used were simple and made from bone or flint. Trephining was commonly used by the medicine man to treat people.

The belief was that it allowed the evil spirits to be released. Some skulls have been found with the holes rounded – this shows that they must have survived as the bone was growing back. There are pictures of hands with only three fingers painted on cave walls. They must have been able to do simple amputations.

Ideas about the causes of disease were based on superstition and the supernatural, but they used some practical treatments. E.g. putting a broken arm in a clay cast to set the bone and burns were treated with sap from a tree.

Ancient Egypt: 3000BC - 400BC:

They were NOT nomadic, but had settled into civilised societies and farmed on the edges of the River Nile. This gave them time to develop their knowledge of medicine and they learnt how to make bronze tools, which helped surgery.

They thought the cause of illness was like the Nile flooding because its became blocked. The body became ill if undigested food blocked the channels. To treat it you had to unblock the channels by taking laxatives, vomiting or having blood sucked out by leeches. They believed that illness was caused by blocking the blood channels in your body.

They also They were the first people to write, so their knowledge could be past on to future generations.

Most of their life was based on religion so most of their medical beliefs were too. With many people to organise and a large empire to control, a powerful government was needed. The pharaoh had absolute control and

was worshipped as a God. Evil spirits entering the body caused illness. To cure this, the evil spirit had to be driven away. Evil spirits could be kept away by worshipping animals or wearing charms e.g.

They were very religious and believed in many gods and the afterlife, almost everything in the Egyptian’s world had something to do with religion.

Some doctors used herbal cures or drugs, but they didn’t think the drugs brought about a natural cure, they thought they drove out evil spirits. Egyptian surgery was mainly based upon simple procedures such as repairing a broken nose. However, due to some of the ingredients they used, some procedures were successful. They commonly used honey which has natural anti-bacterial properties.

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The Egyptians could carry out simple operations such as about this knowledge on papyrus. The most famous book is the Papyrus Ebers. They also learned a lot from Mummification, such as the location and function of organs in the body. However, the brain was discarded and the heart was not allowed to be touched.

Ancient Egypt: 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.

Did Mummification help or hinder medical progress? In many ways, Mummification was excellent as it allowed

them to discover things about the body such as the location of organs. Over time, they could also start to recognize how a person’s lifestyle may have affected their health (organs would look different depending on cause of death).

We have learned a lot about Egyptians through the Canopic Jars. These were 4 jars that were buried with the person, each containing a vital organ - The liver, intestines (guts), lungs and stomach were each preserved so well that we have been able to analyse their lifestyles.

Because the heart was needed in the afterlife, it was not allowed to be touched at all. Similarly, the brain was considered to be worthless, so was mashed up and either discarded or fed to cats!

Because Mummification was a religious ceremony, it was vital that it was completed quickly. Many doctors would have had no time to study the body.

Ancient Greece: 800BC - 400BC

This was the first time that science began to get a stronghold. Some believed in supernatural causes and cures so they built healing temples called Asclepions. Asclepius was the Greek God of healing. At Asclepions the sick would bathe, make a gift to the gods, and rest. They would sleep in a dormitory and be cured by Asclepius’ daughters and a snake

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The Temples of Asclepius were often very simple, but could be huge venues. The Asclepion at Epidaurus contained baths, a gymnasium, an athletics stadium and a theatre seating 14,000 people. Patients built up their strength by having regular meals and plenty of rest.

They could carry out simple operations and surgical tools have been found. The Greek city-states were frequently at war, and Greek doctors became experts at practical first aid. They also learned about setting broken and dislocated bones (they could cure a slipped disc by standing on the patient's back). Overall though, very little surgical progress compared to the Egyptians.

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.

HIPPOCRATES put forward a natural theory based on the four humours. The body had to be in balance. The Humours were connected to the seasons. It was wrong, but set medical development in the right direction.

Hippocrates also believed in clinical observation. Doctors had to observe their patients, recognise the illness and suggest a cure. He also stated that personal hygiene and exercise could prevent disease.

Diagnosis – Prognosis – Observation – Treatment ARISTOTLE’S studies led him to suggest that the heart

provides the body’s heat and the brain cools it down. Though this was incorrect, it would provide a better understanding of the function of the heart in the body.

A Medical library was built at Alexandria. This would be the centre of all medical knowledge throughout the Ancient World. It housed medical books collected from India, China and Mesopotamia as well as those by Greek doctors and writers. Human dissection was allowed for a time at Alexandria.

The Romans: 500BC - 500AD

An Asclepion

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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.

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 provide public fountains for people to use. When the water had to go over hills and valleys the Romans built aqueducts. They were so well built that a number are still standing today.

Besides clean drinking water, the Romans the

Romans also believed in the importance of personal cleanliness. 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.

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.

They built a huge empire in Europe. The empire included a wide range of different tribes and races, which usually co-operated with the Romans. This greatly increased trade and therefore the Empire benefitted from a much more varied diet and better exchange of medicines.

GALEN developed the theory of the Four Humours to now include the use of opposites. Any imbalance in the body caused by a humour expanding and causing illness could be treated with the opposite of the illness to put the humours back in balance. E.g. for a cold you took a hot bath.

Galen also wrote over 350 medical books. His books would still be the foundation of medical knowledge 1400 years later. His books remained influential because his ideas fitted in with the ideas of the Christian Chrurch, which would control education in the Middle Ages. He believed that the body had been created by one god, who had made the body fit perfectly together.

Galen worked with gladiators in Pergamum so gained a good knowledge of our anatomy. His most famous experiment showed the impact of the brain. He cut the vocal chords of a pig that was undergoing surgery. This clearly demonstrated how the nervous system takes messages from the brain to the muscles.

Medieval Western Europe: 500 – 1500 AD

After the collapse of the Roman Empire much of Western Europe no longer had strong government. They were not organised and didn’t see the importance of hygiene. There were many wars and a break down in communication between countries.

The Catholic Church was very powerful and there was return to the belief that God caused and cured disease. Education was often restricted to Monks and natural ideas were not

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encouraged as they went against God and the Church. Most knowledge from the Greeks and Romans was lost. Some churches and monasteries collected, copied and wrote books about religion, but also about herbs and medicine. They were handwritten, rather than printed, so it was not easy to spread knowledge quickly.

The Black Death in 1347-1350 killed more than 25 million people across Europe. There were three types of Plague:

1. Bubonic Plague – this was the most common type of plague. Approximately 90% of plague victims suffered from this type. It was carried on the fleas on rats. About half of all victims died within 7 days of contracting the disease.

2. Pneumonic Plague – this was the most deadly type of plague. It only affected about 5% of the population but nearly 98% of victims died. It was an airborne disease and people died from drowning in their own blood.

3. Septicemic Plague – this was the most rare type of plague. 100% of cases died within 24 hours, and so it was not easily transmitted from one person to another.

Cures for disease were based around the supernatural. E.g. pray, take a blessed potion,

go on a pilgrimage, and flagellate ( whip ) yourself as a punishment from God. People would pay small fortunes for things like an abracadabra pendant that was supposed to prevent you getting the Plague.

There were some natural cures, e.g. blood letting, testing urine and the use of leeches. Some doctors also used astronomy and astrology.

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.

Military surgeons carried out simple operations on wounded soldiers. Wine and hot cauterising irons were used (these ideas were taken from the Arabs). Wine was used as a cleaning agent (antiseptic). Most surgery was simple and external, such as removing cataracts. Most surgery was carried out by barber-surgeons rather than trained doctors. There was also opposition to surgery, surgeons were called thieves, man killers and cheats. Most surgery was either controlled or limited by the Christian Church. It was considered to be a religious crime (heresy) to question the work of Galen. You could be killed for it!

Medieval Islamic World: 500 – 1500 AD

The Prophet Muhammad said: "Make use of medical treatment, for Allah has not made a disease without appointing a remedy for it, with the exception of one disease, namely old age." Medicine was readily accepted in Islam, in direct comparison to Christianity where new ideas were often forbidden.

It was healthier to live in Arab-occupied Europe than in the Christian-ruled areas because the Arabs believed in cleanliness.

AVICENNA (Ibn Sina) wrote the Canon of Medicine, which contained all known treatments of disease. This encyclopedia was translated into Latin. It became the textbook for medical education in the schools of Europe from the 12th-17th century.

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RHAZES (Al –Razi) noticed the difference between measles and smallpox. He was also an expert surgeon and was the first to use opium for anesthesia. He also emphasized the importance of psychological factors on health (such as having a positive attitude, avoiding stress, etc.).

They were very religious and followed the teachings of Islam. This told them to care for the sick and as a result they built many hospitals. Knowledge from the Romans and Greeks was not lost, doctors studied their books and kept medicine alive. The Crusades (religious wars with the west) meant that many Ancient ideas and new developments were kept mainly within the Islamic world.

Greek books were translated into Arabic, some Islamic doctors wrote their own books on surgery. Operations were carried out; even the removal of bladder stones, they stopped the flow of blood by using a cauterising iron. Improvement in surgery was limited due to dissection being forbidden due to religious reasons.

The Renaissance: 1500 – 1750

The word Renaissance means rebirth. Roman and Greek ideas were studied again and improvements were made. The Reformation also occurred, this is when England became Protestant. As a result the Catholic Church had less control over people’s lives and dissection was allowed. It also led to people challenging old ideas and asking questions to find out more.

The 1665 Plague epidemic was the last major one in Britain. During the Great Plague, 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. Almost 70,000 people died from Plague in London alone in 1665.

Inventions such as the printing press helped to spread new ideas across Europe. There was also an improvement in art due to careful observation – artists such as LEORNARDO DA VINCI made detailed anatomical drawings. These helped to improve knowledge about the body as they were printed in books. The microscope and telescope were invented and technology inspired men to understand the human body more. King Charles II was very interested in science and set up the Royal Society in 1661, experimentation and new approaches were encouraged.

However, there was hardly any change; treatments were still based on a mixture of supernatural and the four humours. It was a rebirth of old ideas – ideas from the Greeks and Romans were studied again and some improvements were made, but much of these ideas were wrong in essence. A good example to show that treatments had not progressed is to look at the treatment and subsequent death of King Charles II in 1685. He was treated with laxatives, bloodletting and vomiting.

Most progress was made in other areas of medicine, especially anatomy: ANDREAS VESALIUS dissected human bodies to help him understand how they worked and commissioned life-like drawings. Galen had dissected animals, but this had led to mistakes.

Vesalius found that Galen had been wrong about the human jaw. Galen wrote that it was made of two bones, whereas Vesalius found only one. He also found that the septum in the heart was too thick and had no holes for the blood to flow through, as Galen had said.

Vesalius published his book “The Fabric of the Human Body”. This completely mapped the bones, organs, muscles, etc of the human body.

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AMBROISE PARE developed surgery by challenging old ideas and methods. Pare was forced to use a lotion of oil of roses, egg yolks and turpentine when he ran out of oil to treat gunshot wounds on the battlefield. This chance event worked, it caused less pain and healed wounds more quickly. Silk threads (ligatures) were used by Pare to tie up arteries rather than stop bleeding by using a cauterising iron. However, ligatures for amputations were not really practical until the invention of the tourniquet two centuries later. Also, without antiseptics or knowledge of germs, the silk thread used as ligatures easily carried bacteria into the body and caused infection.

WILLIAM HARVEY demonstrated the function of the heart and how blood

flows around the body through veins and arteries. Harvey’s discoveries concluded that:

o the heart works like a pumpo blood flows in one direction only around the bodyo one-way valves stop the blood going the wrong wayo blood is re-circulated and not replaced

Disease 1750 - modern day

The 18th Century: EDWARD JENNER discovered the cure for Small Pox by chance and the first real vaccination against disease was introduced. In 1796, he carried out his now famous experiment on eight-year-old James Phipps. Jenner inserted pus taken from a cowpox pustule and inserted it into an incision on the boy's arm. He noticed that milkmaids who suffered the mild disease of cowpox never contracted smallpox, one of the greatest killers of the period, particularly among children. Jenner subsequently proved that having been inoculated with cowpox Phipps was immune to smallpox. Jenner was widely ridiculed. Critics, especially the clergy, claimed it was repulsive and ungodly to inoculate someone with material from a diseased animal. A satirical cartoon of 1802 showed people who had been vaccinated sprouting cow's heads. Vaccination saved lives and the idea of injecting people with a disease to prevent them catching the full disease is the foundation of modern vaccinations.

The 19th Century: During this period scientists worked hard to find out more about what caused disease. This was due to the growing rise in epidemics, e.g. cholera. The turning point was in 1861 when LOUIS PASTEUR proved his germ theory of disease - germs in the air caused decay, (It was found by chance whilst he was working on why some wine went bad during production). Before Pasteur, the accepted theory of the cause of disease was called Spontaneous Generation – Germs caused disease and came from anything decaying. Pasteur proved that bacteria could be removed by boiling and then cooling the liquid. This process is now called pasteurisation. Pasteur extended this theory to explain the causes of many diseases - including anthrax, cholera, TB and smallpox. He also found vaccinations for these. He is best known for his work on the development of vaccines for chicken cholera in 1881 and rabies in 1885.

ROBERT KOCH took Pasteur’s work and developed it to identify specific germs that caused disease in humans. Koch and Pasteur were from different countries and were rivals; this spurred them on to further discoveries and encouraged governments to fund their research. Koch and his team developed ways of staining bacteria to improve the bacteria’s visibility under the microscope. From this, he found the germs of two feared diseases – anthrax and Tuberculosis in 1882. He had developed research techniques that others could use throughout the world.

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The 20th Century: After 1900, chemical drugs that cured disease were discovered. In 1909 PAUL EHRLICH discovered the first magic bullet – a compound of arsenic, which killed the syphilis germ, called Salvarsan 606. This, however, was also very dangerous and unstable. In 1932 the second magic bullet was developed by GERHARDT DOMAGK. He used a red dye called Prontosil in a last-ditch effort to cure his daughter who was suffering from blood poisoning. Although Prontosil was successful, it did have a rather odd side effect – it turned his daughter red!

Penicillin was discovered by accident by ALEXANDER FLEMING in 1928. He had left his Petri dishes unwashed over a two-week holiday and then noticed that a mould growing on the Petri dish was killing the streptococci bacteria on the petri dish. However, he was unable to convert this into a format that could be used in animal trials.

HOWARD FLOREY & ERNST CHAIN found Fleming’s paper on Penicillin in an old journal and sought to take his work further between 1939 and 1945. During the Second World War, Florey and Chain turned their department at Oxford into a penicillin factory. Trials of penicillin were held at the Radcliffe Infirmary in Oxford from

1941 and were successful. However, the British scientists struggled to produce the quantities of penicillin needed to sustain their clinical trials on humans and turned to the United States for help. The US government funded Penicillin to the tune of $80 million and it became the second most funded project in WW2. By 1944, mass production would enable 2.3 million units of Penicillin to be available to the soldiers that landed on D-Day. In 1945, Fleming, Florey and Chain were awarded the Nobel Prize for Physiology or Medicine.

In 1953 FRANCIS CRICK and JAMES WATSON discovered the structure of human DNA and how it is passed on from parents to children. In the 1990s the Human Genome Project, a worldwide project, began working out exactly how each part of human DNA affects the human body. Understanding DNA opens up many possibilities, such as…

Gene therapy – using genes from healthy people to cure the sick

Customised drugs – creating drugs to cure one person’s particular health problem

Genetic engineering – allowing parents to ‘design’ their children, including gender and even hair colour

Genetic screening – identifying the illnesses people could suffer from and being able to prevent them

The WORLD HEALTH ORGANISATION (WHO) was set up in 1948 by the United Nations. The WHO’s greatest success has been the wiping out of smallpox. They began their campaign in 1967 and by 1980 was able to declare that smallpox had been wiped out across the globe. In 1987, the WHO launched a campaign to fight HIV/AIDS, which destroys the body’s immune system. Two-thirds of HIV infections are in sub-Saharan Africa. In Zimbabwe, the adult rate of HIV infection is almost 25% (compared to 0.2% in the United Kingdom)

However, there have also been problems with some drugs: Between 1959 and 1962 a new drug called Thalidomide was given to women to

reduce morning sickness. It had not been properly tested and this led to children being born with deformed limbs.

‘Superbugs’ such as MRSA have developed an ability to resist science’s efforts to kill them, either with antiseptics or antibiotics. These have particularly been a problem in NHS hospitals.

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CJD is a rare and fatal brain disease that appeared in 1996. The most likely explanation for its occurrence was from people eating beef from cattle that had been infected with a disease known as BSE.

Surgery 1750 – modern day.

19th Century: Much surgery was carried out but there were three main problems – patients died because of pain, infection and bleeding.

Pain was overcome by the discovery of anaesthetics. Nitrous Oxide (Laughing gas) was discovered in 1799 by HUMPHREY DAVY. Although he published a paper on its properties, he failed to notice its medical benefits as an anaesthetic. HORACE WELLS first used laughing gas during and operation in 1844 but failed to get it recognised. His former colleague WILLIAM MORTON took his idea further with the development of Ether as a useable anaesthetic. Many surgeons at that time used Ether, despite it being very dangerous and the fact that it caused many respiratory problems. In 1847 JAMES SIMPSON discovered the use of Chloroform. Surgeons then became more confident and performed more complex operations, but patients still died of infection. Many people also opposed anaesthetics, they were scared as some patients were allergic and died, also it was against their religious beliefs, especially during child birth.

In 1847, IGNAZ SEMMELWEIS noticed that the death rate of mothers was higher in the wards where they were treated by medical students who had come straight from the dissecting room. He decided that students who had just been dissecting mothers who had died from the disease transferred the disease to healthy mothers. Semmelweis made all the medical students wash their hands between patients, despite the disagreement of his superior, who did not believe hand-washing had any effect. The mortality rate of mothers dropped from about 18% to 1%. JOSEPH LISTER overcame the problem of infection in 1867 by using carbolic acid in a spray to kill infection in wounds. Originally this was unpopular due to the mess that carbolic spray created and the time that it took, however once the death rate decreased and Pasteur’s germ theory was accepted it became widely used.

During the Crimean War in 1854, two key individuals also helped progress in surgery. FLORENCE NIGHTINGALE concentrated her efforts on cleaning the army hospital at Scutari. She reduced the death rate of wounded soldiers from 40 per cent to only 2 per cent. She became a national heroine and on returning home, she set up her first nursing school. In 1859, she wrote her book ‘Notes on Nursing’, and in 1863 ‘Notes on Hospitals’. Both books were very influential all over the world, providing the basis for training nurses and hospital design. MARY SEACOLE paid her own way so that she could help out in the Crimean War. She set up her ‘British Hotel’ providing food and drinks to the soldiers. She also treated soldiers on the battlefield. After the war, as she returned to Britain, her skills and experience was largely ignored. It is only recently that her work has received the acclaim it deserved.

The end of the 19th century saw the start of the development of aseptic surgery. Koch’s discoveries led to surgical utensils being steam-

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sterilised and in 1889 WILLIAM HALSTEAD introduced the wearing of sterilised rubber gloves and surgical masks to prevent further infection in surgery. The problem of bloodloss, however, would not be solved until the 20th century.

20th Century: The discovery of blood groups by KARL LANDSTEINER in 1901 meant that transfusions were now possible. Previously, patients that had used transfusions would randomly die on the operating table. This was especially important during the World Wars. In the 1910s it was discovered that by adding anticoagulant and refrigerating the blood it was possible to store it for some days, thus opening the way for blood banks. During WW2 blood banks were set up and these have continued ever since.

WILHELM RÖNTGEN discovered X-rays in 1895 and these became very important in WW1. Surgeons needed to locate bullets and shrapnel lodged

deep within wounded men and x-rays were the answer. Radiation therapy followed on from Röntgen’s discovery of x-rays through the work of MARIE CURIE. She and her husband discovered radium, which has been used ever since to diagnose and treat cancers.

In the 1940s, ARCHIE MCINDOE learned how to rebuild surgically the faces of airmen (the 'Guinea Pig Club') who had suffered burns in the war. He carried out over 4000 operations on burns cases and pioneered the first plastic surgery. In 2002, nearly 7 million cosmetic surgical procedures were performed in the US alone. In 1950 WILLIAM BIGELOW performed the first open-heart surgery to repair a 'hole' in a baby's heart, using hypothermia. The first organ transplant surgery was done in 1967 by CHRISTIAN BARNARD who transplanted a heart. The patient died after 18 days, but much had been learned and it was still considered to be a resounding success.

The later 20th century saw the increasing use of keyhole surgery, endoscopes, micro-surgery and ultrasound scanning to minimise invasive surgery. It is now possible to make plastic hearts and pace makers.

Public Health 1750 – modern day

Industrial Revolution: 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. There were no planning and building regulations as the government believed in laissez-faire. There was little understanding of the true causes of disease. 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. On top of this, working conditions in the factories were appalling. Workers had long hours, short breaks and could easily fall ill through the work itself, such as swallowing cotton fibres or textile dust.

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. In 1831 a new disease hit Britain and forced the government to take action - Cholera. It terrified people because it could kill them in a matter of hours. It struck people suddenly and at random, with victims losing 1/2 litre of fluid an hour through diarrhoea and vomiting.

In the 1830s 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.

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Average age of death in 1842:

. Manchester Leeds Liverpool RutlandGentlemen and professional people 38 44 35 52 Tradesmen 20 27 26 41 Labourers 17 19 15 39

Chadwick’s report contained many shocking details of what many people had to face every day. He recommended better quality housing, good sewage systems and fresh water. The cost of this, however, would have to be met by the ratepayers, who could afford to live in much better conditions, and so was fiercely opposed by many of them. From 1837 all births, deaths and marriages had to be registered. WILLIAM FARR used this information to build an accurate picture of where death rates were highest and what people died of. His work, coupled with Chadwick’s report put more pressure on towns and the government to do something about public health.

The result was 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. The Act was not compulsory and only a few local authorities took action. By 1872 only 50 councils in Britain had appointed Medical Officers of Health. The taxpayers in particular did not support this Act:

“The Board of Health has fallen. We prefer to take our chance with cholera than be bullied into health” – The Times, August 1854

In 1854, there was a major cholera outbreak in London. It had devastating outcomes with over 500 fatalities. Nearly all families lost at least one member (regardless of socioeconomic class). By talking to local residents, JOHN SNOW identified the source of the outbreak as the public water pump on Broad Street. John Snow had now proved the link between cholera and poor water supply. However, until Pasteur’s Germ Theory will be published, many scientists still clung to the ‘bad air’ theory.

How John Snow proved that the Broad Street Pump was causing the deaths from Cholera.

After Snow had collected his evidence he was allowed to remove the handle of the water pump in Broad Street. It was later discovered that a leaking cess pit containing sewage was only 3ft away from the well and was contaminating the water.

Public Health conditions worsened despite Snow’s work. The summer of 1858 was very hot and as river levels fell, and horrid smells spread across London and into the Houses of Parliament. This was referred to as ‘The Great Stink’. This led to JOSEPH BAZALGETTE designing and building London’s sewer system.

In 1867 working men finally got the right to vote. This now put pressure on the government to do something about public health as it could now affect their popularity and votes. The result was the 1875 Public Health Act. This Act was compulsory rather than optional and so had a much greater impact. All towns were now forced to provide clean water, proper drainage and sewage, and the

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appointment of a Medical Officer of Health. However, even by the end of the 19 th century, public health had not been revolutionised. Infant mortality was actually higher than it was at the end of the 18th century.

In 1889, 46 years after Chadwick’s report, a wealthy businessman called CHARLES BOOTH published his findings of living conditions in the East End of London which still highlighted poor living conditions and ill health. He discovered that 35% of people in the East End were living in poverty – far more than had been claimed. His work was then couple with the work of SEEBOHM ROWNTREE who also investigated living conditions and poverty in York and published his report in 1901. Rowntree had proven that more than a quarter of people in York lived in poverty. Together, their work put huge pressure on the governments to do something about public health once and for all.

The 20th Century: Once the link between conditions and disease had been proven by Pasteur’s germ theory, governments began to take responsibility for housing, hospitals, food quality, pollution, child care etc. It was the beginning of the welfare state. The Liberal Government under

the direction of DAVID LLOYD GEORGE that took office in 1906 was determined to improve public health conditions. They introduced a number of important reforms:

The Liberal Reforms: 1902 - Midwives had to be properly trained and registered.1906 - Free school meals for poor school children.1907 – All births had to be registered and a health visitor visited each mother to make sure she knew how to protect her baby’s health.1908 - Government paid Old Age Pensions.1909 - Back to back houses banned.1911 - National Health Insurance Act—working men received sickness pay and could see a doctor.1912 – Clinics held in schools to give children free medical treatment.

After promising ‘Homes fit for Heroes’ for returning soldiers from WW1, Lloyd George created a new Housing Act in 1919 that ensured that councils provided good home for working people to rent. A quarter of a million new homes were built. In the 1930s, many old, unhealthy slum houses were cleared and another 700,000 new houses were built. However, the economic depression of the 1930s meant unemployment rose to over 3 million. This meant that the National Health Insurance Act was failing.

Why was 1900—1939 a time of progress in public health? Liberal Government (1906—1914) decided it was time for

the government to tackle social evils present in society. The laissez-faire attitude of the 19th century became less

fashionable as attitudes towards causes of poverty changed.

New research by Booth & Rowntree highlighted real causes of poverty. (Sickness, low wages, old age & unemployment.)

War – The nation was shocked to discover 40% of the soldiers fighting in the Boer war suffered from malnutrition.

World War Two had a big impact on people’s attitudes to public health. It was a ‘Total War’, meaning that all parts of society were vital. People were fighting on the home front as well as on the front line, and so the feeling grew that everyone should have access to good health care, not just the wealthy. This led the government to commission up the Beveridge Report in 1942. SIR WILLIAM BEVERIDGE recommended a free national health service that would be paid for from taxes. Doctors, nurses and other medical workers would become government employees instead of charging the sick privately for treatment. The Beveridge Report was greeted with enthusiasm by many people and over 600,000 copied were sold. However, despite the general enthusiasm, there was powerful opposition, mainly from the doctors themselves.

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Why was the NHS introduced in 1948? Impact of WW2. The government was aware that medical services

had to be adequate to cope with casualties and so increased its involvement.

The Beveridge Report, 1942 was a best seller, indicating that the public supported the idea that the state had a responsibility to care for its people.

The election of the Labour Party in 1945. The Conservatives felt that a ‘Welfare State’ would be too costly whereas the Labour Party were prepared to push ahead with social reform.

The work of ANEURIN BEVAN – his speeches in parliament won huge support and he also persuaded the doctors to work for the NHS.

1948 – The start of the National Health Service. Treatment is based on the need and not the ability to pay. All people in Britain were provided with medical treatment completely free of charge. Since then however more and more charges have been introduced, this is because new drugs are expensive, average life expectancy has increased and an increased burden is being placed on the service.

The Key Service of the NHS:

The effect of the National Health Service on people’s health was dramatic. For the first time ever, everyone had the right to free health care. Before the NHS many could not afford to visit the doctor, let alone buy medicines or have regular treatment. By the end of the 20th century, however, the NHS was facing one financial crisis after another. Prescription charges, introduced in the 1950s, rose steeply. Charges were introduced for dental treatment and eye tests. Unable to pay for the necessary staff, many beds remained empty while the waiting lists grew longer.

Why has the NHS ended up costing so much?The provision of free health care for all resulted in people being healthier and living much longer. The NHS had many more people to look after, many of them at an age where they needed increasing amounts of treatment, such as cataract operations or hip replacements. Developments in science and technology resulted in a far greater range of treatments being offered, many of which were extremely complex and expensive. Organ transplants, ultrasound scans, open heart surgery and laser treatments are just a few examples of everyday services offered today.

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Test Yourself

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The Big Medicine Quiz – Get someone to test you!

1. What was the basis of the Four Humours theory?2. Who was the person that created the vaccination for Anthrax?3. In which year was the second Great Plague in England?4. What did Galen do that was so important?5. In which year did Pasteur publish his “germ theory”?6. Give 2 examples of famous Islamic doctors.7. Which surgeon developed the idea of using carbolic spray to prevent

infection?8. What part of the body did the Egyptians always leave alone during

mummification?9. In which year did Fleming discover penicillin?10. In which year was the NHS introduced?11. In which year was the First Public Health Act published?12. How did the creation of the Printing Press help medical progress?13. In which year was the Second Public Health Act published?14. Which Hungarian doctor first told his pupils to wash their hands before

surgery?15. What did Vesalius discover?16. Which city became the centre of all medical knowledge under the

Greeks and Romans?17. Which word means the prevention of infection in surgery?18. What was the process that involved drilling a hole in the skull to

release pressure?19. Who was the Greek God of Healing?20. What was the Hippocratic Oath?21. What did William Harvey discover?22. Why is Queen Victoria important in the history of Anaesthesia?23. In which war was penicillin first used?24. In which year was the cause of cholera discovered?25. What were the three main problems in surgery?26. Who discovered that the problem of cholera was centred on the water

pump in Broad Street, London?27. When did Chadwick write his report about how to improve public

health conditions?56

28. How much did the US fund the penicillin project during WW2?29. In which year was the NHS start charging for prescriptions?30. Who discovered X-Rays?31. What was the average life expectancy for men and women during

prehistoric times?32. What were the two “magic bullets”?33. What did the Egyptians think was causing your “blood channels” to be

blocked, thus making you ill?34. What does diagnosis mean?35. What does prognosis mean?36. What did Archie McIndoe do?37. In which year did Lloyd-George introduce his Liberal Reforms?38. Name three things that people thought caused the Plague.39. What do we call the “bad smells” that people thought made you ill?40. Why is Florence Nightingale famous?41. What did William Halstead do?42. When was the World Health Organisation set up?43. What did Marie Curie discover?44. What were the three main types of anaesthetics you studied?45. Who discovered laughing gas and when?46. In which year were blood groups discovered?47. Why is Christian Barnard an important person?48. Why was there so much opposition to Jenner’s vaccinations?49. What did Seebohm Rowntree and Charles Booth do to improve public

health?50. Which war had the bigger impact on medicine, WW1 or WW2? Explain

your answer.

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The Big American West Quiz – Get someone to test you!

1. What were the main geographical features of the Plains?2. Why were the Indians nomadic?3. Explain how the tipi was perfectly suited to Indian life.4. Who founded the Mormon church?5. Who took over leading the Mormons when their leader died?6. Explain why the Mormons moved West and the main features of their

journey.7. What were cow towns?8. What were the main dangers of the long drive?9. Why did people move to California in 1849 and how many did so?10. What does Manifest Destiny mean?11. What did the Homestead Act do to help the Homesteaders?12. Describe two problems that faced the Homesteaders whilst living on

the Plains. Give one solution for each of the problems.13. Where did homesteaders and cattle ranchers come into conflict in the

1890s?14. What was claim jumping?15. Briefly describe the activities of one outlaw that you studied.16. Give three reasons why there was lawlessness in the West.17. When was the first Fort Laramie Treaty?18. What was the Ghost Dance?19. What happened at Wounded Knee?20. Why was Sand Creek an importance place?21. Explain why Custer lost at the Battle of Little Bighorn.22. Give three reasons why the Mormons were not very popular.23. Give two examples of Cattle Trails.24. Give three examples of how the Buffalo was used by the Indians.25. Where was the first cow town and who set it up?26. In which year was the Dawes Act?27. When was the Permanent Indian Frontier established?28. What did J F Glidden invent?29. What did the Pinkertonians do?30. What was the Perpetual Emigration Fund?

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31. In which war did Billy the Kid become notorious as a gunfighter?32. What happened at Mountain Meadows?33. In which year was Utah handed over to the government as an official

state?34. In which year did Billy the Kid die?35. What was the Desert Land Act?36. What did John Iliff do that was so important?37. What were vigilantes?38. Where was Gold discovered in 1874 that caused the Battle of Little

Bighorn?39. What was the name of the hardy crop that the Homesteaders used?40. Why did the Indians lose the conflicts with the whites overall?

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