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Topics: Surgery, public health and hospitals, ideas about causes and treatments of disease,

Surgery over time

Medieval Surgery (medicine Stands still)

1. What sorts of surgery were done? – bloodletting to restore the balance of the 4-humours,

amputation tooth extraction, trepanning

2. In what context was most surgery done (where was a lot of surgery done) battlefields (war

3. Who would do surgery in a town? Barber surgeons

4. What was the main way of treating various war wounds? Cauterisation

5. How did surgeons learn their trade? Becoming apprentices/watching

6. How respected were surgeons compared to physicians? Considered lower class

7. What was the priority in surgery? speed

8. Anaesthetics as we know them were not used. What is an example of an attempt at an

anaesthetic? Opium/alcohol

9. What, all through time, were the 3 main problems with surgery? Pain, infection and blood

loss (PIB)

10. Who was the most famous medieval English surgeon? John of Arderne

11. How were some advancements made in medieval surgery? from individuals both in Europe

and the Islamic world and the books they published

Surgery – Renaissance – the beginnings of Change

1. Continuity – look at the 11 questions above from medieval times –of those questions, which

are the same in terms of surgery in the Renaissance? First 9

2. Who was the French surgeon who made progress in surgery? Pare ‘The father of modern

surgery’

3. What did he begin to use/change used ligatures to tie off arteries to prevent bleeding

rather than doing cauterisation

4. How did chance help him? Ran out of boiling oil, which was used to treat gunshot wounds,

so he used an ointment (based on an old Roman recipe) which worked better

5. What was another significant development of this person? Prosthetic limbs/artificial limbs

6. How significant were all of his developments? Not very, most surgeons did not take up his

developments, his methods slowed surgeons; speed still the priority due to PIB , dirty

ligatures could cause death by causing deep infections,

7. Who was a surgeon in ‘England at this time who read this man’s work? William Clowes –

followed and used some of Pare’s work

8. If blood transfusions were done, what occurred? Tried using animal to human transfusions

– resulted in death and thus blood transfusions banned

Surgery – 18th century – the beginnings of Change JOHN HUNTER ‘Father of Modern Surgery’

1. John Hunter was a British surgeon in the 18th century. How did he learn do much about

surgery? was a war surgeon, dissected many bodies to learn how they worked. His

dissections enabled him to learn about nature of disease, infections, cancer and blood

circulation

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2. What are other reasons why John Hunter was a significant and successful surgeon? Did a lot

of scientific research, wrote many books, trained many surgeons in his scientific

approach/scientific method (Edward Jenner was his pupil), would not shy away from

experimentation on himself

Surgery – 19th century – A revolution in Medicine

1. How much had surgery changed up to the 19th century? Not much, the main problems

were still PIB, speed was still the mark of a good surgeon, New weapons brought new

wounds and new treatments (from swords to guns) but little real advancement made

– real cause of disease and infection still not known

2. Anaesthetics – who discovered a very good anaesthetic and what was this anaesthetic

and when? Simpson and chloroform, 1847

3. Antiseptics – who discovered a good anti-septic and what was it, and what year was it?

Lister and Carbolic Acid, 1867

4. Blood loss – who discovered blood groups and when? Landsteiner, 1901

5. Knowing about blood groups – what could then be done successfully? Blood

transfusions

6. What were some reasons to oppose anaesthetics? Deeper surgery meant more

infection which meant higher death rate, dosages – overdoses meant death, speed –

surgery could be ‘slowed down’ but the mind set of surgeons was still to go quickly,

fighting the pain was seen as fighting to stay alive

7. Who famously died of an overdose for minor surgery? Hannah Greener

8. Who famously loved chloroform (used it in child birth) Queen Victoria

9. What were some reasons to oppose using antiseptics? Germ theory not yet universally

accepted, it was messy – needed saturate a lot of the equipment and this made hands

crack and bleed, conservative thinking – surgeons didn’t want to change

10. The period from 1850 – 1870 was called the ‘Black Period of Surgery’. Why? Because

despite advancements in anaesthetics and antiseptics and the fact that germ theory

was not discovered and then not immediately accepted the death rate actually rose

due to deeper surgery being done therefore deeper infections, and also from incorrect

dosages of anaesthetics

11. What is it called when the environment is sterile? aseptic

12. How did Lister help Pasteur? His work on antiseptics helped to get germ theory

accepted

13. Who was the first female surgeon? Elizabeth Garrett Anderson

Surgery – Modern Medicine Into the 20th century

1. How did WWI help advance surgery? x-rays – mobile x-ray units helped identify where

shrapnel was, blood transfusions – blood could be stored (use of sodium citrate to prevent

clotting and later refrigeration) meant that problem of blood loss was overcome – no

longer had to do person to person transfusions, plastic surgery – facial wounds/skin

grafting from burning, shrapnel wounds – eg to the head improved surgery, infection more

importance placed on cleaning wounds and equipment

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2. How did WWII improve surgery? plastic surgery, heart surgery, blood transfusions- blood

banks had developed – donations of blood,

3. What are examples of further developments in the 20th century? Organ transplant, key hole

surgery/microsurgery, heart transplants, cancer tumour removal

Factors affecting surgery

Explain how the following factors either helped or hindered the development of surgery

War

Religion

Conservative Thinking

Enquiring Thinking

Role of the Individual

Science and Technology

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Public Health – Reaction/Prevention – Town Life

Medieval Public Health (medicine Stands still)

1. Define the following terms

-privy – medieval toilet – most towns had 1

-cesspit – the dug out hole under the privy where human waste went

-gong farmer – the people who cleaned out the cesspits – usually once per year

-raker – people who cleaned the street

2. What waste could be found on the streets/rivers in medieval towns? Animal waste - from

butchering eg blood, guts dumped on street and in town; human waste – rubbish; animal faeces

(poo) human faeces,

3. Why was there little investment in public health in the middle ages? Real cause of disease not

known, money spent on wars as that was the priority and public health/the government taking

responsibility for the health of the people was not a priority, any laws that existed weren’t

enforced

4. Why was there some investment public health? Miasma (corrupted, smelly air) was believed as a

cause therefore keeping smell away by clearing away rubbish was thought to help with illness

5. Why were monasteries better when it came to public health? Away from towns, built by rivers in

a way that waste would flow away, had filtering systems and pipes for clean water, monks had a

routine of cleanliness as it was seen as a sign of piety ‘cleanliness was next to Godliness’, had

access to medical books that explained the Roman ideas of public health

6. The Black Death 1348 – this can be used as an example of why poor public health was a

contributing factor to the deadly epidemic.

a. What did people think caused the Black Death? God punishing them, Jews, planets aligning in a

bad way, miasma

b. Who were the people who whipped themselves? Flagellants

c. Why did the whip themselves? To take on the sins of others and themselves and self punish in

order to be spared from getting the plague

d. Why did it spread so quickly? Over-crowding in towns, unhygienic conditions (which attracted

rats), lack of knowledge of real cause of disease, bodies buried in shallow graves – which could be

dug up by dogs/raise if there was heavy rain (thus attracting rats), no organised regular way of

cleaning the streets, no enforcement of any laws that might try to keep towns clean

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e. How did people try to deal with the plague? Praying, bloodletting, drinking mercury, strapping

shaved chickens to buboes, in some cases they tried to quarantine

f. Consequences of the Black Death – what were the effects? Negative – 30 – 50% of the population

died, no ‘class’ was spared, people thought the end of the world was coming, food shortages as

lack of population meant crops didn’t get harvested, starvation Positive – short term

empowerment of peasants – Lords lost peasants but still needed to farm land, therefore peasants

had bargaining power and could go to the ‘highest bidding’ Lord. This ended with the Statute of

Labourers Act of 1351 which lowered peasants wages and disempowered them.

7. In summary how would you describe medieval public health? Reactive rather than preventative,

not a priority, some laws based either on reaction to a problem eg the Black Death or due to the

link with miasma, not preventative- no logical or committed way of organising public health, any

laws or regulations that existed weren’t enforced

Renaissance Public Health– the beginnings of Change

1. Change/Continuity – how similar was public health in the middle ages and public health in

the Renaissance – very similar – little had changed

2. The 1665 Plague Epidemic – helps us to understand public health in the Renaissance

a. Causes – how much change from the middle ages? No change – the same – believed

causes were God, planets, miasma,

b. Treatments- How much change from the medieval period? Mostly the same. More

examples of treatments were smoking to keep away poised air, burning tar in the

streets, bloodletting,

c. Government/Officials reaction – how they dealt with the plague – was it more organised

than in the middle ages? Yes there were some changes such as ‘women searchers’

used to examine bodies to see if they had the plague, quarantine based on what

women searchers concluded, watchmen to stand guard to impose quarantine, houses

painted with red corss; people ordered to sweep their doorsteps and keep them clean;

animals not allowed to roam the streets; large crowds were banned – eg no

theatre/plays allowed;

3. How would you describe Public Health in the Renaissance? Very similar to the middle ages.

Reaction rather than prevention. Main example of reaction was the Plague epidemic of

1665. Still not a priority

19th Century Public Health (1800s) – a revolution in Public Health

1. Describe towns in the early 19th century. Over crowded, large families living in small rooms

in back to back housing with poor ventilation, unhygienic – waste from humans animals,

no organised public heath, poor water supply

2. Why were towns like that? Industrialisation meant mass migration from countryside to

towns to work in factories; people had to live close to where they worked (no transport)

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3. What was the prevailing (main) belief about government intervention in terms of public

health and alleviating (lessening/helping) poverty? Laissez faire – ‘leave alone/don’t get

involved

4. Why was there this attitude? For public health – no knowledge of real cause of disease,

those in government were rich and weren’t affected by the poor living conditions; for

poverty it was the mind set that the poor were their own cause of poverty – they should

help themselves

5. Cholera – this was a new disease – When were the 4 main cholera epidemics? 1832/3,

1848/49, 1854/44, 1866/67

6. Who was Edwin Chadwick and what did he do that was significant? Minister of workhouses,

who wrote a report on the labouring poor – he advised that if the poor were helped then

they wouldn’t have to go to workhouses – so the government should spend tax/rates on

public health instead of workhouses

7. When did Edwin Chadwick produce his report? 1842

8. Why did it take until 1848 for his report to be used? Reaction of the government to the

Cholera epidemic – decided to use some of his recommendations from his report

9. What was introduced in the 1948 and what was a major limitation of it? First Public Health

Act, limitation was that it wasn’t compulsory. People didn’t believe in it

10. Several significant things occurred in 1854. List them another cholera epidemic, led to First

public health act being scrapped as people felt that the actions hadn’t worked, John Snow

works out that cholera is in the water; does this by mapping where cholera is most

concentrated and then linked it to the pump that was being used, and then took handle

off of the pump. John Snow used scientific method

11. Why was John Snow not believed? Germ theory was not yet discovered

12. What occurred in 1858 and why was it significant? The Great Stink, Parliament (therefore

the rich) were affected by lack of public health and realised they needed to do something

13. What was one of the first actions to be taken after the great stink, and by whom? Sewer

system began in London, by Joseph Bazalgette

14. What 2 things occurred in 1867 that encouraged the government to take action? Another

cholera epidemic, more working class men got the vote, therefore helping the poor

working classes will get MPs votes

15. What was introduced in 1875? Second public Health Act – compulsory

16. What 2 social reformers did research into the poor in the late 19th and early 20th centuries,

and why were they significant? Charles Booth and Seebohm Rowntree – showed that the

second public health act had not solved all of the problems with illness and poverty and

that more work needed to be done

17. What did Rowntree produce and why was it significant? The Poverty Line – proved that at

certain times of life eg childhood, old age, people fell into poverty and that these

circumstances were beyond the control of the working classes.

18. What did the Boer War reveal? That ‘recruits’ were under weight and under height and did

not meet army regulations, indicating that poverty was still a major problem in England

19. What occurred in 1906 and why was it significant? An election – the Liberal government

won a landslide victory did so because they said that they would introduce reforms

(changes) to improve public health/poverty, forcing and revealing a change in the laissez

faire attitude

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20. List the Liberal Reforms that were introduced between 1006 and 1911. 1906 Free School

Meals Act, 1907 Free Medical Inspections, 1908 Old Age Pensions Act, 1908 Children’s act

1909 Labour Exchanges Act (like a modern day job centre), 1909 Housing Act – back to

back housing banned, 1911 National Insurance Act

21. Why was there opposition to the National Insurance Act? Workers had to make a

contribution to the sickness/unemployment fund – they earned very little as it was and

didn’t want the deduction, also they felt they would never see their money if they didn’t

get ill/unemployed

22. Who was the politician behind these reforms? David Lloyd George

23. Why were the reforms significant? Acceptance by more people that government must get

involved, acceptance by more people that poor weren’t poor as a result of their actions

and that factors out of their control contributed to poverty, acceptance that poverty and

illness were linked, another step away from Laissez faire. The beginnings of The Welfare

State

24. Effect of the wars on Public Health – what were the effects? Change of attitude – the

country/people had sacrificed a great deal and that made them think that a better fairer

society was needed and that included a better fairer healthcare system. In WWII the poor

health/small size of evacuated children from the cities to the countryside alarmed many

middle class people

25. What occurred in 1942 and why was it significant? The Beveridge Report – suggested that

people had the right to be free of the 5 giants that ruined lives –

disease/poverty/ignorance/idleness/squalor (filth) and therefore public health including

health care and education and help with finding employment should be introduced for

everyone. Said government should intervene from cradle to grave

26. What occurred in 1948 and why was it significant? The National Health Service – NHS –

universal healthcare free at the point of access. The Welfare State was created, the

government took control of hospitals, training of medical profession, prevention not

reaction

27. Why was there opposition to the NHS? Cost, still some hung on to the laissez faire belief

and that the poor should help themselves, doctors thought they would lose freedom and

money from private patients

28. Into the 20th and 21st century - what have been some further developments? Healthy living

advice – healthy diet, exercise advice, vaccinations, help with stopping smoking, running

of hospitals and training

How did the following factors affect public health?

Role of the Individual

War

Government

Attitudes – Conservative/Enquiry

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Ideas about the cause of disease and ideas about treatment

Medieval beliefs – ideas about the cause of disease and treatments –

Medicine stands still

1. What was Hippocrates theory called? How was this used to explain health/illness? 4-

humours theory – the body was made up of 4 humours = phlegm, black bile, yellow bile,

blood. If these are in balance you are healthy and if they are unbalanced then you are

unhealthy. Treatment done should be to restore the balance

2. What is the connection between Galen and Hippocrates? Galen was a firm believer in

Hippocrates and kept the 4-humours theory popular and believed for 100s of years

3. What are treatments based on the 4-humours theory? Bleeding (purging) by cutting open a

vein or by using leeches, something that would make you vomit/go to the toilet (again

based on the idea of purging),Galen’s theory of opposites (if you have a cold, eat ‘warm’

food like pepper

4. What were the main ideas/beliefs about the cause of illness? Beliefs based on the 4

humours/Imbalance of humours, miasma, punishment from God, other supernatural ideas

– eg astrology – planets out of alignment

5. What were other treatments? Remedies based on the supernatural – such as prayers or

astrology

6. What was used to diagnose illness/if there was an imbalance? Urine chart – doctor looked

at /tasted/smelled a sample of urine and compared the colour to a chart and that chart

had suggested diagnosis and remedies ; Zodiac Man image used to show a physician the

link between a zodiac sign and parts of the body and also ‘time’– therefore it could inform

doctors on when to treat the patient and what remedies to use, or where to cut the body

if bleeding was being done

7. Who would treat you if you were ill?/Who could you go to if you were ill If you were rich – a

trained physician (there weren’t many trained physicians); ‘wise women’ in the villages

who had knowledge of herbal remedies, they would also be midwives; the ‘Lady of the

Manor’ who also had knowledge of herbal remedies; an apothecary (like a modern day

chemist, would be in a town); a priest, praying to saints (who were attached to specific

illnesses), monastery hospitals, (barber surgeons for surgery eg pulling a tooth)

8. Where were physicians trained and what was the priority of the training? At universities;

took about 7 years. Priority was to prove Galen was right – they would read Galen, watch

dissections based on Galen’s teachings

9. How did Christianity influence ideas about causes of illness and treatments? Believed in

looking after the sick but not necessarily finding the cause/cure as illness came from God;

Illness was a test of faith, punishment from God, so you shouldn’t interfere with God’s

plan. Treatments could be prayer, going on pilgrimage to a particular shrine, treatments

based on Galen, treatments in monastery hospitals – rest, cleaner environment,

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10. How did Christianity hinder the development of medicine? the church controlled the

universities where physicians were trained therefore its aim was to uphold the old ideas

and to discourage new discoveries and thinking; approved of Galen as he believed in 1 God

therefore Galen’s ideas fit with Christianity therefore they did not want his ideas

challenged; they saw the doctor not as a healer but as someone who could diagnose what

was wrong and predict the course of the illness, and give reasons why God has done this

11. Islamic world – who were important people in the Islamic world? Ibn Sina/Avicenna/Avi

Senna (same person, different spelling, pronounced roughly the same), Al Razi

12. Why was medicine more advanced in the Islamic world? Avicenna translated many books

from Ancient world into Arabic, and then these works went to Europe to be translated;

Books/libraries/knowledge in Europe was lost after the Romans left so having the books

from the Islamic world was crucial to Europe, training – medical students received

practical training; hospitals – were clean, well ventilated; Al Razi encouraged challenging

Galen, did research on drugs/disease

Renaissance Ideas/Beliefs about the cause of Illness and treatments– the

beginnings of Change - How scientific was this period? How much enquiry

was done in this period? How many of the new ideas were accepted?

1. What were features of the Renaissance in general? Technological developments – printing

press, microscopes; new ideas/enquiring thinking (by some, not all people); age of

exploration/new lands – many European nations exploring the world, beginning to set up

empires/colonise the world; new inventions eg gunpowder – new wounds mean new

treatments need to be found; new learning – scientific observation/scientific method is

beginning to be used more, people began to question previously accepted truths; new art

– based on more realistic human form; The Renaissance started in Italy and spread

throughout Europe through books – aided by the printing press

2. What, in terms of beliefs in the cause of illness, remained the same from the Middle Ages to

the Renaissance? Beliefs based on the 4 humours/Imbalance of humours, miasma,

punishment from God, other supernatural ideas – eg astrology- planets out of alignment

3. How did exploring new lands help with medicine? It resulted in new treatments due to new

plants being brought back to Europe – eg tobacco for toothache, cinchona tree bark which

is aspirin – used for pain

4. Quackery – What is a Quack? Unqualified ‘doctor’ who sold medicine but who know that

the medicines did not work. They were ‘conmen’ of the medicine world. Interested in

making money. They often sold ‘cure-all ‘medicines

5. Nicholas Culpepper - Why was he important? He wrote ‘The Complete Herbal’ in English,

classified herbs; moved away from examining urine – a step forward in natural treatments

and scientific methods, but not a huge step forward

6. Individuals – Vesalius (Belgian, 1500s)

a. In what area of medicine were Vesalius’ main findings? Anatomy – he dissected

many bodies and studied the skeletons/tried putting skeletons together

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b. How did he get his ideas across? His books eg the Fabric of the Human Body with

the aid of new technology – the printing press

c. In terms of Galen what did Vesalius do? Proved him wrong in terms of anatomy –

eg jawbone not made up of 2 bones, but one.

d. How accepted was Vesalius? Not universally accepted – many said that the human

body must have changed since Galen’s time, rather than consider that Galen must

have been wrong

e. How did Vesalius contribute to medicine in England? His books were read in

England and it influenced thinking in England

f. Who, in the Renaissance period, got ‘better’ due to Vesalius’ work/discoveries? No

one – the significance was long term not short term

7. Individuals – Harvey (English) ( 1600s)

a. In what areas of medicine were Harvey’s main findings? Heart, blood, blood circulation

– the heart acts as a pump to push/circulate the blood. Circulation is a one-way

system, arteries carry blood away from the heart and veins carry it back to the heart

b. What technological advancement inspired Harvey study the heart and its function? The

pump

c. In terms of Galen, what did Harvey do? Blood not manufactured in the liver, blood

didn’t get used up; the heart, not the liver (as Galen had said) was the centre of the

body

d. How accepted was Harvey? Not universally accepted, most still believed Galen

e. Who, in the Renaissance period, got ‘better’ due to Vesalius’ work/discoveries? No one

– the significance was long term not short term

8. Superstitious beliefs/treatments in the Renaissance – besides God and astrology, identify

other typical examples of superstitious beliefs/treatments of the Renaissance. Bezoar Stone

– stone from stomach of a goat said to cure all poisons, King’s touch – for scrofula

(swelling of glands, also known as ‘the King’s evil’)

Early Modern – 1700s – Edward Jenner 1798 (and into 1800s)

1. What is Edward Jenner known for, and what disease is he associated with? First vaccination;

small pox

2. How did he make his discovery? Noticed that milkmaids with cow pox didn’t get small pox,

experimented – injected James Phipps with cow pox, the cow pox ran its course, then he

injected Phipps with small pox, Phipps survived small pox, Jenner then promoted the idea

that small pox could be prevented by having injections of cow pox

3. What opposition did Jenner face, and from whom? Jenner couldn’t explain how it worked;

God – people thought that injection of ‘animal matter’ into a human body went against

God’s plans – it was disgusting to them; Inoculators – inoculation was not new and

inoculators charged money so income was lost; those physicians who were ‘jealous’ that a

‘country doctor’ made a breakthrough, not them – Jenner not ‘fashionable’;

4. How influential was his discovery?/What impact did it have? Mixed – 1800s – in 1840

vaccination free to infants/young children (reaction to small pox epidemic in 1837), 1850s

small pox vaccine became compulsory but this was not enforced (link to public health

section – laissez faire attitude of government); Anti-vaccine league 1860s – opposed

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vaccine; 1871 – compulsory and parents could be fined if didn’t arrange for children to

have it; by 1980 – small pox eradicated (completely gone) from the human population

19th century Ideas/Beliefs about the cause of Illness and treatments – a

revolution in medicine

This part also includes 20th century and beyond…

1. Besides the 4-humours theory, miasma, God, what was another belief of the cause of

illness? Spontaneous generation – microbes/germs appear as if by magic when something

rotted – the disease caused the microbe not the microbe caused the disease

2. Everyday treatments – What were some common everyday treatments that could be found

in the home? Opium powders, laudanum (opium in alcohol) (often given to children to

‘calm’ them), aspirin. Medicines were unregulated so anyone could make them and could

put anything in them – arsenic and mercury were common ingredients in medicine.

3. Explain the significance of 1861 and the person involved. Germ theory – the real cause of

illness is at last identified by Louis Pasteur – a French scientist

4. Germ theory was not initially accepted in England– what helped it get accepted? 1. Cattle

Plague 1866 - a quarantine of the cows stopped the spread and enabled English scientist

(Beale) to identify microbe; 2. Joseph Lister – his work on antiseptics (carbolic acid for

surgery) were based on Pasteur’s idea of Germ Theory; 3. Tyndall – a scientist who

believed in Germ Theory and lectured on it; Typhoid fever – Koch’s work had helped to

find this microbe – typhoid fever was a common problem in England

5. Koch – German doctor – how did he build on Pasteur’s work? He identified which microbes

were which disease – something that Pasteur couldn’t do

6. What did Koch do in order to find the microbes? Stained them, photographed them –

enlarged them using strong photographic lens

7. Which microbe/disease do we associate with Koch, as he found it, as it was so small that

previous scientists and doctors couldn’t find it? TB (Tuberculosis)

8. Vaccines Pasteur and Koch’s work was essential to developing vaccines. Which one found

the first human vaccine and what was the disease? Pasteur, rabies.

9. Vaccines and other cures – Pasteur introduced bacteriology and Koch had built on this.

There were several factors that pushed their work in this field forward. What are those

factors and what do they mean? War – France and Germany were at war – disease caused

more deaths than wounds (eg dysentery) therefore finding cures/vaccinations would

mean healthier army therefore better chance of victory; Government/finance – linked to

war, the governments of both countries were motivated to invest in their research to find

cures and vaccines; Luck – ‘Chicken Cholera’ Pasteur’s assistant by mistake injected a

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chicken with weakened sample of cholera – built up immunity and survived the

experiment of injecting the chicken with cholera – Pasteur could not prove how

vaccinations worked (built on Jenner; Pasteur had read Jenner) Individual Character (role

of the individual) both were determined and motivated, and their rivalry kept them even

more motivated; Communication – Pasteur’s demonstrations and talks about anthrax –

and news of Koch’s work spread in articles in the medical journal ‘The Lancet’; Teamwork

– other scientists were hired to work on vaccines or other chemical cures for the diseases

that were identified;

10. Fleming – What discovery is he associated with? What year? What factor? Discovery of

penicillin (first antibiotic), 1928, Chance – he didn’t clean up and when he returned mould

was growing in the uncleaned petri dishes and the mould was killing the bacteria that he

had been working on

11. What hindered the development of Fleming’s findings just after he discovered it? Fleming

didn’t believe it was an antibiotic and believed it was a natural antiseptic; Fleming didn’t

inject penicillin into an animal to prove it could kill bacteria; few people took interest in

Fleming’s work

12. Who pushed Fleming’s findings forward, and in what year? Florey and Chain; 1938

13. What did these 2 men do that was significant? They began experimenting, asked for money

from government and got very little, so had to be innovative in getting enough penicillin to

test on humans – tests results were mixed; they ended up getting money from the

American government – WWII saw high injury rate/surgery rate and this and Florey and

Chain showed them the effect of penicillin; Pearl Harbour Attack motivated US

government to give funding to mass produce penicillin; by D-D (1944) all soldiers had

penicillin (antibiotics) on them.

14. What was the long term impact of Fleming’s findings? Massive impact. More types of

antibiotic were developed. This meant that deeper surgery could be done, chemotherapy:

those having this cancer treatment need antibiotics to help fight any bacteria that

weakened immune system can’t deal with

15. Crick and Watson – What are they known for? What year was their discovery made? DNA,

1953, DNA leads to gene therapy, knowledge of diseases genetically passed on, genetic

screening for this; in future could be personalised medicine based on your gene profile

16. Other treatments in the 20th century – The second half of the 20th century saw an explosion

of drugs and treatments and full government intervention (NHS 1948) in medicine. List a few

of the treatments/breakthroughs) full range of free vaccines, joint replacements (eg hip

replacements, knee replacements), MRI scans/3-d imaging, micro-surgery, organ

transplants eg heart, lung, liver, cancer treatments, endoscopes, skin grafting,

17. Factors – What are the factors for why drugs and treatments have developed greatly in the

late 20th century? War – WWI and WWII meant greater government investment in drug

development and technology; Government and Finance – connects to war, but also to

investment in research to find treatments/new drugs, finance screening for diseases – the

government takes a full role in the prevention and treatment of all illness and disease,

Change in attitudes – enquiry – it is a priority to protect the health of the nation and

therefore society accepts the taxing that is involved in this, also challenging attitudes and

the quest for knowledge is admired and encouraged, Individual Character – geniuses now

get funding to continue their work eg Crick and Watson

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18. Beyond mainstream medicine – what are examples of alternative medicine? aromatherapy,

hypnotherapy, homeopathy, acupuncture

19. What is antibiotic resistance and why is it a problem? When bacteria evolve and become

resistant/stronger than the antibiotic used to kill it. This means that there may not be

antibiotics that will kill germs and therefore this has an impact – the body will need to

fight the germs with its own immune system – if the immune system isn’t strong enough

(eg someone is having chemotherapy and their immune system is significantly weakened)

then they need antibiotics as their body can’t fight the germs.

Hospitals Over time

Medieval Hospitals – Medicine Stands Still

1. Where were most hospitals situated? Monasteries

2. What was the main priority of treatment? Rest and recover in a quiet, cleaner space. More

like a present day ‘care homes’. Hospitals often looked after poor elderly people. Finding

cure not a priority. Prayer was main treatment, food provided (better diet), no wards

3. Who would be treating the sick? Nuns, monks, no doctor would be present in the hospital

4. How were hospitals funded? By charity, by the church

5. Who was not allowed in hospitals? Those with contagious diseases, lepers had their own

hospital, called Lazer houses and were outside of the towns, pregnant women

6. What are some names of hospitals? St Giles, St Bartholomew’s (St Barts – still exists today)

7. Islamic Hospitals - - How were Islamic hospitals different? Emphasis on caring for sick and

finding cure, by 1100 every large town had a hospital providing medical care and prayers

for the sick, cleaner, different types eg hospitals for those with mental health illness

Renaissance – Hospitals in the Renaissance – the beginnings of change

Wider historical context – Henry VIII was instrumental in the Reformation in England (the change in

the church and the introduction of Protestantism in England) and part of this was the dissolution of

the monasteries (the closing of the monasteries). This of course had a major impact on hospitals as it

changed ‘where they were’

1. How were hospitals funded? by the King – to keep up hospitals and by wealthy people

2. How were hospitals the same as in the medieval period? Still places of rest, simple

remedies like a good diet, and prayer. No priority to cure

1700s/18th century – ‘Hospital Boom’ – many hospitals built in this time – the

beginnings of change

1. Voluntary hospitals – who set these up? Wealthy people funded these. Guy’s hospital in

London is an example of this

2. What are some differences between these hospitals and the medieval ones? No longer just

a place to stay and rest – they began to use new ways of treating the sick. There was a

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move away from ‘punishment from God’ idea to the idea of using scientific

method/observation to diagnose/treat/cure patients. Doctors began to receive training as

medical schools were attached to hospitals, doctors then began to work in hospitals. They

treated poor for free, and charged the wealthy for treatment. Specialist hospitals set up eg

Foundling hospitals set up (foundlings are orphans – so sick, homeless orphans were given

hospital treatment) Harvey worked in a hospital,

3. In what ways were they the same? Nurses untrained and unskilled, there weren’t wards for

different illnesses, surgery not done in hospitals

1800s/19th century Hospitals – a revolution in medicine

1. Florence Nightingale is the major person for hospital reform/change for the better. Which

war did she treat soldiers? Crimean War 1850s

2. How did she reform hospitals? Set up wards for different illnesses/organised hospitals, ,

trained nurses and gave nurses strict rules to work by, set up first nurse training school,

cleaned hospitals/belief in hygiene, ventilation,

3. Did she believe in Germ theory? No – she believed miasma

20th century Hospitals

Wider Context - Germ Theory- once germ theory was accepted, hospitals continued to

improve in terms of wards, hygiene and training of nurses/doctors

1. Was it necessary to pay for hospital and medical treatment at the beginning of the 20th

century? Yes

2. What occurred in 1948 that had a significant impact on hospitals? Creation of NHS/Full

Welfare State, government takes over all hospitals- takes over funding, training of medical

professionals, regulation of medicines (pharmaceuticals) , investing in technology; surgery

moves into hospitals

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Significant Individuals Over time

Below is a list of significant individuals who had a major impact on medicine. Explain what

they did and why it was significant

Hippocrates

Galen

Pare

Harvey

Vesalius

John Hunter

Jenner

Pasteur

Koch

Lister

Simpson

Landsteiner

Archibald McIndoe

Edwin Chadwick

Bazalgette

John Snow

Charles Booth

Seebohm Rowntree

David Lloyd George

Beveridge

Bevin

Fleming

Other Important Individuals that you can

use as examples

Ibn Sina (Avicenna) – ‘The Galen of Islam’ -

his work/book translations were used to

train doctors in Europe

John Ardene – example of an English

surgeon in medieval times

Nicholas Culpepper – wrote the ‘The

complete herbal’ – helped move the 18th

century to more scientific

Thomas Sydenham– helped move the 18th

century to more scientific; critical of quack

doctors, promoted observation

Clowes – example of an English surgeon in

the Renaissance – was influenced by Pare

Charlton Bastian – had to be argued against

as he promoted spontaneous generation –

Tyndall helped to argue against his views

(Bastian was a hindrance to the acceptance

of Germ Theory in Britain

John Tyndall – helped promote Germ

theory in England and lectured in England

about Koch’s findings