Health and the people Flashcards

Question

What was the theory of the 4 humours?

Answer 1

Ancient Greek theory of Hippocrates based on clinical observation - influential for over a thousand years

Answer 2

Ancient Greek healing temple (they didn’t have hospitals) - at odds with Ancient Greek scientific theory like the ‘four humours’

Answer 3

An Islamic hospital- had emphasis on cleanliness, fresh water and clean air. They trained doctors at these hospitals

Answer 4

Hippocrates (‘father of modern medicine’)- believed in clinical observation in diagnosing illness. Clinical observation and Hippocratic Oath still used today

Answer 5

Set of texts written by Avicenna – went on to be the standard medical text book used by European universities until the 1700s

Answer 6

Western Europe entered a period known as the ‘dark ages’ when the Roman Empire lost its power • During this time, the followers of Islam established an enormous Islamic empire • The Caliph (chief Muslim religious leader) ruled over a unified empire which provided the peace and order needed for medical progress • In line with the prophet Muhammad‘s teachings, many of Caliph’s followers were interested in science and learning and supported medicine • Muslim writers played an important role in the following: – saving much lost knowledge – translating the works of Ancient Greece and Rome into Arabic – Translations were eventually passed onto Western Europe

Answer 7

During the reign of Caliph Harun al-Rashid (786-809), the capital city of Baghdad became a centre for the translation of Greek manuscripts into Islamic. In this way, hundreds of Ancient Greek medical books by Hippocrates and Galen were preserved. In 805, Caliph Al-Rashid also set up a major free hospital in Baghdad with a medical school and a library.

Answer 8

Galen (AD130-210 therefore Roman times) furthered the ideas of Hippocrates. He practised dissection of animals in order to better understand the human body. He worked for three years as a doctor in a gladiator school where his knowledge and techniques developed. He used the theory of the Four Humours and emphasised the importance of listening to a patient’s pulse. His ideas profoundly influenced Western ideas of medicine for a long time.

Answer 9

Al-Razi (865-925) also known as ‘Rhazes’ was a Muslim doctor who stressed the need for careful observation of the patient. He distinguished measles from smallpox for the first time. He wrote over 150 books and although a follower of Galen, he believed that all students should improve upon the work of their teacher.

Answer 10

Ibn Sina (980-1037), also known ‘Avicenna’, wrote an encyclopaedia of medicine called the ‘Canon of Medicine’. It covered the whole of ancient Greek and Islamic medical knowledge. It listed the properties of 760 different drugs and contained chapters on medical problems. It became the standard European medical textbook used to teach Western doctors until the 17th century.

Answer 11

Hippocrates (460-370BC) was the first physician to regard the body as a whole, rather than individual parts. He therefore believed in the importance of observation. He believed that diet and rest were hugely important for a patient’s recovery. He is credited with writing some 60 books and is regarded as the father of modern medicine. Even today, new doctors around to world still take the Hippocratic oath.

Answer 12

Al-Rashid’s son, Caliph Al-Mamun (813-833), developed his father’s library into ‘The House of Wisdom’, which was the world’s largest library at the time and a study centre for scholars

Answer 13

- Islam refused to allow dissection of human bodies. This prevented surgeons from studying the human body in order to improve their knowledge and skill. - Charity and caring for others was important in Islam and, consequently, hospitals were set up to care for the sick. The hospital that was set up in Cairo in AD1283 saw that the patients were given money when they left, so that they did not have to go straight back to work - The Islamic religion encouraged medical development and a love of learning which meant that Arabic doctors preserved the medical works of people such as Hippocrates and worked to improve upon, and extend, medical knowledge too. - The Islamic religion encouraged the building of public baths because the Qur’an said hygiene was important for health. Muhammad taught people to ‘keep you house and yards clean. Allah does not like dirt and untidiness. Allah is pleased if you clean your teeth and trim your nails and moustache. Every Muslim must have a bath once a week, when he must wash his head and his whole body.’ - Islamic teaching also taught doctors to try to cure patients: ‘Oh servant of Allah, use medicine. Allah has not created pain without a remedy for it’. Therefore, hospitals were also intended to treat patients, and not simply care for them. Islamic hospitals called ‘Bimaristans’ were built to provide medical care for everyone: men and women, rich and poor, Muslim and non-Muslim. Doctors were permanently present and medical students trained alongside them.

Answer 14

- The Greeks had enquiring minds and they wanted to understand how and why things worked. Wealthy classes spent much time becoming educated and discussing new ideas such as the ‘Four Humours’ theory. Trade also helped to bring knowledge and new methods from other civilisations - Greek thinkers and doctors tried to understand what caused disease through careful observation of people who were ill. This fitted in with the theory of the ‘Four Humours’ – they saw that when someone was ill there was usually a liquid coming out of the body; for example, phlegm from the nose or vomit from the stomach. - The Greeks believed in ‘Asclepios’ the God of Healing. From 600BC, Asclepion temples were built in quiet places – these were the nearest the Greeks got to hospitals. They also contained baths, stadiums and gymnasiums. People believed that if they went to sleep in the Asclepion at night, the God and his daughters (Panacea and Hygeia) would come to heal them. - Greeks believed that the world was made up from four elements: air, water, earth and fire. They said that each of these elements had different qualities – which they could observe from the world around them e.g. water was cold and moist. The Greeks also linked the four elements with the four seasons to explain how and why each was different e.g. water was cold and moist and so, too, was winter. In this way, they were able to explain why phlegm as a ‘humour’ was more likely to become out of balance in the winter.

Answer 15

• People believed that God controlled every part of their lives. (e.g. If they were ill, it was a punishment from God. If they were successful in their work or business, it was God who helped them). • Everybody had to go to church on Sundays and holy days. All around the village there were shrines and holy crosses. • Religion shaped what went on during the year. People looked forward to feasts on special holy days such as Christmas and Easter • The Church was there at the important stages of their lives (Baptisms, weddings, funerals) • Every villager had to give the Church a tithe, that is, one tenth of everything they produced (as a tax). • God decided whether you went to Heaven (eternal bliss and happiness) or to Hell (eternal pain and suffering). So pleasing God in your daily life was pretty important!

Answer 16

- The Church also encouraged the belief in miraculous healing. There were many shrines filled with relics of the bones, hair and other body parts of a holy person. These shrines were places that people made pilgrimages to, for help with their illnesses, such as the shrine of Saint Thomas Becket in Canterbury - The Christian Church approved of Galen’s books because he believed in a single God: this fitted in with Christian ideas. However, this meant that it was difficult to challenge anything that Galen wrote, as it would be seen as a criticism of the church. Church aptitudes to new ideas were shown by what happened to 13th century English monk, Roger Bacon: he was arrested for suggesting that doctors should do original research and should not trust the old books. - Prayers to God were the most important treatment: ‘to buy drugs or to consult with physicians doesn’t fit with religion.’ said Saint Bernard, a famous twelfth-century Christian monk. - There was a strong Christian belief that illnesses came from God and curing an illness would be a challenge to God who had sent it as a punishment or a test of faith. So, it was important to care for the patient, not necessarily cure them. - In Europe, the training of doctors began after 1200. The Christian Church controlled the universities e.g., in England, Oxford and Cambridge. Students were taught the medical ideas of the ancient Greeks and Romans. The training was to make the old knowledge clear and understandable; it was not to discover new ideas. - The hospitals depended on charity for money and were mainly financed by the Christian Church or by a wealthy patron. Many hospitals did not have doctors but a chaplain (a priest) and were run by monks or nuns to a strict pattern of diet and prayer. The Church saw the role of the doctor not as a healer, but as someone who could predict the symptoms and duration of an illness and provided the reasons why God might inflict the illness on the person.

Answer 17

- The Christian Church believed in following the example of Jesus, who healed the sick. For this reason, Christians believed that it was good to look after the sick, and so they founded many hospitals. - The Church also valued the traditional medical knowledge of the Ancient World because it thought Hippocratic and Galenic ideas were correct. Monks preserved and studied these ideas: they copied out the books by hand - There were different types of hospital, for example, there were hospitals or asylums for the mentally ill, such as Bedlam in London. Whilst Lazar houses dealt with people who had leprosy. These were set up outside towns to prevent people catching the contagious disease of leprosy. There were also monasteries with infirmaries (small dormitory wards) that could provided free care to the poor - Between 1000 and 1500, more than 700 hospitals were started in England. Many hospitals were centres of rest where sick people might recover in quiet and clean surroundings.

Answer 18

Drilling a hole in the skull- a common surgical intervention in the medeival era. It was thought that epilepsy was caused by demons in the brain - so a surgeon might cure an epileptic patient by drilling a hole into the skull to let the demon out

Answer 19

- bloodletting - small cut on inside of arm, blood allowed to run out - amputation- cutting off a painful or damaged part of the body. Successful in cases of breast cancer, bladder stones, and haemorrhoids - trepanning also very common

Answer 20

1. Pain 2. Blood loss 3. Infection

Answer 21

Used natural substances such as mandrake root, opium and hemlock, but too strong a dose could kill the patient. More often they not, patients had to be held or tied down during surgery.

Answer 22

Cauterisation was a common technique of burning the wound to stop the flow of blood: it was usually done with a heated iron and was immensely painful

Answer 23

Saws for amputation, arrow pullers, cautery irons and bloodletting knives

Answer 24

•There shall be a master to take good care at the hospital, and to work for the remission of Bishop Suffield’s sins •There shall be at least three or four women, aged over fifty, who are to change the sheets and take care of the sick •Everyone must rise at the crack of dawn to pray •There will be thirty beds or more •There will be weekly mass in honour of St Giles •There will be a poor box from which poor people passing by can receive alms and charitable assistance •The sisters are to sleep in a separate dormitory •No women are allowed to stay in the hospital as patients

Answer 25

A dying woman

Answer 26

Care for them when needed, involved making the patient comfortable, preparing restorative foods and mixing herbal remedies. Also responsible for the garden, in which they were expected to grow various plants known for their healing properties, such as marigolds and clover.

Answer 27

Many hospitals didn’t actually treat the sick. Instead, they offered hospitality to travellers and pilgrims, which is how hospitals got their name

Answer 28

Bout 30% of the hospitals in England were owned and run by the church in the Middle Ages. Run by monks and nuns who lived in nearby monasteries. The rest were funded by an ‘endowment’ ( where a wealthy person had left money in their will for the setting up of a hospital. Since charity was the foundation of religion and the church taught that charitable donations could help heal disease, it’s not surprising there were so many. The church was in charge of running many of these hospitals too.

Answer 29

They were good places to rest and recover. The space would have been kept very clean and the bed linens and the clothing of the patients changed regularly. It was large Peary of the nuns’ duties to do the washing and make sure everywhere was kept clean. This meant that, for people not suffering from terminal disease, hospitals were probably quite successful

Answer 30

Insane and pregnant patients were often rejected, though some hospitals had special beds reserved for unmarried mothers. No lepers, no lunatics, no people with contagious disease, no sucking infants, no intolerable infants

Answer 31

1. Went to the chapel 2. Bath, nuns and sisters would take your clothes, boil them and bake them in the oven. Went into clean sheets overnight - very few hospitals employed surgeons and physicians, most care carried out by nuns or elderly women - prayer and contemplation was was expected to bring about recovery

Answer 32

refers to the health and well being of the population as a whole

Answer 33

- Many people gave monasteries money and valuables as signs of their ‘charity’ - Monks were educated and disciplined with access to books and manuscripts. - Monks produced wool and traded this. This meant they needed large rural for sheep grazing - Monks believed lay people (townsfolk) were sinful so they tended to build their monasteries well away from them in rural areas - Rich people often gave money, resources and land to monasteries in return for prayers to be said for them once they died (safe passage to heaven). - Isolation in rural areas meant the monks did not interact with lay people (townsfolk) - Monks followed the ancient Roman ideals of a simple routine and regimen for life (moderation in diet, sleep and exercise). - Monks followed the ancient principles of good sanitation - Monks believed that water was either clean or dirty and that there was a need to separate these.

Answer 34

Fountains abbey, as so other abbeys, is situated in an isolated, out of the way place but it is very important that it sited near to a (or in our case on) a river. I hear that the monks at Rievaulx Abbey actually diverted a river to ensure a reliable supply of water. We need water to supply our mill as well as to deliver water to our kitchens, bakeries and brew house. At Fountains abbey, the river flows from west to east and takes dirty water away from the toilets which are positioned over the river. We don’t actually use the river for drinking water, instead fresh water is provided from a number of local wells.

Answer 35

All monasteries have an elaborate system of pipes to deliver water to wash basins (lavers). Filtering systems are also installed to remove impurities by allowing dirt to settle out of the water. As you can see, we have excellent facilities for the monks to wash themselves. We call this our lavatorium room and from here waste water can be emptied into the river.

Answer 36

We have toilets, or privies which have potties underneath to collect urine. We use the urine for tanning and bleaching cloth produced from our sheep. Other products from our toilet are emptied into a pit, from which the waste is dug out and carted away as manure. We flush the privies and cess pit clear from time to time by diverting local river water through them.

Answer 37

We have religious routines that we have to follow and which help keep us healthy. Baths are a rare luxury for most but we are ordered to use them since cleanliness is a sign of piety and celibacy (abstaining from sex). Some monks are have a bath as often as once a month; as Benedictine monks we have two per year – one at Christmas and one at Easter. We bathe in the bathhouse, which is connected to the drainage system. We also wash our clothes regularly, as well as our heads and faces. We wash our feet twice per week in a religious ceremony.

Answer 38

We also have an infirmary with a good supply of water so that patients can be bathed and their clothes boiled clean. Finally thee is our physic garden where we grow plants for the treatment of patients. We make sure we always herbs such as peony, ginger, cinnamon and balsam available. We also spend money on aniseed, wine, cassis, cloves, saxifrage, liqourice, olive oil and vinegar for the care of others.

Answer 39

1. There was a lack of knowledge regarding germs and disease at this time. Aside from the religious causes of disease, many people at the time believed that smelly or bad air caused illness so they were keen to remove bad smells 2. Some town authorities took action against local butchers and ordered them to use a separate and identified area to dispose of their waste products. It became illegal in these areas to throw it in the street 3. The open drains that ran down the streets themselves would often overflow as there was no system of this included in street design 4. Some towns employed specific ‘rakers’ who would be paid to remove animal dung and rubbish from the streets 5. Most people got their water from local spring, wells or rivers. These were often polluted by nearby cess pits 6. Most medieval people tended to drink beer as this could not be polluted in the same way that natural water sources could be 7. Fines were introduced in some towns for anyone caught throwing rubbish into the street. You could also be fined for having filth outside of your house that was not cleaned up 8. Some towns installed pipes made of wood or lead to carry clean water into the heart of the town itself 9. Local businesses were based in the heart of towns. This often meant that the ordinary townsfolk were exposed to danger. For example, leather tanners used dangerous chemicals which smelled awful, whilst butchers threw the waste products of their meat (blood and guts) into the river or street 10. Some medieval streets were paved but the vast majority were dirt tracks. The weather impacted accessibility- in the summer, they were dry and rutted and in the winter, they froze. When it rained, they became muddy and unusable 11. On occasions, deceased wealthy townsfolk left money in their wills to be used for the upkeep and maintenance of the town. For example, the repairing or paving of roads 12. Most towns had open drains everywhere to take away waste and water. However, they would often overflow 13. Rivers and streams were where the majority of rubbish and waste was dumped. Often chamber pots (pots that people used in their houses to urinate into) were emptied out onto the streets along with any other household rubbish and waste food 14. Some towns used money acquired to build a ‘town privy’ (public toilet) that was then regularly emptied by gong famers who need manure for their fields 15. Many houses started to be built with latrines (toilets) over fast flowing streams. New town privies were also built in this way; therefore, removing the need for a cess pit in the heart of the town

Answer 40

• The Black Death was an epidemic disease in the Medieval period; it began in Asia and travelled rapidly along the trade routes to Western Europe • It reached Constantinople (in modern day Turkey) in 1347 and arrived in England in 1348 • The Black Death’s arrival in England has been traced to two ships docking in Melcombe harbour in Dorset • The Black Death killed nearly half of Europe’s population • In Britain, at least 1.5 million people died, at the time this was close to a third of the population

Answer 41

- Bad smells, from an overflowing privy or rotting food, corrupt the air. - The Four Humours are out of balance in each victim. - All the victims have been possessed by evil spirits - Victims have had too much sex, it has corrupted their blood. - It was caused by a huge earth quake in China in 1347 - Invisible fumes are spreading across the country - The planets can explain it. Saturn is in conjunction with Mars and Jupiter and that always means something bad happens. - God is angry with us – not enough people have been going to church or behaving properly. - People have been wearing fancy new clothes and showing off their wealth. This has made God very angry and therefore he has sent a plague, like he did in Biblical times, to teach us to behave better. - The Jews have poisoned the wells and springs. - The Saints have cursed us all for our sins.

Answer 42

- March through the streets praying to God to spare us from the Plague: by order of the King. - Avoid eating too much - Stop people from entering and leaving your village. - Clean all filth from the streets: by order of the King - Attend church and pray for your soul everyday - Avoid taking a bath, as opening the pores of the skin will let in the disease. - Bathe in urine three times a day or drink it once a day. - Burn the clothes of plague victims. - Limit the number of mourners at a funeral. - Avoid all plague victims - Carry a posey of sweet- smelling herbs and spices to keep away the evil smells. - Make butchers responsible for cleaning up animal blood and intestines. - Make candles as tall as yourself and burn them in the church.

Answer 43

- Take laxatives to make you go to the toilet. - Have yourself bled to release the evil spirits from your body. - Attach a live chicken (or pigeon) to the buboes to drive away the disease. - Carry out flagellation – walking through the streets praying for God’s forgiveness and whipping yourself. - Pop open the buboes to release the disease - Drink a mixture of vinegar and mercury - Plaster the plague sores with a paste made from cooked onions and yeast.

Answer 44

• By the end of 1350 the Black Death had subsided, but it did not die out completely • There were further outbreaks in 1361-62, 1369, 1379-83, 1389-93 and throughout the first half of the fifteenth century • The plague is thought to have returned at intervals with varying degrees of deadliness until the eighteenth century • It was eventually replaced, in significance, by cholera

Answer 45

- As a result of the increased powers of the peasantry and their new economic freedom, the Feudal System broke down. The government, terrified of losing control, introduced a law called the ‘Statute of labourers’ which capped wages at pre-1346 levels and tied peasants to the Lord of their Manor again. - The anger created by the ‘Statute of Labourers’, along with increased taxes that peasants now had to pay (this was due to the fact that there were fewer of them now to pay for the King’s wars abroad) caused the Peasants’ Revolt in 1381.

Answer 46

- Inflation occurred in the years following the Black Death as a result of the food shortages. The price of food went up because there was less of it around and demand was high. For some families, food became unaffordable. - Eventually, when things stabilised, the prices of everyday items fell. This meant that villagers could now afford to buy products that they would not have had the opportunity to buy before 1349. - The Lords were forced to pay higher wages which they did not like. They were used to paying low wages and charging high rents to their labourers and found that they could no longer do this after the Black Death as they needed the labourers. As a result, the Lords had to spend more money which they did not like! - As many died in the villages of Medieval England, the Lords had to reduce their rents or they would have no one left to work on their land and farm their crops! Before the Black Death they charged high rents and made a lot of money but they had to force down their prices after 1349 if they wanted people to stay on their manor. This meant that they did not earn as much money as they used to. - The shortage of labourers on the land in England meant that wages went up for Peasants in the mid-1300s. This was because their services were now in demand- they, in turn, could then demand higher wages from their Lords or threaten to move to another village!

Answer 47

- Before the Black Death, most Peasants were ‘villeins’ which meant they were forced to work on the Lord’s land and ask his permission for everything. In this sense they were not free men. After the Black Death, villagers became free men because there were so few of them that they were now able to bargain with their Lords! - Misunderstanding of the causes of the Black Death meant there was widespread persecution of minorities such as foreigners, beggars and lepers. - Between 1348 and 1350, the disease killed at least a third of England’s population. Older age groups were most affected and experienced higher numbers of deaths. - The medieval lords who lost their farmer peasants to the disease changed to sheep- farming because it required fewer workers. This further reduced the supply of basic foods that were needed such as bread. - In the immediate aftermath of the pandemic, fields went unploughed as the majority of the peasant farmers had died. Those that survived found there were food shortages as a result.

Answer 48

- Opinions towards the Catholic Church changed. Some of the churchmen were criticised or cowardice when they deserted their villages. The church also lost a great number of experienced clergy who had themselves died in the pandemic.

Answer 49

- The ‘Renaissance’ is a period in history which flourished in the late 1400s. - The ‘Renaissance’ began in Florence in Italy, amongst wealthy businessmen and traders. They used their money to pay educated people to translate the works of ancient Greece and Rome in order to satisfy their renewed interest in this era. - At the same time as the ‘Renaissance’, the Reformation of the Catholic Church began to challenge accepted religious ideas as well. Many turned to Protestantism. - they also became critical of the old ancient texts that had been used for centuries. - People now did not just accept what they were told but they began to ask questions, look for evidence and experiment with new ideas. - People began to believe that being educated in areas such as art, music, science and literature could improve people’s lives. - Since people’s interest in ancient knowledge began to grow again the ‘Renaissance’ is considered a period of ‘rebirth‘ of learning ‘old’ learning - For centuries people had accepted the idea that the church had all the answers but now - people began to challenge these and wanted to find the right answers out for themselves.

Answer 50

My name is Andreas Vesalius. I was a surgeon and carried out my own dissections on humans. I believed that anatomy was key to understanding how the human body worked. Through practicing human dissection, I was able to construct detailed drawings of the inside of the human body for surgeons to understand. I used this to create the first detailed textbook on human anatomy.

Answer 51

proved that animal anatomy was very different from a human being.

Answer 52

My name is Ambroise Paré. My background is in surgery and I learned most of my skills as an army surgeon. Most soldiers I treated had experienced gunshot wounds which has traditionally been cauterized (sealed off) with hot oil because people believed that such wounds were poisonous)

Answer 53

One day, my supply of oil ran out and I created an ointment of rose oil, egg white and turpentine. I found that this ointment worked better and wounds healed more effectively. I also developed Galen’s suggestion of using ligatures (silk threads) to tie blood vessels during an amputation in order to stem bleeding in surgery.

Answer 54

My name is William Harvey. A group of us questioned Galen’s original ideas that new blood was constantly being made in the liver (and was subsequently used as a fuel that was burned up in the body). A friend of mine, Columbo, put forward an idea that blood moved along the veins and arteries.

Answer 55

I spent a long time studying the movement of blood through dissection and my own experiments and I became the first person to prove that blood circulated the whole of the body in a system and was driven by the heart.

Answer 56

I am Edward Jenner. I was a surgeon who was trained under John Hunter. I became his apprentice at St George’s Hospital and learned lots about dissection and experimentation from him. I eventually found that infecting a person with a small dose of cowpox (a milder form of smallpox) vaccinated them against smallpox. This was a deadly disease which killed 30% of the people who caught it.

Answer 57

Up until the 17th century, hospitals were considered a place for the sick to rest, receive simple remedies and to pray. However, by the early 18th century, modern hospitals were set up which were founded and supported by private people. I was originally a Governor at St Tomas’s Hospital in London. I originally set up my own hospital to treat ‘incurables’ from St Thomas’ hospital. Here, patients were cared for, doctors received training and a medical schools was attached to us to further develop staff.

Answer 58

1. Through careful observation, Vesalius found that sometimes Galen’s findings were wrong because they were based on animal dissection 2. Vesalius’ work was soon appreciated in England. Within 2 years of being published, an Italian printer (Thomas Geminus) published ‘Compendiosa’, a book which copied all of Vesalius’ illustrations. This book was used as a manual for barber surgeons in London to learn their trade. 3. Vesalius faced heavy criticism for daring to say Galen was wrong. Vesalius was correcting errors made by greatly respected anatomists and doctors; some of these ideas had been accepted and followed for thousands of years. He eventually left his job in Padua as a result. 4. Although Vesalius’ work did not lead to any medical cures, it was the basis for better treatment in the future. 5. Vesalius’ dissections were popular. He promoted human dissection as a way to discover more about the body and as a way that students could learn about the body. 6. Vesalius also dissected animals to show how Galen had gained his knowledge: the breastbone in a human had 3 parts, not 7 like the ape. 7. Vesalius wrote/illustrated his textbook – The Fabric of the Human Body in 1543. His illustrations were very precise and, unlike previous medical books, which focused on individual organs, he focused on different systems within the body such as the skeleton, muscles, nerves, veins, digestion and reproduction. 8. Many doctors believed that Galen had given the correct description of anatomy and simply carried out dissections to prove he was right. When other doctors observed the same differences as Vesalius, they simply blamed that particular body they were dissecting or said human anatomy had changed since Galen. 9. Vesalius showed others how to do proper dissections. Fabricius, Columbo and Fallopius all followed his ideas and used dissection to find out more about specific body parts. 10. In the latter half of the 16th century, many copies of Vesalius’ original book came to England, where they influenced and inspired many English surgeons

Answer 59

1. During a French battle, Paré ran out of hot oil (which he was using to seal the wound, since surgeons believed that gunshot wounds spread poison in the body) and instead, used a cream of rose oil, egg white and turpentine to smear over gunshot wounds. 2. Paré challenged accepted practice based on observation and experimentation and wrote a book about treating wounds in new and better ways. 3. Paré’s patients that had been treated with the rose ointment slept well and their wounds healed quickly in comparison to those who had their wounds treated with hot oil who suffered pain and inflammation. 4. Due to the number of amputations Paré had to do, he quickly moved on to designing and making false limbs for soldiers and included drawings of them in his books. 5. Paré also revived an old method to stop bleeding. Instead of cauterising a wound he used ligatures (string or thread). He did this by tying the ligature around individual blood vessels, recommended by Galen. 6. Paré admired, read and learned from the work of Vesalius. He also believed in the importance of human dissection to learn more about anatomy. 7. Paré also designed the bec de corbin (‘crows beak clamp’) to halt bleeding while the blood vessel was being tied off with a ligature. 8. The use of ligatures could, however, introduce infection to the wound; they also took longer to implement than cauterising and speed was crucial during battle surgery

Answer 60

- Paré translated Vesalius’ writings into French which increased surgeons’ understanding as most surgeons were not taught Latin. His books were circulated around Europe. - In 16th century England, there were a number of surgeons who followed Paré’s renaissance approach to surgery: they observed, questione - Paré’s book, Works on Surgery, was widely read by English surgeons and an English hand-written one was given to the Library of Barber-Surgeons of London in 1591. This was long before it was printed in English in 1634. - surgical knowledge? Paré’s book, Works on Surgery, was widely read by English surgeons and an English hand-written one was given to the Library of Barber-Surgeons of London in 1591. This was long before it was printed in English in 1634. Impact for the development of surgical knowledge? William Clowes, a surgeon to Queen Elizabeth, greatly admired Paré. He gained most of his experience on the battlefield and was talented at stopping bleeding from wounds and carried a vast amount of heeling potions. He agreed with Paré that gunshot wounds were not poisonous. Clowes acknowledged Paré as the source for his treatments of burns using onions in 1596.

Answer 61

-Harvey built up his knowledge of the heart through dissection. - Harvey was sure the blood circulated the body but he couldn’t explain why. - When Harvey first published his findings, his critics said he was mad to suggest blood circulated and some ignored his ideas. - Harvey studied human hearts and also observed the slow-beating hearts of cold blooded animals to understand how the muscles worked. - Neither could Harvey explain why blood in the arteries was a different colour to blood in the veins - Some doctors rejected his theory since he was contradicting Galen. They thought it was impossible that Harvey was correct. He experimented by trying to pump liquid the wrong way through valves and veins, proving that blood could only go one way. He knew blood moved from the arteries to the veins but he couldn’t explain how. He suggested it was absorbed by the veins. Despite the criticism, Harvey’s theory was accepted by many in his lifetime but it took another 50 years for the University of Paris to teach it to its medical students. Harvey was a careful scientist who drew conclusions from methodical observation and experimentations. Others were very hostile towards Harvey such as the anatomist Jean Riolan, at the University of Paris, who called Harvey a ‘circulator’: slang for a travelling quack (an unqualified, often useless, doctor). - Harvey’s work on the circulation of blood challenged the idea of bleeding as a cure. If Harvey was right then it was impossible for the body to have too much blood which was out of line with Hippocrates’ theory of the 4 humours.

Answer 62

1. Surgeons like Pare had reduced infections during operations by developing new methods such as using ligatures during amputations or using ointment to cauterise wounds. 2. In the 18th century, in reality, most practising ‘doctors’ were men who had only served apprenticeships. 3. The ‘Royal College of Surgeons’ made sure that surgeons could only practice as long as they had a licence. You could not practise as a surgeon within 7 miles of London unless examined by the College. 4. There were still no reliable anaesthetics by the 18th century. Wine and opium were used to attempt this but the results were unpredictable. An incorrect dose of anaesthetic could prove fatal. 5. In 1856, there were 10,220 people listed in the Medical Directory (a book with all doctors, physicians and surgeons in it). However only 4% of those in the book appeared to have a medical degree from an English University. 6. The increased amount of training that surgeons had worked well to improve their skills. In the 1720s William Cheselden was famous for his speed and dexterity- for example, he was able to remove a stone from the bladder in less than a minute. 7. In 1811 it was insisted that, if you were to be a surgeon, you had to attend at least one course in anatomy and one course in surgery run by another respected surgeon. Two years later, it was also insisted that you had to have at least 1 years’ experience in hospital in addition. 8. Many 18th century patients described their experiences of surgery negatively. They said it was “excruciating agony” and many patients were surprised (and happy!) that they had survived their surgery.

Answer 63

• Born 1728 in East Kilbride • He joined his elder brother William in London aged 20 • He worked at his brother’s anatomy school (specialising in childbirth) • He performed dissections and robbed graves to supply the anatomy school!!!!

Answer 64

- admitted to the Company of Surgeons in 1768, after which he set up a large practice and trained hundreds of other surgeons in his scientific approach - many young surgeons who he trained and inspired became great medical teachers and professors and helped to bring about famous teaching hospital in 19th century Britain and America - for example Edward Jenner trained with him and became a firm friend

Answer 65

- his writings were widely read and a major contribution to surgical knowledge - showed the theoretical knowledge about anatomy that evert surgeons needed (based on his observations, his dissection skills and willingness to experiment - in 1771, published ‘The Natural History of the Teeth’ - published book ‘On Venereal Disease’ in 1786. Partly based on self experimentation; translated into several European languages and was widely read - experienced in the army contributed to his book ‘Blood inflammation and gunshot wounds’ which finally put to rest the idea that gunshot wounds were poisoned and had to be cut out. He also said that the wound should be made larger

Answer 66

- early promoter of careful observation and the use of scientific methods in surgeries - experimented on himself in 1767 (there was debate wether syphillis and gonorrhoea were the same venereal disease) thought that 2 diseases couldn’t exist in one organ. Hunter injected himself with pus from sores of gonorrhoea patient. Unfortunately the patient had syphills as well. It took Hunter 3 years to-recover using the standard mercury treatment - 1786, a man admitted to St George’s hospital with a throbbing lump (aneurysm) o; his knee joint. Usual treatment was amputation. Hunter’s dissections led him to believe restricting blood supply above aneurysm would encourage new blood vessels to develop and bypass the damaged area. Tested on animals before doing surgery on the patient. Six weeks later the man walked out of hospital

Answer 67

- preserved 3000 stuffed or dried animals, plants, fossils, diseased organs, and other body parts - experimented with inflating narrow blood vessels with wax to study blood flow - a famous item in his collection was the skeleton of a 2.3 metre tall Irish giant, Charles Byrne. His collection was later given to the Royal College of Surgeons in England

Answer 68

1. Many new drugs were found in foreign lands: the bark of the Cinchona tree from America contained quinine which helped treat malaria, opium from Turkey was used as a form of numbing and tobacco from North American was (wrongly) used in an attempt to cure many conditions, from tooth ache to plague. Rhubarb was hailed as a wonder drug when it arrived from Asia and was used as a laxative. 2. One infamous medicine called ‘Daffy’s Elixir’ was invented by a Leicestershire clergyman in 1647. He claimed, falsely, that it cured convulsion fits, worms, gout, kidney stones, colic etc. – all common problems at the time. It did none of these things, despite his claims that it did. 3. Lady Johanna St John carried out a typical lady’s role in medicine. She collected family remedies and complied recipe book of cures. Her cures included using paper soaked in vinegar which had been dried in order to cure a bleeding nose. 4. Nicolas Culpeper published ‘Complete Herbal’ in 1653 which is still in print today. He wrote in English in an attempt to help people access medicine without having to pay the inflated fees of physicians. 5. In 17th and 18th century Britain, there was a huge increase in people inventing and selling medicines that quite simply did not work, yet they continued to push them on the population. 6. Military surgeon John Woodall began using lemons and limes to treat scurvy. 7. Many apprentices set up their own shops treating people for free by talking to, and examining, their patients rather than simply examining their urine. They used herbs in a more coherent way than previously and classified herbs and plants by their use. They also combined the use of herbs with astrology. 8. People advertised, falsely, that the royal touch could cure the disease scrofula, also called the ‘king’s evil’. Thousands of people arrived in London at this time hoping to be cured by the King’s touch. 9. There were many homely remedies that were passed down from generation to generation by the wives of the family. Some worked, for example, honey was used to kill bacteria and the willow tree

Answer 69

• Medieval hospitals were set up and funded, largely, by the Church • Henry VIII closed the monasteries during the Reformation in the 1500s and seized their land and wealth – monasteries no longer had the money to fund hospitals • The King gave money to fund the creation of certain hospitals after that (St Bartholomew's and St Thomas’) • By the 18th century, hospitals had greatly changed from those of the medieval era...

Answer 70

- up to 17th century, hospitals were still places for sick to rest and recieve simple remedies, and to pray - in early 18th century idea of modern hospitals using modern methods to cure patients began - founded an supported by the charitable gifts of private people e.g. Westminster hospital in London was founded by a private bank in 1719, and Guy’s hospital founded bu a merchant called Thomas Guy in 1724. He initially supported St Thomas Hospital, but then gave money to build Guy’s. - Hospitals were also built by ‘private subscription’, where local people clubbed together to pay for the construction and running of a hospital

Answer 71

- not only the sick were cared for, but doctors of the future received training, as medical schools were often attached to hospitals - individual wards developed for different diseases - although learned mainly through lectures and reading in medics, schools, new charity hospitals (e.g. the one in Edinburgh) gave final- year students the opportunity to gain experience by following medical professors through wards - while the doctor attended the ordinary people in the hospital for free, the fees paid by private patients were a doctor’s main source of income Types of treatment still primarily based on the four humours; bleeding and purging - towards end of eighteenth century; hospitals added dispensaries where the poor would be given medicines without any charge

Answer 72

- St Luke’s hospital in London 1751 became the second largest public hospital after Bethlehem, for the mentally ill - London’s Lock Hospital for venereal diseases opened in 1746 - maternity hospitals were also a thing; e.g. wards set aside in Middlesex Hospitals for pregnant women in 1747, British Hospital for Mothers and Babies set up in 1749 - high child mortality rates became very noticeable, severe epidemics of typhus and influenza in 1720s and 1730s, death rate among children was alarming. - a retired ship captain (Thomas Coram) built a hospital for sickly or poor children he ‘found’ on the street. Started the hospital in 1741, some simple education till the age of 15

Answer 73

Pain was a real issue for surgeons as it meant that they had to operate very quickly to spare the patient (this in itself led to problems: Robert Liston once amputated a leg in two-and-a-half minutes, but accidentally cut off his patient’s testicles too

Answer 74

- In 1775, the Bristol physician Thomas Beddoes and his young assistant Humphry Davy, experimented with inhaling nitrous oxide. - It became a fairground novelty: people paid to inhale it and then fell about, laughing hysterically. It was not until 1844 that an American dentist, Horace Wells, used it in the removal of one of his own teeth. However, his demonstration failed to convince doctors.

Answer 75

Davy published an account in 1800: he described how the gas made him laugh, and feed giddy and relaxed, but he did not recognise its medical value.

Answer 76

- In October 1846, William Morton gave a public demonstration in the use of ether in a Boston hospital. News of this reached Britain where the acclaimed surgeon Robert Liston used it to amputate a leg in December. Ether was haled as an effective anaesthetic. - In 1842 William Clark, an American dentist experimented with ether. He used it in a tooth extraction and was quickly followed by Crawford Long, a doctor who also used ether to remove a neck growth from a patient.

Answer 77

- However, ether was difficult to inhale, it caused vomiting and was highly flammable. This could be disastrous given that many patients chose to have their operations at home in front of an open fire.

Answer 78

- In 1847 a Scottish doctor James Simpson discovered chloroform after experimenting on himself and his friends. - Chloroform induces dizziness, sleepiness and unconsciousness in patients. Simpson used it successfully to reduce pain in child birth most notably for Queen Victoria in 1853 in giving birth to Prince Leopold. - The story goes that Simpson and friends had been testing a number of different substances when somebody knocked over a bottle of chloroform. Simpson’s wife brought them dinner but found them all sleeping peacefully.

Answer 79

The idea that microbes could appear as if by magic when something rotted therefore it was believed the disease caused the microbes not the other way round.

Answer 80

The idea that not all microbes were the same and certain ones caused specific diseases.

Answer 81

The idea that there was ‘bad air’, and that disease was spread by this air.

Answer 82

• Believed that cleaning up the environment would stop epidemics. • Believed that epidemics (e.g. Cholera, Plague and Typhoid) were caused when infections interacted with the environment (soil or water) • This interaction created the disease that then attacked the weak. • Linked to the popular theory of miasma, the idea that there was bad air that spread disease. • Example supporters: William Farr and Florence Nightingale

Answer 83

• Believed that infection was spread by contact with an infected person or bacteria. • Believed that any contact between an infected person and a healthy person would lead to the illness being transmitted. • Example supporters: John Simon

Answer 84

• Pasteur was the first to conclude that bacteria (germs) were the REAL cause of infection • This became known as his ‘germ theory’

Answer 85

1. The French silk industry was being ruined by a disease that was killing their silkworms. Through a series of experiments, Pasteur proved that they were dying of a disease which was caused by a germ. 2. In 1857, French scientist Louis Pasteur was asked to find out what was making a company’s beetroot alcohol turn sour. He concluded that germs were harming the liquid... and they did the same to milk and beer 3. Pasteur then looked for ways to solve the problem. He killed the bacteria by gently heating the liquid. He used the same technique with beer and milk. He had invented a process called pasteurisation. 4. Pasteur was now convinced that germs were coming from the air. He set up an experiment to prove spontaneous generation wrong. He used two glass containers and put liquid in each. Then he boiled it to kill the germs. 5. He heated the spout of one flask and it started to melt. Then he bent it into a curvy shape. He claimed that the liquid in the flask with the bent tube would last for years and not turn sour 6. Pasteur said that the spout would stop the movement of air. He said that the germs in the air would settle in the lowest part of the curve and wouldn’t reach the liquid. 7. Pasteur argued that the liquid in the other flask would soon go bad. He said that the straight spout would allow germs to get to the liquid easily. 8. Everything Pasteur said was correct. He had proven that germs did not come alive on their own. Germs will only be found in places they are able to reach. They infect things and turn them bad. 9. In 1861, Pasteur published his ‘Germ Theory’. But he had other ideas. In 1865 he got to test his theory that disease in animals is caused by germs.

Answer 86

• Born in Essex • Studied surgery and became a fellow of the Royal College of Surgeons in 1852 • Moved to Glasgow in 1860 to become a Professor of Surgery • Introduced new principles of cleanliness in surgery

Answer 87

1. Lister thought that Pasteur’s Germ Theory might explain the problems of infection he encountered. Carbolic acid was suggested to Lister as a chemical that could kill bacteria. 2. Lister believed that infections only happened when the skin was broken, and that microbes could get in and start an infection 3. In Glasgow, 1860, Joseph Lister realised that operations went well as long as the wound was kept free from infection. He was referred to Pasteur’s work by a colleague.

Answer 88

1. In place of the skin, Lister decided to put a chemical barrier. In August 1865, he experimented on a young boy who had fractured his leg so badly that the bones were sticking through his skin. 2. When Lister removed the dressings he found that the fracture and skin was healing well; the irritation was because of the strength of the carbolic acid. 3. Lister set the bones and used dressing that had been soaked in carbolic acid. The dressings stayed in place for 4 days, after which time the boy complained of irritation. 4. The dressings were replaced and the wound stayed infection free. After six weeks, the boy walked out of hospital. 5. Lister began to test this antiseptic approach out on other surgeries: his method was to spray carbolic acid to coat the surgeon’s hands, the wound and the instruments used in the operation. He also soaked the bandages, ligatures and dressings to be applied to the wound in diluted carbolic acid.

Answer 89

1. Lister said that infection in wounds was caused by microbes in the air. Lister argued that the oxygen in the air was irrelevant: it was the microbes in the air that were important. He said that the cause of sepsis came from outside the body and not from spontaneous generation, and recommended his form of antiseptic surgery, which people nicknamed ‘Listerism’. 2. Lister published his results in March 1867, giving details of 11 patients with compound fractures, none of whom had died of infection. He also publicised Pasteur’s Germ Theory through his explanation of antiseptic technique.

Answer 90

1. Despite opposition, Lister’s methods marked a turning point in surgery. In 1877 he moved to London to train young surgeons under his own supervision. 2. With some of the basic problems of surgery now solved (pain and infection), surgeons now began to attempt more ambitions operations. 3. Operating theatres and hospitals were now rigorously cleaned to ensure absolute cleanliness. From 1887 all instruments were steam sterilised and in 1904 rubber gloves were used for the first time. 4. The first successful operation to remove an infected appendix came in the 1880s. 5. In 1878 Koch found the bacterium which caused Septicaemia and proved that disease was spread through contact with an infected surface. This gave a real boost to Lister’s ideas. 6. Surgeons also began to scrub their hands and arms before entering the surgical theatre, to wear face masks and to change their clothes for operating gowns. 7. The first heart operation was carried out in 1896 when surgeons repaired a heart damaged by a stab wound. 8. By the late 1890s Lister’s antiseptic methods (which killed germs on the wound) became aseptic surgery which meant removing all possible germs from the operating theatre to create a sterile environment. 9. In 1892 Lister and Pasteur were together given an award at the Sherbonne University in Paris for their contribution to the fight against disease.

Answer 91

- The carbolic spray cracks skin and makes everything smell. - Having to spray the whole surgery and coat bandages etc also causes extra work and makes operations more expensive. - Speed is still essential in an operation because we still have the problem of bleeding. Lister’s antiseptic methods just slow my operations down. - I’ve tried to use Lister’s methods but without success – this poor man has developed an infection to his wound and will probably die anyway. I challenged Lister about this and he said that I obviously had not been systematic enough in preparing the operating theatre. I disagree, I think that the antiseptics actually prevent the body’s own defence mechanisms from operating effectively. - I really find it very difficult to accept the idea that there are tiny micro-organisms all around which could cause disease! - Its part of the tradition of being a surgeon – knowing that there is a good chance your patient will die. What’s wrong with that? - What? You’ve changed your technique again. Ridiculous! You are simply changing your methods because they do not work.

Answer 92

• 1843-1910 • Born in Germany • Studied to be a doctor and worked as a surgeon in the Franco-Prussian War • Became a pioneering microbiologist • Awarded the Nobel Prize

Answer 93

Koch discovered the bacteria that caused tuberculosis in 1882. He then published his ideas on methods that could be used to identify disease-causing microbes. Koch continued to look for the microbes causing different diseases. In 1883, he discovered cholera, and in 1884 he proved it was spread in water supplies when he found it in the drinking water in India during a cholera epidemic. This also proved John Snow’s theory about cholera in Britain. Koch made it easier for future scientists to study bacteria by developing a new method of growing them using agar jelly in a petri dish, which made it easier to see the bacteria under a microscope. He also developed a method to stain the microbes, making them even easier to see. Koch’s research was funded by the German government, allowing him to use up-to-date technology and to have a strong team of scientists. Their work inspired other scientists as well. Koch and his team went on to discover microbes for specific diseases such as diphtheria, pneumonia, meningitis, the plague, and tetanus. Koch received a Nobel Prize in 1905 and is considered to be the ‘father of bacteriology’. His methods used to discover microbes are even still used today. Koch’s ideas were far more accepted in Britain that Pasteur’s initially were. The identification of microbes which caused particular disease was a major breakthrough in diagnosing diseases. Before, Doctors had only treated symptoms, but now they could study the disease itself. Doctors began to realise that it was the microbe that needed to be killed off to cure the disease in a patient. For example in 1883, the microbe that caused diphtheria was found. This was a horrible disease which affected children giving them a painful cough and a fever. A leathery skin would grow over the tonsils and the back of the throat, meaning the patient could not breathe easily. Doctors realised that the microbe produced a poison. This meant the Doctors could seek ways of attacking the poison which caused the symptoms, meaning the patient got better.

Answer 94

- Pasteur proved that spontaneous generation theory was wrong and that germs, in fact, were in the air and caused decay - Pasteur proved that germs were causing disease in animals and theorised that they may also cause disease in humans. - Pasteur built up a research team to help him to discover the germs which caused diseases faster than Koch. - Pasteur realised that weakened versions of germs were useful when it came to inoculation. - Pasteur was able to prove how Jenner’s vaccines worked, using Germ Theory. - Pasteur helped create vaccinations for typhoid, tuberculosis, diphtheria and tetanus.

Answer 95

- Koch discovered the specific germ which caused anthrax. This was the first time that a specific germ had been proved to case an individual disease. - Koch developed a method of proving a particular germ caused a disease. This could be used by other scientists, including Pasteur. - Koch improved methods of studying bacteria. He stained bacteria so that they could be photographed. - Koch discovered how to grow bacteria on potatoes which made them easier to study than in a liquid. - Koch helped discover the germs which caused anthrax, tuberculosis, typhoid, tetanus, meningitis and cholera. - Koch inspired other scientists to join him in the hunt to find other bacteria.

Answer 96

- assumed the disease started spontaneously. The disease spread rapidly as farmers were reluctant to kill cattle. - soon realised that the outbreak could be controlled through quarantining and slaughtering of cattle - so food shortages and prices result - the government appointed the leader scientific user of the microscope, Professor Lionel Beale, to investigate the crisis - in June 1866, Beale’s findings not only recognised the specific microbe responsible, but demonstratives how the microscope could help with complex medical research - the cattle plague was clearly identified as an example of a contagious disease

Answer 97

- he was the professor of Anatomy at University Clollege London - he had written many articles in the late 186s supporting spontaneous generation - in January 1870, came up against the arguments of John Tyndall

Answer 98

- publicly defended Pasteur’s germ theory, and argued against Bastian - lectured on both dust and disease bring Pasteur’s and Lister’s work with experiments on light that showed the tiny microbes in ordinary air

Answer 99

- a Manchester doctor had supported Tyndall’s criticisms of spontaneous generation - he developed a doctor’s version of the Germ Theory of disease: he linked all the lab work with practical evidence of surgeons and public health doctors

Answer 100

- translated Koch’s work into English - wrote a paper based on Koch’s findings - explained some of the microbes present in healthy tissue and wounds were harmless and did not always produce disease

Answer 101

This was spread by poor sanitation or unhygienic conditions.

Answer 102

This was spread through germs in the air and through sneezing and coughing.

Answer 103

This was mainly contracted through using contaminated water and there were many epidemics in the 1800s (the first two happened in 1832)

Answer 104

A contagious infection that causes a red blotchy rash. It mostly affected young children

Answer 105

The common symptoms are fever, headache and a rash. It was often spread through contact with fleas.

Answer 106

• Britain’s towns and cities grew very quickly in the first 50 years of the 1800s • As they grew the health of the people living in them grew steadily worse • People had flocked to towns to get a job in one of the new factories – since a single factory might employ hundreds of people, rows of houses were built quickly, ‘back to back’ • These squeezed as many workers as possible into each street • Almost all the houses were crowded, often with five or more people living in one small room

Answer 107

- In the yards, the smell was often terrible. This was sometimes from the waste but often it came from the privies (outside toilets). These were communal toilets which poorer families had to share. These were a wooden shell which was open at the front and the back with a hole which connected to a cess-pit beneath the yard - Councils in the 19th century, unlike today, did not have to provide basic services like pipes. There were very few people that had clean water piped to their houses. Many had to queue in their yards to use the communal tap or they carried it in buckets from the river - Most streets in Leeds were built without drains to take away any waste. This meant that usually there were pools of stinking water and rubbish in the middle of the yards. The stench became unbearable for many people, particularly after it had rained - People back in the 1800s did not know that dirty water could kill them. They could not afford to buy clean water from the town water-sellers so they were forced to drink the unclean water that they either collected from the river or after it rained - In Leeds, in 1832, there was the first cholera epidemic. Within a few months, almost 700 people died from the deadly disease and, by the time the epidemic ended the year later, nearly 31,000 people had been killed. Cholera sufferers had dreadful sickness and diarrhoea - Many builders wanted to make a quick profit from building new houses in the city centre. There was little space so most builders built ‘back to back’ houses which were rows of houses built on to the backs of the ones in the row behind. These houses were built around yards (small courtyards) which could be accessed from the street by a small alleyway - Cholera was not the only disease that towns-people feared in the 1800s. Other diseases such as Tuberculosis, Typhoid, Typhus, Scarlet Fever and Measles killed tens of thousands of people in the 1830s and 1840s - There were many deadly diseases in the 19th century and most of these diseases struck those that lived in cities like Leeds. This is because the city centres were overcrowded and dirty - In the 1800s more and more people moved to the towns and cities from the countryside in search of work in the new factories that had opened. These workers needed to live as near to their work as possible. Houses for poor workers were built and were crowded together in narrow streets around the smoky factories - We often take it for granted that we have hot running water plumbed in to our houses. This was not the case for most people in Leeds in the 1800s. - - - Water was in short supply and its collection was a daily chore for many women. As a result of this, most people only took a bath once a week and the whole family has to use the same, cold bath water - In towns and cities like Leeds there was no underground sewer system to remove waste safely. - - Mostly, there were narrow gutters that ran through the middle of streets and yards to take away waste that people threw out of their windows. However, this often got blocked by rubbish and leaves so waste lay stinking for months - Houses in Leeds were built with very few windows because they were ‘back to back’ houses. Most had two rooms- one for cooking and washing and the other for sleeping. Those that could not afford this had to rent the underground cellars of other people’s houses. These were damp and dark and often crowded - Many of the houses in the city centres were not well built. In the early 1800s there were no rules to make sure that houses were built properly like there are. - - - These houses were small and cheap

Answer 108

• In 1847, a ‘Public Health Bill’ was finally introduced into Parliament. – It was strongly opposed by a group of MPs who were nicknamed the ‘Dirty Party’. – They believed in laissez-faire and argued that it was not the government’s responsibility to clean up the towns • Then in 1848, cholera struck again and the majority of MPs voted in favour of the Bill which became the first Public Health Act 1848

Answer 109

- The 1848 Public Health Act set up a ‘Central Board of Health’ in London. This was a group that would oversee improvements to public health. It could force some areas to set up ‘Local Boards of Health’ where there was a high death rate or where more than 10% of rate payers in the area ask for one. - The local ‘Boards of Health’ had the power to improve water supply and sewage disposals. They took over from private companies and individuals and regulated the supply and disposal of water and waste. - The 1848 Public Health Act also enabled the Central Board of Health’ in London to appoint specialist Medical Officers, provide sewers, inspect lodging houses and check food quality which was offered for sale.

Answer 110

- Under the Act, town councils were given the power to set up local Boards of Health’ which would be able to spend money on cleaning up their towns. However, this was not compulsory and, by 1853 only 103 towns had done this (there are well over 4000 towns in England). - The fact that there was a limited number of towns (approx. 100 out of 4000) who had established a local ‘Board of Health’ meant that sewage disposal and water supplies were improved in some places only. - Many water companies, landlords and builders had hated the existence of ‘Boards of Health’ and the changes they tried to implement. Many were making lots of money from the current conditions and did not want to improve them and lose out. - The 1848 Act, whilst giving powers to local and central government to clean up the towns, was not compulsory. It was not fully applied nationwide and, therefore, bought only limited improvements in pockets of the country. - There was such strong resentment of government interference that, by 1854, the ‘Central Board of Health’ in London was closed down. - Many people in England still firmly believed in the ‘laissez-faire’ principles of government – that it was wrong for the government to interfere in people’s private lives.

Answer 111

• The crisis brought about by the cholera epidemic of 1832 prompted the government to act • Edwin Chadwick, a lawyer, was given permission to investigate the living conditions of the poor in London • By 1840 he had began a national investigation by sending out doctors to most major towns and cities • In 1852 he published his Report on the Sanitary Condition of the Labouring Population • Chadwick’s report revealed the terrible conditions in the towns and shocked the nation • Chadwick argued that if the towns were cleaner, there would be less disease and people would not need to take time off work • As a result, fewer people would need poor relief and this would save the ratepayers money • His work inspired the sanitary reform movement • Chadwick said that Parliament should pass legislation to improve sewage disposal and water supplies

Answer 112

Excerpts: • Disease is caused by bad air and these diseases are common all over the country • The bad air is caused by rotting animals and vegetables, by damp and filth, and by overcrowded houses. When these things are improved, the death rate goes down • A medical officer should be appointed to take charge in each district • More people are killed by filth and bad ventilation each year than are killed by wars • People cannot develop clean habits until they have clean water • The poor conditions produce a population that doesn’t live long, is always short of money, and is brutal and rough

Answer 113

Chadwick’s 1842 report, sparked off a fierce debate about cleaning up the towns • Supporters of reform became known as the ‘Clean Party’ • In 1844 the Health of Towns Association was set up to campaign for healthier living conditions • Local branches of the Association were set up across the country. Each produced evidence of filthy streets, lack of sewage facilities and inadequate supplies of fresh water • The Association called for an Act of Parliament

Answer 114

• Many people studied the 1832 cholera epidemic and, after careful observation of the disease, deduced that there was a link between cholera and water supply • Cholera is actually spread by infected water, the faeces of a sufferer contain the cholera germ and if they get into the water supply the disease spreads rapidly • Cholera returned regularly with major epidemics again in 1848 and 1854 • In 1854 Dr John Snow made a break through in proving that there was a link between cholera and water supply • Snow, a London Doctor, used meticulous research, observation, and house to house interviews to build up a detailed picture of a limited cholera epidemic which hit one particular area of central London

Answer 115

In the mid-1850s, London was a dirty, overcrowded and unsanitary city. The River Thames was overflowing with raw sewage and the streets were filled with rubbish and waste. The Thames had become a dumping ground for human sewage, household rubbish, horse dung, slaughterhouse waste and chemical waste from factories. Edwin Chadwick’s report on living conditions from 1842 had highlighted that poor living conditions was the cause of disease and illness and had advised the city to clean up its streets- his advice was to discard all waste into the river! However, the river was also the main source of the population’s water for washing, cooking and drinking. The summer of 1858 was unusually hot and, unbeknown to many, encouraged bacteria to thrive. The stench from the city, and particularly the Thames itself, led to this becoming known as the summer of the ‘Great Stink’.

Answer 116

when the smell became so powerful that business in the House of Commons was suspended and moved up the river to Hampton Court, MPs realised that they needed to do something about the Thames and the poor conditions of the city.

Answer 117

Three years earlier, an engineer called Joseph Bazalgette had been asked to draw up plans for a network of underground tunnels to intercept all the waste from nearly a million London houses before it had a chance to flow into the River Thames. This was a beauty of a plan because it used gravity and the slope of the London river basin to get the tunnels to flow downstream towards the sea instead. However, these plans were put on hold and his work was not commissioned at the time. By the summer of 1858, the situation had become so dire that Bazalgette was given £3 million (about £1 billion today) and told to start work immediately. Bazalgette’s project was a massive undertaking and involved 83 miles of brick-lined tunnels (sewers) using a total of approx 318 million bricks. Bazalgette also designed the Thames Embankment to house the large sewers running parallel to each side of the Thames, carrying the contents to the 4 massive pumping stations that delivered untreated sewage downstream into the Thames at high tide where it was taken directly out to sea. Bazalgette’s sewer system was finished in 1866 and, when it became fully operational, cholera never returned to London. As a result parliament were spurred into action to improve other aspects of public health.

Answer 118

- The 1866 Sanitary Act made local councils responsible for sewers, water and street cleaning. In addition, each town was to have a ‘Health Inspector’. The following year, in 1876, the government passed laws against the pollution of rivers. - By 1869, the Medical Officer for Health (Sir John Simon) had persuaded the government to set up the Royal Sanitary Commission. It found that the provision of clean water was still very patchy across the country. - From 1870, every local authority had to set up schools. Heath education was taught in school and improved literacy made it possible for people to read pamphlets giving advice about drainage, ventilation, diet, personal cleanliness, care of children and care of the sick. - In 1875, the Artisan’s Dwellings Act (also known as the Housing Act) was passed. This made house owners responsible for keeping their properties ion good order. It also empowered Councils to buy up areas of slum housing, knock them down and build new houses. Few councils took advantage of this power but in 1876 the government introduced building regulations to standardize new building projects. - The government set up the Local Government Board in 1871 and then, in 1872, the second Public Health Act divided the country into ‘sanitary areas’. Each area had an appointed Medical Officer of Health. Other measures taken by the government and local councils during the later 1800s include: compulsory vaccination against smallpox from 1853 and the regulation of doctors’ qualifications from 1858. From 1889, isolation hospitals were introduced for infectious diseases in order to separate the sick form the healthy. - In 1875 the Second Public Health Act was passed. It brought together all previous laws under one act. Councils were now compelled to provide street lighting, clean water, drainage and sewage disposal. As part of this, Councils also had to employ Medical Inspectors. - The 1875 Sale of Food and Drugs Act introduced guidelines for the quality and sale of food and medicine across the country.

Answer 119

- measures to improve public health, it was a slow process. When Charles Booth investigated the East End of London in 1889 he found many people still living in appalling conditions of poverty and ill health.

Answer 120

Pasteur’s germ theory had finally proved the link between dirt and disease

Answer 121

In 1867 working class men had been given the vote. This meant that MPs were more likely to take notice of the needs of the people in their towns who were the main victims of poor public health

Answer 122

As a result of all these changes the government saw it could no longer leave important public health measures to individuals or councils. The government realised that it was in everyone’s interest to force towns to clean up

Answer 123

Education was improving. In 1870 the government made every local authority set up schools

Answer 124

From 1837 the giver collected statistics on births, marriages and deaths. William Farr used these to compile an accurate picture of where the death rate was highest and what people died of. He was able to prove, beyond any shadow of a doubt, a link between unhealthy towns which shamed some of them into action

Answer 125

In 1865 cholera came back again. With the link between the disease and dirty water proved once and for all by John Snow, and then explained by Pasteur’s germ theory. Ratepayers we’re finally prepared to take action clean up their towns

Answer 126

Look at Leeds - a major industrial town- for example. Until 1866 very little action had been taken. Then in 186b the town appointed its first Medical Officer of Helath. In the same year a pressure group was formed to force the council to act. It was backed by the local newspaper who publicly blamed the council for 2000 unnecessary deaths in Leeds each year. In 1870 a local firm got a court order to prevent sewage being pumped into the river from which it drew its own water. In 1874 Leeds had had its first sewage purification works. In other towns, throughout the country, similar changes were taking place, and towns began to compete with each other to be the cleanest

Answer 127

• Developed ‘germ theory’ by experimenting on the effects of microbes on liquids • Invented the process of ‘pasteurisation’ • First person to establish link between germs and disease/ infection • He built on Jenner’s work with vaccination and took Koch’s identification process and learned how to ‘grow’ vaccines in labs (rabies vaccine)

Answer 128

• Robert Koch 2 Further developed ‘germ theory’ by linking different microbes to particular diseases He used experiments to grow bacteria in laboratories and stained microbes to make it easier to identify them Identified the different bacteria causing deadly diseases like cholera, anthrax and Tuberculosis.

Answer 129

chemical or artificial substances that attack and destroy these microbes (attacking the infection without harming the rest of the body).

Answer 130

• Ehrlich had worked in Robert Koch's lab on the use of chemicals that would stain specific germs to make them easier to see under the microscope. • He reasoned that he could not only stain but also attack these germs if he could find a chemical that would both attach itself to the germ and kill it. A bit like the bodies own antibodies. • He called these chemicals ‘magic bullets’. (According to an old superstition, bullets could be charmed to make sure that they would hit a particular person). • Ehrlich intended that his magic bullets would hit the specific germ, but not damage anything else in the patient's body. • In 1907, Ehrlich and his co-workers began trying hundred of chemicals on the microbes that caused syphilis. They tried over 600 with no apparent success

Answer 131

• In 1909, Japanese bacteriologist Sahachiro Hata joins Ehrlich’s team and asked to retest the previous 600 compounds. • Hata found compound 606 did kill the syphilis germ and this drug became known as Salvarson 606. • Ehrlich feared that other doctors would give the wrong dosage, or that the drug might have dangerous side effects, so he ordered the repeated testing on hundreds of deliberately infected animals – he found that the drug always targeted the syphilis germ without harming the rest of the body. • In 1911, the Salvarson 606 was first used on a human patient. However....the patient died... it took another 20 years to find a magic bullet which was safe for humans to cure sypihllis.

Answer 132

• About 20 years later, in 1932, scientist Domagk, discovered that a bright red dye called PRONTOSIL killed bacterial infections in mice (he had tested this a number of times, but never on a human). • He was forced to test prontosil out when his young daughter pricked her finger on one of his infected needles in his laboratory. She became gravely ill, so he risked giving her the prontosil. • It worked! His daughter suffered no side effects. • The second Magic bullet had been discovered. And this time it cured the patient without harming them! • It was determined that SULPHONAMIDE was the important chemical which made the magic bullets work. This was developed into drugs like M&B 693 which killed disease like pneumonia. In fact this saved Winston Churchill’s life.

Answer 133

• Fleming was a scientist working on finding a ‘magic bullet’ to kill the staphylococcus germ • He accidentally left several petri dishes of the germ by his window when he went on holiday • Upon his return, he noticed the following... The Staphylococcus bacteria which had been left on the petri dish. Those germs far enough from the mould had survived, those nearer the mould had been killed off Mould This was probably grown in the lab above Fleming’s, and spores had floated out of the window and in through Fleming’s window, landing on the petri dish which had been left out

Answer 134

- In 1937 Howard Florey and Ernst Chain, working at Oxford University, began to research penicillin after reading an article by Fleming. Were given only £25 by the British Government - developed enough to experiment, at first, on mice in 1940. The following year they conducted their first human trial, a badly infected policeman (from being scratched by a rose bush). The trial showed that the penicillin worked to reduce the infection, but the man died after five days when their stock of the drug ran out. The trial showed success with the drug but that they needed to find a way of manufacturing enough penicillin for a full dose. - Instead, Florey and Chain went to the US government (not involved in the war until 1941) who gave them enough money to begin their experiments.

Answer 135

The progression of the war ended up providing a huge incentive to the development of the drug as a result of the scale of injuries that soldiers faced. In 1943 it was used for the first time on Allied troops in North Africa, with great success. America and Britain jointly produced huge quantities of penicillin and without doubt it saved many lives by 1944-45. Some have estimated that as many as 15% of wounded Allied soldiers would have died if they had not been given penicillin to fight their infections.

Answer 136

- After the war, it was widely used to treat many illnesses like bronchitis, impetigo, pneumonia, tonsillitis, syphilis, meningitis, boils, abscesses and many other kinds of wounds. - Fleming, Florey and Chain received the Nobel Prize for Medicine in 1945. Some argue, if it was not for the war, the pharmaceutical industry would not have developed as it did as a result of the growing demand for the production of penicillin. - As a result of the growth of the pharmaceutical industry, larger companies like GlaxoSmithCline and Beecham started to try to find other ‘wonder drugs’. Consequently, the money made from penicillin and other government sponsored programmes, funded further research and eventually developed medicines for other diseases. Other antibiotics soon followed penicillin, such as streptomycin in 1944, tetracycline in 1953 and mitomycin in 1956. Cortisone was developed in 1950 to treat arthritis. New vaccines emerged to treat polio and measles. Tranquilisers came on the market, birth control too. There were new pills to treat depression, psychosis, hypertension, you name it; it seemed that medical research and scientific medicine had the answer to every health problem. As a consequence, the pharmaceutical industry is estimated to be worth £200 - £300 billion today.

Answer 137

X-rays: • X-Rays had been discovered in 1895 by a German scientist called Rontgen. • By the December of that year, the London Royal Hospital were using x-ray machines to see if bones were broken. Blood transfusion: • Issues with blood loss had been a major cause of death and for centuries • Doctors had been looking for a way to give patients blood to make up for blood lost. • When people were given blood from another person, sometimes they survived and many times they did not • In 1900 Karl Landsteiner (Austria) discovered BLOOD GROUPS (proving some blood groups were incompatible with others) • However, Doctors could not work out how to store blood once it had been taken from a donor – it clotted

Answer 138

• Thousands of doctors taken away from their jobs to go and fight on the western front (especially after 1916) • Medical research was halted due to the focus on the war effort • War disrupted towns and cities, often damaging hospitals, medical schools and libraries • Medical advances delayed whilst the focus was on winning the war

Answer 139

The mental strain of war could cause psychological damage known as shell shock. Some shell shocked soldiers had panic attacks; others shook all the time or were unable to speak or move. To begin with, the British army refused to believe that shell shock existed and many of the men were treated as cowards. However, by the end of the war, there were so many cases that shell shock was officially recognised. Today the condition is known as PTSD, or post-traumatic stress disorder.

Answer 140

Although blood transfusions had been tried for centuries, it wasn't until 1900 that scientists worked out how to do them successfully. Karl Landsteiner discovered blood groups, which helped doctors to work out that a transfusion only worked if the donor's blood type matched the receiver's. Even then it wasn't possible to store blood for long because it clotted so quickly. As a result, many people still died from loss of blood, so a solution to the problem of storing blood was needed. In 1914, Albert Hustin discovered that glucose and sodium citrate stopped blood from clotting on contact with air. Other advances meant that blood could be bottled, packed in ice, and taken to where it was needed by surgeons operating on soldiers.

Answer 141

X-rays were discovered in 1895, and soon hospitals were using them to look for broken bones and disease. However, it was during the First World War that X-rays became really important. Mobile X-ray machines were used near battlefields to find out exactly where in the wounded soldier's body the bullets or pieces of shrapnel had lodged - without having to cut him wide open!

Answer 142

During the First World War, the hard work and dedication of Harold Gillies, a London-based army doctor, led to the development of what we now call plastic surgery. He set up a special unit to graft (transplant) skin and treat men suffering from severe facial wounds.. He is commonly recognised as one of the first surgeons to consider a patient's appearance when treating wounds. Queen's Hospital in Kent opened in 1917 and by 1921 provided over 1000 beds for soldiers with severe facial wounds. Gillies and his colleagues treated over 5000 servicemen by 1921.

Answer 143

Battlefields are very dirty places and lethal wound infections such as gangrene were common. Through trial and error, surgeons worked out that the best way to prevent this was to cut away any infected flesh and soak the wound in salty (saline) solution. This wasn't ideal, but as a short- term answer in a battle situation, it saved many lives.

Answer 144

New techniques were developed during the First World War to repair broken bones. For example, the Army Leg Splint (or Keller-Blake Splint) was developed, which elevated and extended the broken leg 'in traction. This helped the bones to knit together more securely. The splint is still in use today.

Answer 145

A doctor from New Zealand who trained and worked in Britain, Archibald McIndoe (a cousin of Harold Gillies). used new drugs such as penicillin to prevent infection when treating pilots with horrific facial injuries. His work on reconstructing damaged faces and hands was respected all over the world.

Answer 146

Shortages of some foods during the war meant that the government encouraged people to grow their own food. This improved people's diets because the food they encouraged civilians to grow - fresh vegetables for example - was very healthy.

Answer 147

During the war, over one million children were evacuated from Britain's towns and cities into the countryside. Many of the children were very poor and the cleaner, healthier, lifestyle they enjoyed in the countryside improved their health. The whole experience highlighted the levels of poverty endured by some children in Britain, and increased the government's commitment to improve things after the war.

Answer 148

Advances in storing blood in the years after the First World War meant it could be kept fresh and useable for longer. This led to the British National Blood Transfusion Service opening in 1938. Large blood banks were developed in both the USA and Britain during the Second World War.

Answer 149

Penicillin, the first antibiotic, was developed in the years leading up to the war. The British and American governments realised how important this new 'wonder drug' could be in curing infections in deep wounds. By 1944, enough penicillin was produced to treat all the Allied forces in Europe.

Answer 150

In order to keep Britain 'fighting fit, posters were produced to encourage people to keep healthy. They warned against the dangers of poor hygiene, for example. A national immunisation programme against diphtheria (a bacterial infection which killed many children) was launched too.

Answer 151

Heart surgery progressed during the Second World War. American army surgeon Dwight Harken, stationed in London, cut into beating hearts and used his bare hands to remove bullets and bits of shrapnel. His findings helped heart surgery develop greatly after the war.

Answer 152

When the Second World War broke out, the British government increased its involvement in medical care. After the war people started to think about how best to organise health care on a national basis. In 1942, a civil servant named William Beveridge proposed a free National Health Service for all - and just after the war finished, the NHS was born.

Answer 153

- An example of an antibiotics-resistant bacteria is MRSA (methicillin-resistant Staphylococcus aureus). - Several major scandals have caused a lack of confidence in conventional doctors and hospital care. E.g. Dr Harold Shipman murdered his patients and stole their money. - Alternative treatments consider the patient as a whole, instead of beating a disease down by finding the cause and then hitting it with drugs. - There is generally a greater interest in prevention rather than cure – ‘positive health’. An emphasis on is now being placed on healthy diet, exercise and life style. - The range of new drugs produced every year is huge but not all drugs work: even proven antibiotics fail. - Nearly every high street now includes its own health food shop where a wide range of alternative herbal remedies are sold. - Doctors are still not able to cure some diseases, such as viruses such as AIDS and the common cold. - - Cancer although treatable depending on the type – is still a major killer disease. - Some alternative medicine e.g. acupuncture is now available on the NHS. - Some antibiotics have been overused, prompting bacteria to evolve an become increasingly resistant to common antibiotics.

Answer 154

Fine needles are placed at key points around the body- the places link to the particular needs of certain illnesses. It has been a key part of traditional Chinese medicine for thousands of years.

Answer 155

The needles are said to release blocked energy and balance it properly. This allows the energy to flow again which stimulates healing and relieves pain. It has even been used as an anaesthetic during surgery.

Answer 156

This is where a therapist uses techniques to relax the patient – once fully relaxed the patient is then more susceptible to changing thought patterns and can be relieved of things like stress, allergies or addictions.

Answer 157

The treatment is completely centred on positive thinking and the power of the mind. The idea is that a patient’s state of mind can bring about their own healing.

Answer 158

Patients take a medicine (usually a plant, animal or mineral material soaked in water) which then causes similar symptoms to the actual illness for which they are being treated.

Answer 159

The idea is that tiny doses of the medicine that cause similar symptoms will cure or relieve the patient by stimulating their natural defences against the illness; similar to how a vaccination works.

Answer 160

It is the use of essential oils from flowers, fruits, roots nad leaves. The pls are usually inhaled or massaged onto the skin in order to absorb them.

Answer 161

The scents are said to stimulate particular points of the brain, which promote healing, whilst oils are massaged into the skin which then pass into the bloodstream. These can impact the nervous system, mental function and emotions.

Answer 162

Granted compensation for injury at work.

Answer 163

Introduced free school meals.

Answer 164

Created school medical inspections.

Answer 165

Maintenance payments to be paid to divorced women.

Answer 166

Made it illegal to sell alcohol, tobacco or fireworks to children.

Answer 167

Over 70s received 5 shillings a week, 7s 6d for a married couple.

Answer 168

Helped get people back into a job.

Answer 169

Made it illegal to build back – to – back houses.

Answer 170

Sick and unemployment pay introduced if you paid contributions into the scheme.

Answer 171

I am an army doctor, it is 1899 and a large scale recruitment campaign is taking place to find men to fight in the Boer War. Some of these men will not make it into the army. 40% of those that have volunteered are suffering from malnutrition and diseases such as rickets, caused by poor diet. It is clear that ill health is linked to poverty and that the government really needs to take action to raise living standards.

Answer 172

My name is Charles Booth, I am a ship owner and social investigator. It is 1903 and for the past 17 years I have been carrying out a survey into living conditions in the East End of London. I published my findings in Life and Labour of the People in London. I have discovered that one third of the British people live on incomes lower than 21s (£1.05) per week. I think that this is below the poverty line. They live in sub-standard housing and have a poor diet. If they fall ill they cannot afford to pay a doctor.

Answer 173

I am Seebohm Rowntree, a member of the chocolate manufacturing family. In 1901, I conducted my own inquiry in York and my findings are similar to Charles Booth’s. My study, Poverty: A Study of Town Life, has found that 28% of the population do not have the minimum amount of money to live on at some time of their life. This has really worried the British Government who are concerned that the unhealthy state of Britain’s workers could lead to the decline of the country as a great industrial power. This is particularly worrying given that Germany has a good system of state welfare for workers and is beginning to produce as much coal, iron and steel as Britain.

Answer 174

• Sir William Beveridge • Wrote a national report in 1942 about the state of the nation (Beveridge Report) • Argued that British people had a right to all be freed from the five ‘giants’ that could ruin their lives; idleness, want, disease, ignorance and squalor

Answer 175

• In the summer of 1945 the nation went to the polls in a national election... – The Labour Party (led by Clement Atlee) promised to follow Beveridge's advice – The Conservative Party (led by Winston Churchill) refused • The Labour Party won the election in a landslide victory and kept its promises... – Within the next few years, they put many of Beveridge’s reforms into place through introducing the Welfare State and the NHS (national health service)

Answer 176

• The name of the system in our country which helps those in need (old, sick, unemployed and children) • It aims to ensure that no one goes without the basic necessities of life like food, shelter, clothing, medical care, education etc because they can’t afford it • The government introduced the following as part of the creation of a ‘welfare state’: – The National Health Service (NHS) – A system of benefits – Raised the school leaving age – Programme of slum clearance & town planning

Answer 177

• The name of the health care system in our country (National Health Service) • It was set up in 1948 (introduced to Parliament in 1946) by the Labour Minister for Health, Aneurin Bevan – Son of a coal miner, he understood the hardships of poverty and sickness • He argued that medical treatment should be made available to all (rich or poor) on the criteria of need and nothing else • The NHS made all medial treatment (access to doctors, hospitals, ambulances, dentists and opticians free to all who wanted it)

Answer 178

- doctors were afraid they would lose their freedom and be unable to treat private patients who paid fees - some people still believed that the poor and the sick were poor simply because of laziness. They did not think they should be helped - some people thought that people would grow lazy because they were getting‘something for nothing’ and this would make people less likely to bother working - local councils and charities objected to the government takin over control of hospitals from them

Answer 179

- all workers had to pay for it through taxes, and over the years the cost of it rocketed - the NHS didn’t stay totally free for long; working people have to pay for doctors prescriptions and dental treatment - waiting lists seem to be getting longer - doctors and nurses are overworked - big media scandals such as ‘dirty wards’, ‘crumbling hospitals’ or ‘nurses doing long hours’ or a news headline such as ‘doctors strike in UK-wide protest over pensions’. - modern drugs and medicines are expensive and people live for longer, so more elderly (which use the NHS more than younger people). - even now life expectancy is still affected by wealth and living conditions

Answer 180

- although you have to pay for doctors’ prescriptions and dental appointments, the NHS ensures that no one is deprived from family services such as family planning, physiotherapist, child care, cancer screening, asthma clinics and minor surgery simply because they can’t afford it - women’s needs became a priority: 4 times more likely to see a doctor than men - life expectancy for women has risen from 66 to 83 since 1948, and for men from 64 to 79.

Answer 181

- The National Health Service (NHS) was set up in 1948 to provide health care for everyone. This made all medical treatment- doctors, hospitals, ambulances, dentists and opticians-free to all who wanted it. - A weekly family allowance payment was introduced to help with childcare costs. - The very poor received financial help or "benefits. - The school leaving age was raised to 15 to give a greater chance of a decent education, and more free university places were created. - The government's programme of 'slum clearance continued as large areas of poor-quality housing were pulled down and new homes were built. Twelve new towns were created and by 1948, 280,000 council homes were being built each year.

Answer 182

- Surgery using lasers, rather than a scalpel, has become increasingly popular since the first eye operation in 1987. Lasers are now increasingly used to treat a variety of skin conditions, help clear blocked arteries and remove tumors and ulcers and control bleeding. - In 1967 the first heart transplant operation took place. The patient survived for eighteen days. Now they are routine: in 2014, 181 heart transplants took place in the UK. - The development of key-hole surgery, using small fibre-optic cameras linked to computers, means surgeons can perform operations through very small cuts, negating the need to open a patient up. - Microsurgery allows surgeons to magnify the areas they are working on so they can re-join nerves and blood vessels – enabling sensations to return to damaged limbs. - Skin grafts (using a patient’s own skin from elsewhere on their body) had been commonly used but, in 1984, the first ‘skin farm’ was developed in a laboratory where large piece of skin was developed from tiny fragments.

Answer 183

- Technology has aided disease diagnosis. CAT scans, MRI scans and endoscopes (tubes inserted into the body which contain miniature cameras) all allow surgeons to see inside a person without the need to cut them open. - The discovery of DNA in 1953, and the subsequent ‘human genome’ project, have all enhanced the medical profession’s understanding of how the body works and how to make it better when it is malfunctioning.

Answer 184

- In 1961 the first heart pacemaker, a mechanical device that keeps the heart pumping blood around the body, was developed. - Throughout much of the 20th century, radiation therapy has been used to treat cancerous cells, making them easier to target as technology has refined the technique. - Hip replacements were introduced in 1972 and they have brought mobility to many who previously found walking difficult. - In 1978 Louise Brown became the world’s first test-tube baby, bringing hope to many couples desperate for a child. The use of IVF is now common amongst couples with fertility issues. - The first miniature hearing aid was produced in Britain in 1952.

Answer 185

- Technology has enabled, yet simplified, more complex surgeries and procedures (e.g. use of key-hole surgery or the use of fibre-optic cameras). - Technology has enabled earlier diagnosis and monitoring of disease and illness so leads to greater life expectancy.

Answer 186

- Many people argue that it is one thing to use medicine to treat someone if they are ill, but it is another thing to create life or go further than treatment. Medicine should only be used in a treatment form. - The use of greater technology has led to the increase of the illegal trade of organs which are stolen from people (usually in poorer parts of the world). - Technology has become so developed that it has enabled health care providers and doctors to ‘play God’ and extend/create life where it would not exist without such technological development. - Some governments have interfered greatly in science and medical development and sued this to their own advantage and to their own agenda (for example- the Nazis introduced compulsory sterilisation in order to dictate the gene pool of their nation). - Greater use of technology has enabled more procedures to be conducted but this has led to a greater demand for services. In turn, this has created waiting lists and frustrations amongst the public. - New drugs and new technology are often developed by private companies and is then too expensive for the NHS to use- creating a divide between those able to afford to use private healthcare and those only able to use the NHS. - Many new technological developments in health care and first tested and developed using animals (for example- cloning). Would the next step be to trial things on humans? Many such developments using humans are not legal.