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Aspect or themeBeliefs about causes of illnessTreatmentsSurgeryPublic Health measuresWarUse of manuals such as the wound man.War and famine were some of the main killers of peopleImproved skill in sealing wounds.Quicker amputations happening.Improved ointments-John Arderne’s painkiller.New tools, such as the arrow cup-used to remove arrowheads from the body.Use of wine as an antiseptic in surgery.Opium as a painkillerWar led to the Roman Public health systems being lost for centuries. ReligionDoctrine of signatures followed-taught that God had the power to create illness and guide doctor treatments.Use of Zodiac chart and the planets.Churched banned dissection-Roger Bacon imprisoned for questioning the church.Islamic doctors wrote books-Avicenna wrote the Canon of Medicine which was important for students until the 1700’s.Believed that God caused the Black Death as a punishment for their sins.Minority groups blamed for Black Death-Jews accused of poisoning the water.Prayer was the way for people to repent their sins and to cure themselves. The church controlled hospitals where doctors were trained.Hospital wards had altars for prayers.Black Death-Flagellants believed inflicting pain upon themselves would save them from death. Church supported Galen’s work as he supported the “design theory” that god designed humans. Church banned people from questioning Galen’s work.Hospitals linked to nunneries and monasteries-monks and nuns relied on prayer and herbs for treatment. Around 160 hospitals set up.Islamic hospitals-treated patients and trained doctors.Monks could read, therefore understood public health more.Monks required fresh water supplies for monasteriesCanterbury cathedral used water tanks to purify water.Toilets and kitchens kept apart.Not everyone was treated in church hospitals. . ChanceMany treatments were ineffective and were in the form of old wives tales. CommunicationHippocratic oath book used to treat doctors for 100s of ernmentLocal level-People believed it was not their role to ensure good public health.The King’s role was to protect from invasion not illness.Lack of regulation caused by lack of understanding.Some waste disposal came in response to epidemics such as the plague in Coventry.Most towns had poor sanitation-water supply and waste disposal.Bath houses for those who could afford them.Science and technologyNo scientific understanding of the causes of germs. Robert Grosseteste of Oxford Uni studied optics leading to spectacles being developed.Role of individualsHippocrates and his clinical observation and four humours were influential. Galen and the theory of opposites. John Ardene-Told doctors to trust their own judgement and not simply follow Galen and Hippocrates.John Ardene-charged the rich as much as he could for surgery but treated the poor for free.John Ardene-Trained as a surgeon in London. 50% survival rate for his surgery on anal growths.Created pain killer ointments-reduce the number of deaths caused by deep cauterisation.Wrote the practice of surgery book in 1350.Other information.Some believed in the theory of Miasma (bad smells causing illness)Bleeding used to prevent/treat illness. Use of herbs by women and doctor.Use of urine charts.Medieval MedicineRenaissance MedicineAspect or themeBeliefs about causes of illnessTreatmentsSurgeryPublic Health measuresWarThe work of Ambroise Pare.Chance to work with new wounds.The work of Ambroise Pare.The work of Ambroise Pare.ReligionChallenges to religious ideas: Protestantism vs Catholics, Luther and Henry VIII vs the Pope. 1665 Plague: Prayer commonly used to ask God for forgiveness. Church funding for hospitals decreased.ChancePlague doctors used amulets to protect them from the plague.Pare running out of oil and trying his municationPrinting press led to the spread of new ideas across Britain and Europe.Improved travel and communication led to more advanced ernmentHowever, it would be wrong to think that people did not care about dirt and disease:Henry VIII insisted that everyone at court was healthy, and courtiers were sent away even if they had a cold.Although people thought bad smells caused disease, this led them to do things which improved health – eg cess pits were cleared regularly, and housewives spent a lot of time boiling underclothes, to keep them smelling nice.Parliament passed the first law requiring people to keep the streets and rivers clean in 1388.Towns paid 'gong farmers' to clear out human waste from cess pits.Many towns had quarantine laws, boarded up the houses of plague victims, and isolated people with leprosy in 'lazar houses'.Royal college for physicians and surgeons established between 1600-1800.Eventually led to doctors sitting examinations.1665 Plague: Miasma theory led too streets being cleaned. Science and technologyPeople start to challenge the beliefs on how the world works-beginning of the “scientific method”. The microscope revolutionised the work of doctors and physicians.Printing press invention by Caxton led to ideas spreading across Britain. Treatments limited due to a lack of understanding.Plague-observed that death rates were higher in poorer, dirtier places.Watchmen-Prevented people entering and leaving infected houses.Role of individualsVesalius-dissected humans-gave accurate knowledge of the human body. Proving Galen wrong. Worked with skilled artists to document the body. Produce “on the fabric of the human body” which helped to question the ancients, Pare-French army surgeon, experimented on wounded soldiers. Use an old Roman treatment to treat a wound instead of oil. Used ligatures to tie wounds following amputations. Spread ideas through his book. British doctors studied his books. Harvey-English Doctor and for Kings. Proved that veins have valves and that the beating heart circulated blood. Proved Galen’s liver theory wrong, helped question use of bleeding. Published “On the Motion of the Heart”.John Hunter- Trained many British surgeons after 1768. Used dissection to advance the understanding of anatomy. Told surgeons to trust the body’s natural healing process. Taught the importance of observation and experiment-a principal used by Edward Jenner.Vesalius had a limited impact on treatments-doctors still did understand causes of illness or have effective treatments,Pare- limited impact- only the rich could pay for medical care which only trained doctors new about.Not everyone in Britain accepted Pare’s new ideas.Harvey-Some patients refused to be treated by Harvey. Conservatives who supported Galen rejected him due to his use of experiments in medicine.Some people rejected Harvey because they could not see capillaries for another 60 years.Lady Grace Mildmay-new herbsRobert Burton-Mental illnessJane Sharp-Midwifery.Edward Jenner created his smallpox vaccination. However many opposed it due to use of animals and religious beliefs.John Sydenham-believed in close observation of the symptoms of disease.He insisted that physicians should avoid speculation and carefully monitor both the symptoms and treatments of patients.Other information.Rebirth of buildings, statues, paintings and texts from classical times.Biggest killers were; fever, teeth, consumption, gripping in the gut and convulsions-shows the lack of understanding.They continued superstitions such as 'touching for the king's evil' (they thought the touch of a king would cure the skin disease scrofula).Quack doctors travelled around selling false treatments to people in Britain, in order to make a profit.People continued to be treated by female family members.1665 Plague: Plague doctors hired by towns-wore special clothing which covered all body parts.Medieval surgeons were very good at practical first aid and even attempted some internal surgery. They could:heal wounds and broken bonesdo external surgery on such problems as ulcers and eye cataractsdo some internal surgery such as bladder stones1741- Thomas Coram raised money for a hospital to support and educate vulnerable child up to the age of 15.Nurses remained untrained and unskilled.Industrial MedicineAspect or themeBeliefs about causes of illnessTreatmentsSurgeryPublic Health measuresWarDuring the Boer War of 1899 to 1902, the government discovered that half the volunteers for the army were unfit for service. In the 1900s, therefore, the Liberal government passed a string of welfare reforms based on 'the personal principle' – the belief that the government had a responsibility to care for the individual citizenFlorence Nightingale helped to transform conditions leading to less deaths in history.Florence Nightingale- helped to clean up the hospitals during the Crimean War. Cut mortality rates from 40 to 2%.Mary Seacole and her role with nursing and hospitals.ReligionReligion took a step back as science and technology began to prove theories wrong.ChanceNo controls over production of medicine-some were successful and some could kill you, especially those with municationThe Victorians were great at collecting data.Germ Theory Published. Chadwick’s report on the sanitary conditions.Charles Booth’s map of London.Thomas Southwood Smith-studied causes of disease amongst the poor.By the end of the 19th C people could find out about the new within 24 hours. Florence Nightingale wrote a book notes on nursing.She set up a nurse training school-paid ?44,000 of her own money to fund it.Mrs Beeston’s book of household management encouraged people to keep specific items in the home for treatments (still in print today)Aspirin developed in GermanyGovernmentOvercrowding a major problem-families living in one room, shared toilets and water pumps with other people.Infectious diseases such as typhus and typhoid spread quickly.Few safety rules in the workplace led to injuries. No regulation of food or hygiene. In the 19th century, governments adopted 'the preventative principle' – implementing public health measures to prevent disease1848 Public Health Act-Followed Chadwick’s report but not made compulsory.1864 Factory Act-Illegal for unhealthy factory conditions.1866- Sanitary Act-Local authorities responsible for sewers, water and street cleaning.1875-Public Health Act-compulsory to provide clean water and have medical officers to improve sanitary conditions.Early 19th C- Government followed a Laissez-Faire policy-shouldn’t interfere with the lives of people.Attitudes gradually changed by a combination of growing evidence of health problems and major events.Public health laws introduced to amend the problems.Great Stink forced the government into action. Science and technologyPasteur’s germ theory- Major breakthrough in microbiology. Used Jenner’s work on vaccination to create new vaccines. Proved the existence of germs around us using a microscope. Koch- Helped to identify specific bacteria using a microscope. Koch identified the causes of some of Britain’s major killers-diphtheria and typhoid. Technique allowed others to hunt for microbes. Ehrlich-Used scientific experiments to identify and treat disease. Created chemical cures “magic bullets”.Machines invented to make tablets. Nottingham’s Boots the chemist established to produce and sell medicine. Stethoscope invented in 1816 to listen to breathing issues.First X-ray machine in 1895.Charles Chamberlain-Steam steriliser for medical instruments.Gustav Neuber-Aseptic surgery, removal of all germs.Berkeley Moyniham-surgical gloves.Role of individualsSimpson-Developed anaesthetics in 1847. Discovered the use of chloroform-used by Queen Victoria in childbirth. Joseph Lister-Developed antiseptics-after reading germ theory, Lister developed a carbolic spray. John Snow- Proved through research and observation that Cholera was caused by infection water and not other beliefs. Discovery made before Germ Theory.Chloroform-useful for shorter treatments however surgery still led to blood loss and death even with it.Lister created an automatic spray for carbolic acid to be used during operations. However it slowed down operations and made conditions unpleasant. Thomas Barnado set up a school where Hungry children were given an education and food to eat. Different activities run for the children to give them a better life.Chadwick’s report on the sanitary conditions of the labouring population.Other information.Elizabeth Garrett Anderson-Gained highest marks of anyone at the Society of Apothecaries-the society responded by banning women from doing the exam. She went on to set up a hospital for women and children and well as getting a degree to then teach other women. Only 485 women on the nursing register by 1911. Industrial Revolution had a major effect upon Public Health. Infrastructure of society changed-first postal system, the telegraph, cheap transport and the railways, growth of newspapers. High rates of infant mortality-in 1899- 142/1000 babies died before the age of 1.Many could not afford doctors. Modern MedicineAspect or themeBeliefs about causes of illnessTreatmentsSurgeryPublic Health measuresWarThe Beveridge Report-set out proposals for welfare changes after WW2.20million soldiers inured during WW2.WW2-US and British governments funded the production of penicillin. By 1944 it was available to treat all wounded allied soldiers.Hospital trains created to transport injured soldiers,Skin grafts developed.Shell shock treatment.Harold Giles-techniques for facial injuries.Mobile X-ray machines and blood transfusions.1921-Red cross blood banksCataract surgery developed.Sir Archibald McIndoe-Burn injury treatment. ReligionChanceAs new antibiotics were invented, doctors were bombarded with new information and drugs. Some companies cut corners such as thalidomide introduced as a sleeping pill in the 1950’s. However it has led to thousands of babies being born with malformed limbs. This later led to a major lawsuit. Mould spores landing in Fleming’s petri dish. Homeopathy-uses substances very diluted with water to stimulate the body’s healing power.Acupuncture-involves stimulating the nerves with municationBeveridge report outlined the changes needed to improve Britain’s social and public ernment campaigns to promote healthy eating and other medical advice.WHO-World Health Organisation spending millions on awareness campaigns for AIDS and other diseases. GovernmentNHS- aimed to provide free healthcare from “cradle to the grave”.NHS set up in 1948-only 10% of doctors supported its creation.Councils built new towns with modern homes and heating/bathrooms. Morality rates in hospitals carefully monitored. In 1952 London was covered in killer smog, led to around 12,000 dead. Seen as the worst example of air pollution in Britain.New cities such as Milton Keynes developed. Unfit housing demolished and replaced by tower ernment spending has led to shortages and even removal of some drugs and treatments within the NHS.The government focused on prevention of poor health through; education on healthy eating, compulsory vaccination and screening for cancers.NHS surgery, operations and treatments are struggling due to funding cuts to the NHS in the 21st Century. Previous diseases such as rickets and measles are returning to our towns.1906-Education Act-Free school meals.1908-Old Pensions act-People over 70 receive 5 shillings (25p) a week. 7 shillings for married couples.1909-Housing and town planning act-Illegal to build back to back housing.1909-Labour exchange act-help unemployed find work.1911-Insurance Act- Introduced sick and unemployment pay.Science and technologyFleming rediscovered the properties of penicillin and published his findings. Chain and Florey then researched its medical purposes. Tested on mice then humans.Discovery of DNA structure in 1953.AIDS identified in 1981-doctors noticed large numbers of homosexuals dying.Pharmaceutical companies developed new drugs.Radiation therapy used for cancerous cells.1952-first kidney transplant.1967-first heart transplant1972-hip replacements1978-first test tube baby.CAT and MRI scans.Medical research council funds university scientists to research new; dressings for burns, new flu vaccines and a home test kit for cancers such as lung disease.The discovery of vitamins allowed doctors to cure diseases such as rickets. In 1922 the first clinical trials of injected insulin saved people with diabetes. However, doctors were still unable to cure viruses such as AIDS or diseases like cancer, and overuse of antibiotics led to the development of drug-resistant strains of killer diseases such as the MRSA hospital 'superbug'.1961-First heart pacemaker attached to a patient.Keyhole surgery and laser treatments improved surgery times and healing process. In 1900, Willem Einthoven in Holland invented the electrocardiograph, or heart monitor.In 1901, Karl Landsteiner in Austria discovered blood groups.In 1931, The electron microscope was developed.In 1953, Francis Crick and James Watson in Britain discovered DNA.In 1953, Leroy Stevens in America discovered stem cells.In 1972, Geoffrey Hounsfield in Britain invented the CAT scanner.In the 1990s, the Human Genome project mapped all the 40,000 genes in the human body.Role of individualsAlexander Fleming and Florey and Chain.Other information.Evidence of progress in this areaEvidence of lack of progress in this areaHighly trained surgeonsSurgeons would learn on the battlefieldOr they would learn by being apprenticed to another surgeonMost common surgeons were barber-surgeons: they cut hair and performed minor surgeriesDetailed knowledge of human anatomy (the body and how it works)Mondino wrote the book Anathomia which was the dissection manual for over 200 yearsKnowledge of anatomy was based on Galen – he did not carry out dissections on humansIf dissections did not match Galen’s teachings, they assumed the body was wrong, not Galen Dissections were restricted by the ChurchNecessary equipment: operating theatres and surgical toolsMuslim surgeon, Abulcasis invented 26 new surgical instrumentsTools included saws for amputation, arrow pullers, cautery irons and bloodletting knivesTools would not have been kept clean Anaesthetics (pain killers)Hemlock, opium or mandrake root were used to dull painPatients would drink alcohol to dull the painToo much of these could kill the patientNo anaesthetics to put patients to sleep during surgeryPatients would sometimes die from the shock of pain in surgeryTechniques to prevent blood-loss and infection Cauterisation was used – burning the wound to stop bloodLigatures were used for tying off blood vesselsHugh of Lucca and his son Theodoric used wine on wounds to reduce changes of infectionCauterisation was extremely painfulSurgery had to be performed quickly to stop a patient bleeding outNo knowledge of germs – equipment would be dirtyNo antisepticsSophisticated methods of treatmentFrugardi of Salerno, Italy warned against trepanningMost common form of surgery was bloodletting (opening a vein)Trepanning was drilling a hole in the skull – it was believed this would let out a demon which was believed to cause epilepsy405130034925Medical TrainingChristianity: Believed ideas of Hippocrates and GalenMonks preserved and studied their booksTraining began after 1200Church controlled universitiesAim was not to discover new ideasIslam: Arab scholars collected and studied medical manuscriptsMedical students trained alongside doctors in hospitalsScientists encouraged to seek cures00Medical TrainingChristianity: Believed ideas of Hippocrates and GalenMonks preserved and studied their booksTraining began after 1200Church controlled universitiesAim was not to discover new ideasIslam: Arab scholars collected and studied medical manuscriptsMedical students trained alongside doctors in hospitalsScientists encouraged to seek cures635034925Causes, Cures and TreatmentsChristianity: Illness was a punishment from God Sick should be cared for, but not curedPraying was the main form of cureIslam: Believed there was a cure for every diseaseMuslims should care for the sickSick were considered to be unfortunate victims of illness, rather than being punished400000Causes, Cures and TreatmentsChristianity: Illness was a punishment from God Sick should be cared for, but not curedPraying was the main form of cureIslam: Believed there was a cure for every diseaseMuslims should care for the sickSick were considered to be unfortunate victims of illness, rather than being punished 469138036830SurgeryChristianity: 1300 Dissection bannedBut 1340 allowed one corpse per yearKnowledge of anatomy based on GalenIslam: Forbidden to dissect bodiesDoctors should not carry out surgeryDevelopments in eye surgery, removing tumours and caesarean deliveriesAlcohol used to clean wounds00SurgeryChristianity: 1300 Dissection bannedBut 1340 allowed one corpse per yearKnowledge of anatomy based on GalenIslam: Forbidden to dissect bodiesDoctors should not carry out surgeryDevelopments in eye surgery, removing tumours and caesarean deliveriesAlcohol used to clean woundsleft36830HospitalsChristianity: Centres for recovery in quiet surroundingsPatients to be cared for but not curedMany did not have a doctor but did have a priestMore than 700 hospitals in England set up between 1000 and 1500. Islam: Hospitals were to treat patients, not just care for themMedical students trained alongside doctorsDifferent departments depending on the disease00HospitalsChristianity: Centres for recovery in quiet surroundingsPatients to be cared for but not curedMany did not have a doctor but did have a priestMore than 700 hospitals in England set up between 1000 and 1500. Islam: Hospitals were to treat patients, not just care for themMedical students trained alongside doctorsDifferent departments depending on the diseaseExplain the significance of anaesthetics in the development of medicine.In the 19th century anaesthetics were significant because even though they allowed surgeons to do more complex surgeries, they still brought new problems. This was because Simpson discovered how effective chloroform was in 1847, surgeons did not understand about infection. This meant that many patients had operations which infected them and they died from blood poisoning or hospital sickness. Chloroform also lead to deaths because surgeons did not understand how powerful it was, like when Hannah Greener died in 1848 for an operation to remove her toenail, which led to opposition against anaesthetics by people who thought they were more harm than good. However, later on anaesthetics became accepted and significant for more positive reasons. After John Snow used chloroform to help Queen Victoria give birth in 1853, the reputation of anaesthetics began to grow and opposition faded away allowing anaesthetics to develop an become safer. For example, in the 21st century surgeons use a safe mixture of chemicals to produce gradual loss of pain and consciousness, which leads to better and quicker patient recovery and more complex operations. For instance, the most advanced modern anaesthetics allow brain surgery with the patient being conscious, like in the treatment of mentary – level 4. The answer explains and relates two different aspects of the significance. It explains the short term problems associated with the introduction of anaesthesia in the 19th century, supported with accurate knowledge and understanding. Complex thinking is shown in the substantiated explanation of how the significance of anaesthetics changes over time, with the long-term positive impact of anaesthetics explained and supported with examples in the second pare the Black Death in the Middle Ages with the cholera epidemics in the 19th century. In what ways were they similar?The cities in both the 19th Century cholera epidemic and Medieval Black Death were extremely dirty. This dirt was the prime cause of both epidemics – dirty water being the cause of cholera and dirty streets attracting the rats that were infested with Black Death carrying fleas. However, with both diseases people didn’t know the true cause (not until John Snow made the link between cholera and dirty water). Instead for both diseases they believed in causes such as miasmas and God punishing people. This caused thousands of people to die in both epidemics. Even though both epidemics caused a huge loss of life, there were some positive outcomes that improved people’s living and working conditions. Following the Black Death, surviving peasants were able to demand better rights and higher wages from the lords. This was because their labour was in demand due to so many peasants being killed by the Black Death, particularly in farming where peasants knew that the lords were desperate to get their harvests in. Similarly, following the cholera outbreak, the Government passed the first Public Health Act of 1848 which was then followed up by the improved 1875 Public Health Act. Both acts worked to improve the conditions of the poor, though everybody benefitted in the long run because they ended laissez-faire thinking and encouraged the government to take action in public health, leading to later developments like the founding of the NHS. Commentary – level 4 The response analyses more than one similarity, comparing the causes and consequences of both events. Complex thinking is shown in the analysis of their similar consequences that link the explanation to the broader historical context, such the positive effects on the lives of peasants after the Black Death and increased government action after the outbreak of cholera.Has religion been the main factor in the development of medicine in Britain since Medieval times? Explain your answer with reference to religion and other factors. Use a range of examples from across your study of Health and the people: c1000 to the present day.At the beginning of the Middle Ages, religion hindered medical development as it was used to explain and treat illness. For example, people in Britain believed that God punished people with illness for living sinful lives, and that only God could cure illness and therefore prayers to God were offered in the hope of being relieved of disease. The Medieval Church offered a place for the sick to go and herbal remedies were given by monks and nuns in places like Fountains Abbey, Yorkshire, but the main focus was on prayer and receiving God’s forgiveness. The Church’s strong belief in the theories of Galen also hindered medicine as Galen’s ideas were wrong as they were based on animal dissection. The Church also banned human dissection and even punished critics like the C13th English scientific monk, Roger Bacon. However, during the Renaissance the hold of the Catholic Church got less powerful as people began to challenge old ideas using new techniques and technology. For example, in the 16th Century Vesalius proved by dissection that Galen’s anatomy was wrong. Printing helped because Vesalius’ book came to England and was copied by Thomas Geminus. As the Church became less important in understanding disease, science and technology began to play a greater role. For example, Van Leeuwenhoek developed the microscope in the late 17th century he saw germs for the first time and men like John Hunter in the C18th showed more and more science in their approach to medicine, and surgery. However, science and technology would have been meaningless if it hadn’t been for the role of individual geniuses using technology to further medical understanding. For example, Louis Pasteur’s swan-necked flask experiments convinced Lister that germs caused disease. But the flawed theory of spontaneous generation used by people like Charlton Bastian to explain germs was influential in Britain and it needed dedicated scientists like John Tyndall to win the argument. Similarly, the technology that was used for mass producing penicillin wouldn’t have mattered if it wasn’t for Florey and Chain’s insight. They saw Fleming’s discovery of penicillin in the 1920s and corrected his conclusions about its ability to destroy bacteria with good science. Overall, religion made some important contributions to Public Health in the middle ages, because it started hospitals and cared for sick people but it held the understanding of disease and anatomy back because it wouldn’t accept any ideas other than Galen’s. Science and technology was more important than religion as it they helped individuals to challenge old ideas and made later discoveries possible. For example, the discovery of the microscope made the Pasteur’s Germ Theory possible. However, without the insight and determination of individuals like Vesalius, Koch and Florey, new technology would not have been used to discover new ideas and new treatments about medicine. Commentary – level 4 The response shows complex thinking related to change, showing the relationship between the different factors and substantiating an evaluation of relative importance related to the question. For example, the response shows how individuals interacted with technology in order to develop medicine. Supporting examples are detailed and span across the period. ................
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