Medicine Through Time

Question 1

What was medicine and public health like in Britain before the Romans in summary?

Answer 1

• The Ancient Greeks had developed an explanation for ill health based on the idea that it was caused by an imbalance in a person’s Four Humours. Treatment could be based on changes in diet, and encouraging the patient to exercise and take rest. However, treatment could also be bloodletting or purging by letting out excess humour.
• Many people relied on religion, by praying and carrying charms, herbal remedies were also used.

Question 2

What was medicine and public health like in Britain after the Romans came?

Answer 2

• In 1347, the Black Death arrived in Europe and approximately one third of the population died.
• The understanding of disease was very limited and people continued to base their treatments around Galen’s ideas. But discoveries in the 16^th and 17^th centuries began to improve the understanding of the body.

Question 3

When did the Romans conquer Britain?

Answer 3

43AD

Question 4

Why did the Romans become interested in improving public health but less interested in what caused disease?

Answer 4

They relied on healthy citizens for trading and farming therefore they needed a healthy empire however they thought that it was unnecessary to know about what caused disease.

Question 5

What did Romans bring with them which lead to major improvements in public health?

Answer 5

They brought a system of government which brought:

• Access to clean water
• Sewage systems
• Public baths

The Romans put emphasis on hygiene and fitness which meant that fewer people stood a chance to get ill.

Question 6

Even though the Romans brought new ideas to improve public health, there was a lot of continuity in treatment. What was still carried on?

Answer 6

• The use of Galen’s ideas such as bloodletting
• Herbal remedies
• Praying and charms

Question 7

Why didn’t the Romans help all citizens?

Answer 7

As treatments such as bloodletting which may have been the most sophisticated out of all the treatments was only done if you were able to afford for a physician.

Question 8

What increased the chance of disease?

Answer 8

More and more people moved into the towns, making them more crowded and therefore disease spread quicker.

As soldiers moved from country to country, there was a more likely chance of a pandemic adding to the chances of an epidemic.

Question 9

Overall what was the effect of the Romans?

Answer 9

They bought many changes to public health which lead to healthier people and an increased life expectancy however due to very little progress in treatment and medical understanding your chances of survival were no greater than before. Bloodletting was only afforded by the wealthy so not everyone’s health improved.

Question 10

Who influenced Roman medicine and what did he believe?

Answer 10

Hippocrates

He believed that disease wasn’t sent by God but had a physical, rational basis and therefore can be treated

Question 11

What was Hippocrates’ main ideas?

Answer 11

• A doctor should respect life and if he did not know how to treat something, he should not try anything harmful
• He developed The Theory of the Four Humours as an explanation for disease. If there was an excess of a humour it needs to be let out to prevent or cure an illness.
• He developed the Clinical Observation

Question 12

What does the Clinical Observation state?

Answer 12

• Study the patient’s symptoms and ask about how this illness had developed
• Make notes and use knowledge from similar cases to predict what would happen next.
• Once the predictions are accurate, correctly diagnose the illness and treat it, preferably through diet, exercise and rest

Question 13

What were the Four Humours?

Answer 13

Four different liquids of the body

• Blood
• Phlegm
• Yellow bile (sick)
• Black bile (blood in vomit)

Question 14

What did each humour represent?

Answer 14

(Refer to diagram and pic)

Question 15

How does the Four Humours identify when a person is suffering from illness?

Answer 15

The humours will become imbalanced.

Question 16

When did Claudius Galen work in Rome?

Answer 16

2^nd century AD

Question 17

What did Galen develop?

Answer 17

Using the Four Humours he developed the Theory of Opposites, eg. if you had a cold you should eat hot peppers

Question 18

How did Galen develop knowledge on how the body works?

Answer 18

By doing dissections on animals.

Question 19

Overall, what was Galen’s impact on medicine?

Answer 19

Many of his ideas were based on Hippocrates therefore there was a lot of continuity. He did dissections of animals and developed knowledge on anatomy however as it was on animals his findings weren’t entirely accurate. Due to him boasting about perfecting Greek ideas, he developed the reluctance in believing in new ideas in people to discover further in medicine.

Question 20

What were Romans ideas on the causes of disease?

Answer 20

• It was a supernatural reason; God has given a punishment for someone’s sin
• Bad air from swamps and other places with bad smells (they realised that hygiene was linked to health but didn’t know why)
• Caused by an imbalance of the Four Humours

Question 21

What did the Romans do when they needed treatment?

Answer 21

There were very few doctors therefore the majority was treated at home within the family. The wealthy who were able to afford a doctor would be treated at home too. There were a few hospitals but they were assigned to the wounded and injured soldiers. They were well equpped and provided excellent training for physicians and surgeons. However, very few hospitals were open to the public so they would have had very little impact on ordinary lives.

Many visited temples to offer prayers to God and often consulted with a priest. They also went to public baths as they believed that they had healing properties.

Pregnant women relied on other women to help them with child birth. Some women were very experienced and were used as midwives.

Question 22

Overall what were medical treatments and ideas like during the Roman era?

Answer 22

There were various supernatural as well as rational ideas about the causes of disease. Threatments were also a mix of supernatural and practical. A variety of people treated the sick but only a few used trained doctors as there were very few of them and they were expensive.

Question 23

What did Romans notice about disease?

Answer 23

That disease seemed to increase if you lived near bad smelling places such as swamps and therefore started building in much cleaner, and hygienic places. They believed in the theory of miasma (bad air causes disease) and also recognised a link between dirt and disease however could not explain it. They stressed on removing sewage and cleanliness.

Question 24

Was admission free to enter public baths?

Answer 24

No

Question 25

What were the functions of public baths?

Answer 25

• Social - places for people to meet for pleasure and discuss businesses.
• Hygiene - people kept clean here
• Exercise - they provided places for people to keep fit
• Medical - they believed that the water had healing powers so they visited regularly to get cured

Question 26

What did people do at public baths?

Answer 26

1. Before going to the baths, both men and women would do exercise.
2. Public toilets were less private than nowadays but waste was removed by the sewage systems and people washed hands with clean hands.
3. Baths came in various warm temperatures and oil massages were given and dirt was scraped off.
4. After having a warm bath, people will have a dip in a cold one.

Question 27

How were complex water systems used to transport water to towns and homes?

Answer 27

1. Fresh water form springs in the hills were transported to towns via pipes and aqueducts
2. Water was stored in reservoirs near towns
3. Pipes carried water from these reservoirs to public wells, baths, fountains or private houses of the rich.

Question 28

What were the set backs of the sewage systems?

Answer 28

Although the piped water and sewers were impressive and enabled people to stay healthy and prevent disease, in most towns there were open drains and when water supply was low there wasn’t enough sewers to work properly therefore waste built up and made disease more likely.

Question 29

What were the three main factors which made public health important?

Answer 29

• Government
• Army
• Communications

Question 30

How did government help with public health?

Answer 30

• They made the central decisions
• Organised large-scale projects
• Raised taxes to pay for projects and provided the manpower to carry them out

Question 31

How did the army help with public health?

Answer 31

• They needed a good standard of public health
• They had soldiers from all over the empire who brought different ideas and extra manpower
• During peacetime, they built roads, baths, sewers .etc

Question 32

How did communications help with public health?

Answer 32

• Good quality roads made travel which meant that communications were easier and quicker across the empire.
• Central control from Rome and regular changes of officials kept Britain up-to-date with new ideas.
• Knowledge and ideas spread as people travelled throughout the empire.

Question 33

What was the period with huge chaos after the Romans left?

Answer 33

410AD to 1000AD

Question 34

What happened after the Romans left?

Answer 34

• Loss of the Roman army
• Loss of one ruler or government
• Wars and chaos

Question 35

What happened with the loss of army?

Answer 35

• No one to maintain law and order amongst the locals.
• No engineers or builders to keep the public health systems in towns running
• No one to stop invasions

Question 36

What happened with the loss of one ruler or government?

Answer 36

• No control to commission or pay for public health schemes to be built or maintained.
• New rulers used money to expand kingdoms therefore didn’t use time or money for public health systems and education.

Question 37

What happened with wars and chaos?

Answer 37

• Led to destruction of towns therefore libraries and books got destroyed.
• Became more dangerous to travel so ideas and people did not spread.
• As people’s possessions and crops got destroyed poverty increased.

Question 38

What was the impact on medicine and public health when the Romans left?

Answer 38

Public health systems were destroyed by war and many left the towns. When towns started gradually growing back again, they became far more unhygienic therefore a more likely chance for a spread in disease. Also, trained physicians began to disappear as:

• Books and libraries with medical knowledge had been destroyed
• New rulers were illiterate and weren’t interested in educating doctors
• People no longer travelled far to obtain knowledge from elsewhere
• An huge increase in poverty meant that no one was able to afford for a trained physician

Question 39

When did Christianity’s importance increase?

Answer 39

After the Norman invasion when the Roman’s left in 1066

Question 40

What was England like when Christianity had grown?

Answer 40

• Christianity affected all over Europe
• Most priests were literate and senior churchmen were included among the king’s advisors
• Learning was preserved in libraries of monastries and convents
• Monastries and convents had an infirmarian who cared for the sick
• people were strongly into religion and accepted the Church’s authority over their lives
• Illness was a punishment from God

Question 41

Which were the two biggest changes between 50 and 1350?

Answer 41

The decline of public health systems and the growth of the importance of Christianity

Question 42

What period is known as the Middle Ages or the Medieval?

Answer 42

Between the ancient world and modern world

Question 43

What was treatment in the Middle Ages like compared with the Romans?

Answer 43

No big change as the Romans did not develop any understanding in disease and people in the Middle Ages took the idea of local herbs and praying to local Gods from the Romans and using trial and error, remembered successful remedies and repeated using them eventhough they did not know how they workes. For instance, honey. Most remedies were passed down by word of mouth but some were written in Leechbooks.

Question 44

What was the impact of religion and superstition on the Middle Ages?

Answer 44

People would say prayers and give offerings to God and may go on a pilgrimage to the holy shrine. Many may carry lucky charms or carry out a superstitious ritual. Scholars used astrology and linked it with the four humours eg. when to do treatments.

Question 45

What did richer people get treated by during the Middle Ages?

Answer 45

Physicians used Galen’s ideas such as bloodletting and also used herbs.

Question 46

What were the biggest health problems in towns caused by during the Middle Ages?

Answer 46

• Lack of clean water - latrines(toilets) were built over rivers where people got their water from
• No sewage removal - it remained in open drains and rivers
• The remains of butchered animals were left on streets and attracted rats.

Question 47

Why was London so unhygienic during the Middle Ages?

Answer 47

• Lead pipes had leaks which contaminated water
• Animal and human excrement on streets, butchered animals, no rubbish removal which attracted rats

Question 48

Why did the laws have limited affect during the Middle Ages?

Answer 48

As the systems weren’t developed well

Question 49

What were some of the attempts made to improve hygiene in towns during the Middle Ages?

Answer 49

• In 1281 pigs were prevented to enter the streets
• In 1347 the Sanitary Act tried to keep streets cleaner.
• In 1388 a parliamentary statute complained about the filth.

Question 50

On the other hand, how was hygiene like for the rich and others?

Answer 50

The rich had private latrines and lead pipes with a water supply and would bathe in a wooden tub.

Monks and nuns had fresh water piped to the buildings and latrines were built over running water.

Question 51

What happened after the town councils realised the importance of public health in the 15^th century?

Answer 51

London, Exeter and Bristol had supplies of fresh water running through pipes in some areas. There were also large baths called stewes which worked like large wooden tubs.

Question 52

Overall what was public health like in the Middle Ages compared to the Roman era?

Answer 52

In Roman times, the government provided a good standard of public health through the help of the army and taxes. It w’as different in the Middle Ages, there was little organised provision of water and sanitation. The rich weren’t affected as they afforded for a better quality of life, neither the peasants as they lived in villages which weren’t crowded. It was the poor in towns.

Question 53

What were doctors like during the Roman era?

Answer 53

They weren’t respected as many of their treatments did not work. Many doctors were foreigners therefore the Romans thought that they were trying to take advantage of them. Doctors hated Galen as he criticised their old methods and was a foreigner.

Question 54

How was a new doctor trained in the Ancient era?

Answer 54

• Alexandria in Egypt had a library which held medical knowledge from Egypt, Greece and India and was the main centre for medical training as people were allowed to dissect bodies.
• Many read books such as the Hippocrates Collection or worked with a successful doctor.
• Doctors were not examined and no organisation to follow up complaints against them.
• Anyone who wanted to be a doctor can just set up a business.

Question 55

What were doctor’s treatments based on until the 12^th century?

Answer 55

Roman medical knowledge, Christians monastries and convents turned into centres of learning and this is where later doctors gained their knowledge from.

Question 56

What was medical training like from the 12^th century onwards during the Middle Ages?

Answer 56

Some works which were studied were written by Muslim scholars. By the 13^th century, people could be doctors if they were able to prove that they completed several years of study.

Education and training was now controlled by the Church which strongly believed in Galen’s ideas, this meant that change was slow in ideas and treatment. Medical training was based on reinforcing Galen’s ideas and students were not encouraged to study anatomy or look for mistakes in his teachings

Question 57

Overall what was medical training like between the Roman period and early Middle Ages?

Answer 57

Nothing changed until the 12^th century when trade increased and economy improved, increasing learning. Universities and medical schools began to be set up in monastries and convents and training was more focussed. However the level of knowledge and treatments did not change very much due to the reluctance to accept new ideas.

Question 58

What were hospitals like during the Middle Ages?

Answer 58

Hospitals were run by monks and nuns as they believed that Jesus wanted his followers to care for the sick. As they believed that illness was a sign of a punishment from God they did not cure diseases but cared for them. Hospitals did not allow patients with infectious diseases or poeple who were in incurable conditions. However, the care which was given did actually make people get better. Food was grown, fresh fruit and vegetables and beds were positioned so that patients saw stained glass windows and religious statues to focus on religion. Some did not allow women unless over the age of 50 as they would distract patients

Question 59

What were almhouses and when were they set up?

Answer 59

14^th century and craed for the poor an old who were able to live under strict rules about behaviour and prayer.

Question 60

What was the treatment for leprosy like during the Middle Ages?

Answer 60

Leper houses were places for lepers to live and during this time leprosy was incurable. They were kept apart from others and had to carry a bell to warn people to stay away. Care was only provided in these houses, similarly during the plague, pest houses were set up.

Question 61

What was the role of religion on medicine and public health during the Middle Ages?

Answer 61

• Christianity became the main religion after the Romans left as the last emperor changed into a Christian making it an official religion.
• Controlled the training of physicians and preserved the ideas of Galen making it a source where you gained knowledge from.
• War destroyed other libraries, this was the only source.
• Affected the use of dissections not being allowed and not questioning Galen
• Prayers were said to get cured and the King’s Touch when a patient gets touched by the king he would cured.
• Care was given not treatment as illness was a punishment.

Question 62

What was the role of government on medicine and public health during the Middle Ages?

Answer 62

• Once the Roman empire collapsed, the new kings focussed on expanding and protecting the people and empire from empire therefore had little to do with medicine.
• In the Roman era, the goverment funded and organised a good system of public health after the collapse, public health fell.
• As towns grew and public health became more important, local authorities began to become more active.

Question 63

What was the role of war on medicine and public health during the Middle Ages?

Answer 63

• War caused the Romans to settle and they improved health and communications by bringing knowledge from Europe.
• A negative effect was that the fact that the Druids had a good understanding of using plants as herban medicines caused herbal remedies to be a major use.
• Once Romans left due to war, there was destruction to public works and people were less likely to travel and exchange knowledge therefore fewer chance of building knowledge and training.

Question 64

What sort of information should a historian be looking for in a useful source?

Answer 64

• What sort of information does the source give and how relevant is it to the enquiry?
• Does the source have any added weight because of its origins or intentions? eg. does it come from a person who was involved in the event it describes or represents?
• If the source gives you only one example, can you assume it is representative of the wider situation? eg. would all doctors at the time have behaved in the same way?

Question 65

What was medicine and public health like before 1350-1750 in summary?

Answer 65

• Beliefs about what caused disease and treatment changed very little since Roman times
• Roman’s public health system has collapsed and few attempts were made to improve it
• Church grew importance and controlled medical understanding and treatment

Question 66

What was medicine and public health like after 1350-1750 in summary?

Answer 66

• It was not until the late 18^thand 19^thcenturies were there significant advances in the understanding of illnesses and a greater use of science and technology.

Question 67

What was approximately the life expectancy in the 1350s?

Answer 67

30 years

Question 68

Who had a better chance of a higher life expectancy?

Answer 68

• Rich
• People who did not do manual work
• Had better diets

Question 69

What was death caused by?

Answer 69

illness, injury, poor living conditions and malnutrition

Question 70

When was the Black Death?

Answer 70

1348-1350

Question 71

How many people died during the Black Death?

Answer 71

Around 1/3 of the population

Question 72

What did people believe caused the Black Death?

Answer 72

• God was testing to see if they stayed faithful Christians
• An unusual positioning of the planets
• Poisonous fumes from earthquakes and volcanoes
• Miasma
• An imbalance in the Four Humours
• Foreigners or witches

Question 73

How did people avoid catching the Black Death?

Answer 73

• Carrying herbs to smell
• Carrying lucky charms
• Smelling bad smells
• Tidying rubbish from streets
• Lighting fire in room
• Ringing bells or keeping birds around the room to keep air moving
• Not letting people enter or leave areas

Question 74

How did people treat the Black Death?

Answer 74

• Praying and holding lucky charms
• Eating cool things and taking cold baths
• Bloodletting/purging
• Draining the pus or cutting open buboes
• Holding bread against buboes and burning it in ground

Question 75

What was the effect of ideas about the cause of the Black Death?

Answer 75

No effect at all as the ideas about treatment and prevention was inaccurate.

Question 76

What was a trained physician like?

Answer 76

• He had trained in medical school and passed exams
• Will diagnose urine and use atrology
• Does treatments based on Galen’s ideas
• Expensive
• Gets medicines from apothecary
• Lets barber draw blood
• Male

Question 77

What was an apothecary like?

Answer 77

• Trained using passed-down knowledge - no qualifications
• Makes own medicines
• Cheaper than physician
• Probably male

Question 78

What was a barber-surgeon like?

Answer 78

• Bloodletting
• Does basic surgery
• No anaesthetics - surgeries are of low success rate
• Not trained or respected

Question 79

What was a hospital like?

Answer 79

• Monastry or convent
• Cared for
• After reformation in 16^th century, free hospitals were set up

Question 80

What was a housewife-physician like?

Answer 80

• Knew traditional remedies for common illnesses eg. sore throats
• Deals with brpken bones and childbirth
• Uses charms, herbs and spells

Question 81

What was a prayer and pilgrimage like?

Answer 81

Many people will go on a pilgrimage to a holy shrine looking for a cure

Question 82

What was women and medicine like during the Middle Ages?

Answer 82

Most treatment was done by women at home, very few were also physicians however they weren’t allowed to attend universities which drove them out of the medical profession by 14^th century. They continued as midwives but had to get a licence form their bishop to prove that they were of good character.

Question 83

How much of change was there in treating the sick from the early Middle Ages?

Answer 83

Not much, in fact there was continuity due to Galen and the Church. The dominance of the Church continues therefore people still believed it was a punishment and therefore were only cared for. Education was still controlled with most collections of books being found in monastries. Medical schools taught Galen’s ideas and no one questioned them therefore physicians continued to base their diagnosis and treatment on the Four Humours.

Question 84

How did health treatment vary for the rich and poor during the Middle Ages?

Answer 84

There were many different choices for the rich but very few for the poor. There were few new treatments as there were few new ideas about the causes of disease.

Question 85

What is meant by the Renaissance?

Answer 85

Rebirth - it describes the period in European history when Ancient Greek and Roman ideas became fashionable again.

Question 86

What other things happened during the Renaissance?

Answer 86

• European exploration in Africa and America led to new attitudes and a search for knowedge - new plants on new lands
• Reformation led to the decline in Church’s authority eventhough many stayed religious - reluctance to accept new ideas.
• There was a scientific approach of testing and recording details, questioning old ideas and sharing results with others.

Question 87

How did the Royal Society in 1660 help with medical progress?

Answer 87

With King Charle II’s approval and support, the society had its own laboratory and latest scientific equipment so that members can experiment and show discoveries. They published regular accounts on ideas which helped spread ideas.

Question 88

What were the new inventions during the Medical Renaissance?

Answer 88

• Pumps and clocks which helped people accept the idea that the body functions as a machine
• Leeuwenhoek developed better lenses for microscopes and discovered bacteria calling them animacules in a letter to the Royal Society in 1673.
• Most importantly, the printing press - copies of books and journals could be produced more quickly and cheaply in ordinary language (English) so that physicians could learn from each other.

Question 89

What happened in 1543?

Answer 89

Andreas Vesalius, Professor of Durgery at Padua University published a book called The Fabric of the Human Body. This included drawings of muscles, nerves, organs and skeletons on the human body based on human dissections due to the Church losing its authority. Human dissections meant that Galen’s ideas were proved wrong.

Question 90

What happened in 1628?

Answer 90

William Harvey also found errors in Galen’s ideas and published an explanation of his ideas in An Anatomical Account of the Motion of the Heart and Blood in Animals.

Question 91

Name two ways (each) in which Harvey and Vesalius proved Galen wrong.

Answer 91

Question 92

What was the impact of Vesalius and Harvey on medical treatment?

Answer 92

Both Vesalius and Harvey used the scientific method to investigate how the body works and this helped other physicians also begin using the scientific approach to diagnose and treat people. However it took over 40 years for Harvey’s ideas to be accepted by other doctors and be taught at medical schools as many were resistant to change and especially as most doctors still based their training around Galen’s ideas and did not carry out dissections themselves. Further, Vesalius’ and Harvey’s work was based on anatomy and physiology rather than the cause and treatment of disease therefore weren’t that relevant and had limited impact.

Question 93

What was the impact of the Renaissance on doctors’ training?

Answer 93

• Improved technology eg. microsocopes, thermometers
• Improved knowledge on anatomy and physiology through Vesalius and Harvey
• Growing acceptance that physicians should carry out dissections themselves
• Introduction of some medical schools and teaching hospitals
• Growing importance of a scientific approach - observation of symptoms and experiment with treatments.

Question 94

Why was John Hunter important in medical progress?

Answer 94

• His lectures on anatomy helped to develop a more professional approach towards medical training
• He emphasised the importance of the scientific method
• His students included Edward Jenner who followed his methods
• He hired people to write up notes and draw the discoveries he made through dissection
• He published important works such as about the changes which occurred in pregnancy
• He set up an own medical school with his brother which gave intense training

Question 95

Overall, what was the impact of the Renaissance on doctors and training in summary?

Answer 95

The Renaissance brought new advances in knowledge of the body and emphasised on the scientific approach. This began to improve training which can be seen towards the end of the 18^th century. However doctors still had limited ability to treat disease.

Question 96

What attempts were made to improve public health provision?

Answer 96

• Some local authorities paid for piped water
• Some towns had public baths
• Richer people had own latrines which ran into a cesspit
• Some towns had public latrines to prevent excretion on streets

Question 97

Why was there such a little impact on progress in public health even when the town councils took action?

Answer 97

Even though people were fined when they broke rules, no one expected the local authorities to organise rubbish removal and people had to pay for their cesspits to get emptied. They did not expect the government to make laws or increase taxes and as local individuals had to pay, people did not bother.

Question 98

How did London get clean water?

Answer 98

In the 13^th century, lead pipes were laid to bring water from the River Tyburn but this water was polluted so people drunk ale instead. Two men Colthurst and Myddleton helped improve the situation.

• Colthurst suggested constructing an artifiical river from the River Lee in Hertfordshire.
• He only completed two miles due to financial difficulties so Myddleton took over
• James I payed half the cost and the project finished

Question 99

What did the artificial river help with?

Answer 99

Fresh water was available in parts of North-east London but unfortunately supply could not keep up with growing population. By 1750, most water was supplied by private companies which were turned on at set times each day.

Question 100

What was sanitation like between 1350 and 1750?

Answer 100

• Toilets were usually wooden seats above cesspits and people wiped themselves with leaves or moss. These may be shared by several families and ash was scattered over sewage to keep the smell down.
• Inside the house, people used chamber pots which were emptied into the drain in the middle of the streets or they might just pour it out of the window without watching.
• The rich eg. Henry VIII had someone to wipe his bottom. The waste was emptied into brick-lined drains and then into the River Thames.

Question 101

Overall, what were the problems in public health between 1350 and 1750?

Answer 101

Public health became a problem for the local authorities as towns gre bigger. There were some improvements in clean water but it was not organised and was not paid by the authorities therefore there was little change in dealing with sewage.The link between health and hygiene was not very clear.

Question 102

When was the Great Plague?

Answer 102

1665

Question 103

How many people did it kill?

Answer 103

Around a quarter of the population

Question 104

What laws were passed to try and prevent the Great Plague?

Answer 104

• Theatres were closed to prevent crowd gatherings and large funerals were banned
• Dogs and cats were killed
• Barrels of tars were burned in the streets
• Dead bodies were collected and buried in the deep in the ground at night
• Fasting and prayers

Question 105

Why didn’t isolation work with the Great Plague?

Answer 105

Because this disease was not spread by human contact but was carried by fleas on rats.

Question 106

Why is the role of government important in public health provision?

Answer 106

They have the power to pass laws to bring about changes.

Question 107

What was the problem of gin?

Answer 107

In the 18^th century cheap gin was having a bad effect on the poor. The government passed laws to make gin expensive this was partly to improve health but also due to the economy as they did not want workers to be drunk. The increase in price reduced death rate from excessive drinking.

Question 108

Overall how much did medicine change between 1350 and 1750 in summary?

Answer 108

There were some important changes in knowledge of the body but there was a great deal of continuity especially in the ideas about illness and medical treatments that were used.

Question 109

What was medicine and public health like before 1750-1900?

Answer 109

People did not know what caused diseases to dpread and medical treatment was based on theories such as the Four Humours or miasma. During the Reformation the influence of the Church declined and the understanding of the body began to develop based on a more scientific approach towards understanding and knowledge.

Question 110

What was medicine and public health like after 1750 and 1900?

Answer 110

The role of science and technology improved the ability to diagnose and treat disease. There was also emphasis on the prevention of disease through vaccinations, genetic research and changes in lifestyle. Government took on a wide range of responsibilities for public health and women became more involved.

Question 111

What period is known as the industrial revolution?

Answer 111

The period when London became hugely industrialised and there were manny changes in the way people worked and lived.

Question 112

What caused disease to spread quickly and a low life expectancy in the mid-18^th century?

Answer 112

• Conditions in factories were extremely poor, eg. poor ventilation
• Often accidents in factories due to machinery
• Housing was of poor quality and were damp with poor ventilation
• Living conditions were cramped often shared by several families
• Sewers ran into rivers where people collected water
• In towns and cities, there was less access to fresh food than rural areas

Question 113

What were the ideas about the causes of disease between 1750 and 1900?

Answer 113

• Miasma - disease was caused by bad air filled with poisonous fumes from rotting matter
• Spontaneous generation - disease caused by germs produced by flesh and vegetables when they rot

Question 114

How does cholera spread?

Answer 114

Through bacteria passed on by contaminated food and water by excreta of an infected person

Question 115

How many sufferers died due to cholera?

Answer 115

2/3 of population

Question 116

How is smallpox spread?

Answer 116

By touch or through tiny droplets from sneezing or coughing

Question 117

How many sufferers died due to smallpox?

Answer 117

1/3 of the population

Question 118

What were diseases like during the late 18^th century and early 19^th century?

Answer 118

Epidemics of infectious diseases killed many people especially in towns where disease spread quickly. There were new diseases such as cholera which were frightening.

Question 119

Where did inoculation come from and what was the process?

Answer 119

In China

1. A small amount of pus is taken from a sufferer’s smallpox blister.
2. It is spread into a small cut made between the thumb and forefinger of the person being inoculated.
3. A mild version of smallpox develops and the person survives and is now immune to any further attacks.

Question 120

Who spread the idea in Britain?

Answer 120

Lady Mary Wortley Montagu

Question 121

Why didn’t inoculation completely solve the problem?

Answer 121

As not everyone was able to afford for it.

Question 122

What chance played a role in Edward Jenner’s discovery of vaccinations?

Answer 122

He met a milkmaid called Sarah Nelmes who told him that if you caught cowpox you did not catch smallpox and prompted to start his discoveries.

Question 123

How did he test his discovery using a scientific method?

Answer 123

He took some cowpox matter from a blister on the arm of Sarah Nelmes and inserted it into two cuts made into James Phipp’s arm. He felt chilly and had mild side effects. When Jenner injected small pox into him, he was fine. He repeated this a few months later and also tried it on other people.

Question 124

What was the role of government in Jenner’s discovery?

Answer 124

• Napolean and President Jefferson in the USA spread the discovery thinking that vaccination was a great breakthrough.
• Government provided a grant for free vaccinations so everyone was able to afford it
• In 1852, the government made it compulsory
• In 1871 it was enforced

Question 125

When did Jenner publish his ideas?

Answer 125

In 1798

Question 126

What was the role of communication in Jenner’s discovery?

Answer 126

• He printed pamphlets for other scientists to read with his experiments clearly explained so that they can check too

Question 127

What was the role of scientific method in Jenner’s discovery?

Answer 127

• He used the scientific method by doing a number of tests

Question 128

What were the set backs in Jenner’s discovery?

Answer 128

• He could not explain the link between cowpox and smallpox. It did not work for other diseases.
• The procedure was not always successful as some doctors did not carry it out carefully.
• Many doctors opposed his work as they lost money

Question 129

What happened when the British government enforced compulsory vaccinations in 1871?

Answer 129

The number of smallpox cases dropped dramatically and the World Health Organisation in 1979 announced that smallpox had been completely wiped out.

Question 130

Why was Jenner’s discovery important?

Answer 130

It was an important way in preventing smallpox and saved many lives but his methods could not be applied to other diseases.

Question 131

What did many people at the time think about getting inoculated with cowpox?

Answer 131

They thought that they will turn into cows.

Question 132

What was Louis Pasteur investigating in the 1850’s and what did he discover?

Answer 132

The problem of liquid turning sour in the brewing and vinegar industries.

He discovered that heating a liquid killed the bacteria and stopped liquids turning sour and published the germ theory in 1861.

Question 133

What did his germ theory state?

Answer 133

There were microbes in the air which caused decay and proved old theories wrong, By using a sealed container with matter stored in it he proved that microbes caused decay and weren’t produced from the matter itself.

Question 134

What further discovery did he discover?

Answer 134

In 1879, he was studying chicken cholera microbes. By chance, a culture of this bacteria was left and became weakened and Pasteur realised that this could be used as a vaccine for chickens.

Question 135

What factors affected Pasteur’s work?

Answer 135

• Government - government funded money to help him with the experiments
• Industry - he used the liquids in brewing industries
• Technology - more powerful microscopes helped him identify bacteria
• Role of individuals - he used Jenner’s work to help him with the vaccinations, worked in a team
• Scientific method - he tested his ideas, worked in a team to check ideas

Question 136

What did Robert Koch discover?

Answer 136

That bacteria were linked to disease. Working with his team with money funded by the government he identified specific microbes that caused anthrax ins heep, TB (1882) and cholera (1883). He found chemical dies to stain specific bacteria so that they can be studied more easily under a microscope.

Question 137

What was the significance of the germ theory?

Answer 137

It disaproved the theory of spontaneous generation and led Koch to identify specific bacteria. It improved understanding in the cures of disease which helped with prevention and treatment. He realised that by using a weakened version other diseases can be prevented. However each disease had to be reasearched separately to identify the microbe which causes it.

Question 138

What was the overall impact of the germ theory?

Answer 138

It was an important breakthrough in scientific knowledge and understanding. However had limited impact at the time as each disease had to be reasearched individually therefore progress in prevention and treatment was slow but eventually led to chemical cures.

Question 139

What was the importance of research teams?

Answer 139

• More likely to have funding
• Able to afford expensive new technology
• Check other’s work
• Large-scale testing
• Varied knowledge

Question 140

What were doctor’s qualifications like between 1750 and 1900?

Answer 140

In the 18^th century doctors were able to set up practices once accepted by the Royal College of Surgeons, Physcians or Society of Apothecaries.

It began to improve after 1815 when examinations were introduced. In 1858 the General Medical Act stated that all qualified doctors had to be registered at a General Medical Council.

However, as they were only able to still do little to treat disease they weren’t always respected.

Question 141

What was practical experience like between 1750 and 1900?

Answer 141

This was improved by observing doctors as they worked, volunteering at charity hospitals, working under the supervision of an experienced doctor.

Question 142

What were dissections like between 1750 and 1900?

Answer 142

Many students recognised the importance of dissections and resulted with body snatchers in the 18^th and early 19^th centuries - seizing bodies of hanged criminals or digging up newly buried corpses. To stop this the government brought the Anatomy Act of 1832 which allowed licensed anatomists to take corpses of anyone dying in the workhouse and not being collected by a relative.

Question 143

What theory did Florence Nightingale believe in?

Answer 143

Miasma

Question 144

How did she play a huge role in treatment in hospitals?

Answer 144

• War occurred in Crimea and therefore with a team to crimea by the government to serve the wounded.
• Hospitals across Europe had cramped, stuffy wards, few toilets, poor sewage systems - spreading diseases quickly
• Nurses were criticised of being drunk and weren’t trained

Changes she made:

• New wards built and were scrubbed regularly, sheets and towels boiled, good food, spacious, light, well-ventilated wards

Question 145

How did she play a huge role in nurse training?

Answer 145

• She trained nurses
• She set up a nursing school and wrote a book called Notes on Nursing in 1859 and Notes on Hospitals in 1863.

Question 146

What was the impact of the improvements Nightingale brought?

Answer 146

• The number of deaths fell from 42 percent to 2 percent
• Due to disbelief in germ theory nursing schools only concentrated on training nurses in very practical skills. Continuity as doctors aren’t allowed to teach germ theory, only miasma.
• Better training meant that aspects of medicine which needed trained nurses such as surgery improved.

Question 147

What other factors helped in Nightingale’s contribution?

Answer 147

• Technology - new engineering technique to build the new sewers .etc
• Government - enforced government laws on public health meant something had to be done
• Communication - newspapers allowed her works to be reported back to Britain which helped her gain money and build a nursing school.

Question 148

When was John Lister present?

Answer 148

Between 1827 and 1912

Question 149

What problem did he tackle?

Answer 149

The problem of patients dying after surgery

Question 150

After reading Pasteur’s works what did Lister discover?

Answer 150

That bacteria might be causing the problem therefore he decided to use carbolic spray to kill these bacteria. Therefore he discovered antiseptic surgery in 1867

Question 151

What was the impact of his discovery?

Answer 151

• In the short term, many of his patients survived, his ideas spread and were used by many doctors however at first his discovery wasn’t accepted due to the reluctance to accept new ideas; fell from 46 to 15 percent
• In the longn term, other doctors built on his ideas hence hospitals and operating theatres became much cleaner places. All medical instruments were sterilised and longer and more complicated operations became possible.

Question 152

What improvements were made in hospitals and the care for the sick between 1750 and 1900?

Answer 152

• There were around 300 hospitals which provided nursing care along with medical treatment from local GP’s.
• There were around 18 voluntary hospitals where services were given for free.

Question 153

What were the set backs in the care for the sick between 1750 and 1900?

Answer 153

• Hospitals were funded by individuals or subscription
• How you were treated depended on how much money you had.
  
  • The middle and upper classes were treated at home by a doctor
  • Some doctors set up sick clubs and people had to pay a small amount weekly to cover the cost of treatment
  • The working class attended the dispensary or out-patients department of a hospital
  • The old, sick and disabled had to enter local workhouses which had been set up by the Poor Law Amendment Act in the 1860s

Question 154

What was public concern about care for the poor like?

Answer 154

There was a lot of publciity on the care given to the old, disabled, mental health patients, unemployed poor

Louisa Twining established a campaign for workhouse reform and improving the standard of nursing.

Question 155

How did public concern help improve the quality of life in hospitals?

Answer 155

They were pressurised as they did not want a bad reputation therefore hospitals had to improve the provision of hospital care.

Question 156

What did the Poor Law Unions order in 1867?

Answer 156

• To build infirmaries which were separate from workhouses and had a fulltime doctor, these should be payed by local rate-payers
• New asylums for mental health issues
• Fever houses for patients with infectious diseases

Question 157

What changes were brought due to the improvements brought by the Poor Law Unions?

Answer 157

Even though they were built, people still stayed in workhouses eventhough care improved. Infirmaries and fever hospitals and asylumsrun by the local authorities dealt with far more patients than the voluntary hospitals

Question 158

Overall, what were the hospitals and the care for the sick like in summary?

Answer 158

By 1900, it was recognised that hospital care had to be improved. The standard of care in workhouses was rising. This meant that the differentiation between the classes reduced and the care was more or less equal. However, not all areas got affected and hospitals weren’t still funded by the central government

Other factors which helped hospitals:

• Nightingale
• Lister
• Pasteur

Question 159

What were used to prevent and/or treat cholera?

Answer 159

• Praying and carrying lucky charms
• Burning barrels of tar in streets to create smoke
• Making special mixtures
• Smoking cigars

Question 160

How did Edwin Chadwick help improve public health?

Answer 160

By helping the working-class. In 1842, he published his results on a survey called, Report on the Sanitary Conditions of the Labouring Population of Great Britain. He suggested that it would be cheaper if local authorities used their taxes on improving housing and hygiene rather than supporting the sick in workhouses. Suggestions were improving cleanliness of water and removing sewage and rubbish.

Question 161

Why did several criticise his suggestions?

Answer 161

• There was an attitude of laissez-faire so government did not interfere in ordinary lives
• The water companies objected as they thought the changes might reduce their profits
• Middle-class did not see why they should help the poor when they don’t pay towards these improvements

Question 162

What happened to Chadwick’s ideas?

Answer 162

• It did gain attention in 1842 but little was done and some did not accept them and became known as the Dirty Party
• His ideas were only tried out in the first cholera epidemic in 1848

Question 163

What did Dr John Snow investigate?

Answer 163

The theory that cholera was spread through contaminated water during the next outbreak in 1854.

Question 164

What did Dr John Snow do to prove his theory?

Answer 164

He marked on the map all the deaths that occurred and recognised a link. Many deaths occurred near Broad Street, there was a pump where people got their water from which had a leakage from the sewage. He removed the handle and the number of deaths dropped dramatically.

Question 165

What were the impacts of Chadwick’s and Snow’s discoveries on public health?

Answer 165

Chadwick’s report lay a basis for reform and Snow proved a connection and added weight to the need for better public health. He disapproved old preventions and led to a vaccine being created in 1879.

Question 166

What did the Public Health Act of 1848 allow towns to do?

Answer 166

• Set up their own local Board of Health
• Appoint a local medical officer
• Organise the removal of rubbish
• Build a sewer system

Question 167

Why didn’t the Public Health Act of 1848 work?

Answer 167

Towns weren’t forced so they did not bother to pay money

Question 168

What prompted further action on public health?

Answer 168

• Snow’s work proving the link between water and cholera
• Pasteur’s germ theory showed her disease spread and why hygiene was important
• Snow proved that death rates varied according to water sources
• William Farr showed that death rates were much higher in towns and cities rather than villages

Question 169

What pressurised the local councils to take action?

Answer 169

• Another cholera outbreak in 1866 - least affected towns with improvements in public health
• When working class men in 1867 got the vote and put pressure on government and local councils.

Question 170

What did the 1866 Sanitary Act do?

Answer 170

Forced all towns ti appoint inspectors to check water supplies and drainage

Question 171

What did the 1875 Artisans Dwelling Act do?

Answer 171

Gave local authorities the power to buy and demolish slums

Question 172

What did thr Sanitary Act and Artisans Dwelling Act lead to?

Answer 172

The Public Health Act of 1875

Question 173

What did the 1875 Public Health Act do?

Answer 173

Made local councils responsible for ensuring that the following was provided:

• Clean water
• Public toilets
• Rubbish removal
• Sewers and drains
• Appoint Health and Sanitary Inspectors
• Medical Officer of Health

Question 174

What did local councils also become responsible for in the years after 1875?

Answer 174

• Checking the quality of food in shops
• Ensuring that the quality of new housing was improved
• Enforcing a new law against polluting water supplies

Question 175

Despite the public health checks by the local councils what was still in the hands of private companies?

Answer 175

Basic services such as water, lighting and paving

Question 176

Overall, what was government action in public health like in the second half of the 19^th century?

Answer 176

There was a greater acceptance of the need for action by central government and local authorities to improve public health. Change was rapid and far-reaching.

Question 177

What was the Great Stink?

Answer 177

There were plans being made for a new sewage system in 1858 however as the weather was extremely hot, the level if the River Thames decreased leaving an enormous smell from exposed sewage along the banks.

Question 178

How did the Great Stink prompt government to take further action on public health?

Answer 178

Hanging sheets soaked in disinfectant to cover up the smell wasn’t strong enough and this added to the outbreaks of cholera and the work of Chadwick.

Question 179

What was Joseph Bazalgette known for?

Answer 179

Building new expensive sewer systems which meant uncontaminated water and less chance of a cholera outbreak,

Question 180

What was the role of industry and technology in public health between 1750 and 1900?

Answer 180

People had learnt the best ways to design pipelines, tunnels and embankments. In 1865 a pumping station was installed which pumped water through London’s sewage and these factors accelerated change in treatment and prevention.

Question 181

What were the elements of continuity between 1750 and 1900?

Answer 181

• Still resistance to change which makes advances in medicine slower - Jenner’s vaccination
• Still pray
• Lack of complete understanding in how germs cause disease
• Few people had access to doctors and medical care - rich

Question 182

What were the elements of change in hospitals between 1750 and 1900?

Answer 182

• Wooden floors for easy cleaning
• Tidy and orderly appearance
• Clean sheets
• Big windows for light and ventilation
• Nurses have a central role on the wards; in uniforms
• Parents and visitors not allowed to help with patient care, visiting is restricted

Question 183

Overall how much change was there between 1750 and 1900?

Answer 183

Quite a lot of change took place especially in the understanding of causes in diseases and however there were still few elements of continuity. It was known that germs caused disease but there wasn’t a complete understanding on why. People were still resistant to change and prayed and not all people had access to doctors or medical care - only the rich did. There was rapid industrial changes at the start early 19th century but this helped to find out ways of preventing and understanding disease and the government became more involved.

Question 184

What did Karl Landsteiner discover?

Answer 184

In 1901 he discovered there were 4 different types of bloof groups and that transfusions were only successful if the donor’s and patient’s blood groups were the same

Question 185

What was medicine and public health like at the beginning of the 20th century?

Answer 185

People still worked in cramped and unhygienic conditions. Despite the medical advances such as more vaccinations being created, there was little progress in the cure of diseases and many medicines still used plants. Most people weren’t able to afford for medical care. Life expectancy was still low - 47.

Question 186

Give the dates of when these vaccines were developed:

• Tuberculosis
• Diptheria
• MMR
• Cervical Cancer

Answer 186

• 1906
• 1913
• 1988
• 2008

Question 187

What was the first magic bullet?

Answer 187

Salvarsan 606

Question 188

How was the first magic bullet developed?

Answer 188

• Emil von Behring developed Koch’s work to isolate antitoxins and found a way to inject them to cure diseases
• Paul Ehlrich knew that certain dyes stained specific microbes from Koch and that antitoxins only attacked disease microbes from Behring
• He tried combining a dye with other chemicals to cure syphillis. This was a magic bullet which only harms the microbe not the body.
• He researched and this was only due to German funds
• Dr Sahachiro Hata from Japan discovered that the 606th compound tested was actually effective and this was called Salvarsan 606.

Question 189

What and when was the second magic bullet discovered? Who discovered it?

Answer 189

Prontosil in 1932 by Gerhard Domagk

Question 190

How was the second magic bullet discovered?

Answer 190

Domagk discovered a red dye which was effective against some cases of blood poisoning and developed the drug Prontosil. Many died of cuts so this saved many lives.

Question 191

What did the discovery of Prontosil lead to?

Answer 191

It contained the ingredient sulphonamide which led to other drugs being based on this chemical to cure against disease such as meningitis and scarlet fever. These saved many lives and now the pharmaceutical industry began to grow rapidly as the technology in the late 19th century had made it possible to mass produce drugs. The magic bullet is the first synthetic cure for many diseases.

Question 192

What was Alexandra Fleming’s discovery in 1928?

Answer 192

Penicillin

Question 193

How was penicillin discovered?

Answer 193

A culture of bacteria growing in a petri dish was getting killed by a mould and he discovered it was an antibiotic

Question 194

When did Fleming publish his results?

Answer 194

1929

Question 195

Who continued Fleming’s discovery? What were they aiming to do?

Answer 195

Howard Florey and Ernst Chain

Mass produce penicillin

Question 196

How did they mass produce this antibiotic?

Answer 196

• By chance they began to learn about Fleming’s research
• In 1940 and 1941 they tested the drug on mice and on a patient and it was effective but it ran out so the patient died
• In order for penicillin to be grown it needed to be cultured and exposed to air and this needed a lot of equipment and assistants
• As the British were busing on creating weapons and many factories were destroyed by bombing raids during the Second World War, there was no firm which was able to create the technology and the government wasn’t prepared to fund Florey.
• In June 1941 Florey and Norman Heatley went to the USA to see if they could receive funding there.
• In December 1941 the USA entered WW2 and as they needed something to help cure their soldiers they accepted to fund them for the mass production of penicillin.
• Florey managed to find a way to preserve and purify penicillin more effectively and this needed to be done at low temperatures.
• In 1944 the freezer company Pzifer helped to develop the freeze-drying method by using an ice-cream freezer

Question 197

Why did it take so long for penicillin to be mass produced?

Answer 197

• Fleming refused to continue the research as his main research was on typhoid and he was unable to receive funding. He also focussed on why and how penicillin killed bacteria not how to purify and mass profuce it.
• It took 10 years for this research to begin again by Florey and Chain
• They had to travel to the USA and find funding as the UK couldn’t fund which took a long period
• It took 3 years for a way to preserve penicillin came in use

Question 198

What made Francis Crick and James Watson to further investigate the structure of DNA?

Answer 198

• Mendel’s discovery on how characteristics were passed down from one generation to the next in 19th century.
• The technique of crystallography and elctron microscopes and x rays helping scientists to take photographs of cells in the 20th century.
• DNA was dsicovered that it controlled genes and set codes for human characteristics
• Scientists had to work out how these codes fitted together in DNA to be able to identify what genes for resposible for what conditions

Question 199

Who helped Crick and Watson in their discovery of the double helix structure?

Answer 199

Wilkins and Rosalind’s use of crystallography - Rosalind’s photoes suggested this structure

Question 200

How has Crick and Watson’s discovery led to new cures for genetic conditions?

Answer 200

• 1953 Crick and Watson discovered the structure of DNA
• 1990 The Human Genome Project led by Watson mapped out every single gene in the 23 chromosomes in every cell of the body
• This included 100s of scientisys and the first draft was produced in 2000
• Scientists have identified certain genes that pass on specific hereditary conditions

Question 201

What was the result of the DNA helix structure discovery?

Answer 201

• There are new techniques for better production of insulin for diabetes amd better vaccines
• There is a better understandingof condition such as Down’s syndrome and whether people are more likely to develop a certain form of cancer
• Further research to develop teachniques to alter faulty genes and preventing genetic diseases from developing
• Discovery of stem cells which can replace faulty cells with healthy ones

Question 202

Give examples of areas of current research using DNA

Answer 202

• Breast - repair faulty genes indentified for causing breast cancer
• Heart - modify cells in bone marrow to send out stem cells more quickly to repair damaged tissue from heart attacks

Question 203

What has scientific research in the 20th century led to?

Answer 203

• chemical treatment of disease - magic bullets
• antibiotics - using natural living organisms to treat disease
• more vaccines to prevent disease
• a better understanding of genetics
• tretaments being developed for conditions such as diabetes

Question 204

How have science and technology helped medicine?

Answer 204

These have had a huge impact on medical research, diagnosis and treatment but rely on the developments in technology.

Question 205

What did Landsteiner’s discovery mean?

Answer 205

• People who might die from losing a lot of blood could now be kept alive
• People with blood disorders such as anaemia could receive treatment

Question 206

What was the problem with blood?

Answer 206

It could not be stored as it clotted so the donor and patient had to be together for the transfusion to take place

Question 207

What was the solution to the problem of blood? What sped up the search for a solution?

Answer 207

In 1915 it was discovered that adding sodium citrate to blood prevented it from clotting but the cells soon deteriorated. In 1916 blood banks were established to store blood for longer periods.

WW1 sped this up as soldiers needed to be treated.

Question 208

Give examples of technologies which have helped medicine progress.

Answer 208

• Scans - x-ray machines were the first scanning machines and now MRI, CT and ultrasound scans can be used. These can be used to scan a patient and diagnose internal problems. eg. ultrasound can be used to study an unborn baby
• Endoscope - this is a flexible tube containing a camera which can be passed inside the body so doctors can see what is happening without the need for surgery
• Pacemakers - help people’s hearts work properly
• Dialysis machines - help keep people alive when their kidneys aren’t functioning properly

Question 209

What was the care of the sick like in the early 20th century?

Answer 209

Women were sttill mainly responsible for treatubf illnesses and caring for the sick as doctors had to be paid to visit and therefore they were only called for serious illnesses. Other than that folk remedies such as a red cloth helping you recover from influenza was used. Minor surgery was done by a doctor using tonsils at a kitchen table or a GP might do it in a local cottage hospital. Serious ones will be referred to a specialist consultant.

Question 210

What were charitable hospitals?

Answer 210

These were hospitals that provided basic care for the sick and some aimed at specific groups of people. For example, sanatoriums were built to help people with TB. These provided a healthy diet, fresh air and hygienic conditions. These hospitals were funded by charities.

Question 211

What was done in 1912?

Answer 211

Queen Alexandra started a national Rose Day on which volunteers sold roses to raise money for hospitals.

Question 212

What was improved in the access of health care?

Answer 212

• By 1900 most cities had built infirmaries, fever houses and asylums to care fir the oiir. There were local cottage hospitals and speciallised sanatoriums but most relied on charity for funding.
• 1907: health visitors were introduced to vsiit mothers and help them care properly for their new born babies.
• 1911 National Insurance Act: working men, their employers and the government all paid to cover doctors’ fees and medical cost if a worker became ill but this only applied to certain groups of men and not their families

Question 213

What was improved in the standard of medical care available?

Answer 213

• Nurses were trained within a hospital
• By 1900 doctors must have a university medical degree abd accepted by the General Medical Council and they would have carried out dissections while training and have accompanied a doctor when working on wards. Doctors increasingly chose to became a GP treating the community or a doctor working in a hospital specialising in one area of medicine.
• 1902 Midwives Act: midwives had to be properly trained and registered
• 1919 Nursing Act: this set up the General Nursing Council to enforce high standards of nurse training

Question 214

Why have the government been playing an increasing role for government and what have they been doing?

Answer 214

During the late 19th century over a third of the British Army’s men were turned away as they were unfit. As Britain relied on the army and navy to control the empire, improving the health of working class became an important issue for the government. Therefore war has been a factor in speeding up these changes.

Question 215

What was the impact of the government playing an increasing role in medicine?

Answer 215

More care has been taken in the poorer areeas however by 1939 there was still no national organisation offering the same level of care for everyone as doctors could choose who to accept as their patients and they could refuse them if they couldn’t pay.

Question 216

What did Charles Booth’s and Seebohm Rowntree’s surveys show?

Answer 216

The standard of living amongst the poor was low due to ill-health and unemployment

Question 217

What laws were passed out by the Liberal government elected in 1905?

Answer 217

• 1906 free school meals for poor children
• 1907 School Medical Service and health visitors to check on the health of young children
• 1908 Old Age Pensions Act
• 1911 National Insurance Act

Question 218

What did the 1911 National Insurance Act provide?

Answer 218

• free medical treatment and medicine
• sick pay for up to six months and support payment while unemployed for up to 15 weeks

Question 219

What happened in 1919?

Answer 219

The Ministry of Health was set up and this showed that the government was becoming more responsible however there was still a mixture of private care, local authorities providing support and hospitals relying on charities for funding.

Question 220

What problems arose during 1900 to 1948?

Answer 220

• An epidemic of influenza in 1918-19 showed that there wasn’t enough hospital places
• Women and children were not covered by the National Insurance scheme so their treatments got delayed as they couldn’t afford to pay for a doctor

Question 221

What had the life expectancy by 1931?

Answer 221

58 for males and 62 for females

Question 222

In what ways were the government involved by 1931?

Answer 222

• secondary school pupils received medical inspections
• free milk for poor primary school children was introduced in 1934
• health clinics gave vaccinations and sold baby food cheaply
• many hospitals were brought under the control of local authorities
• there was a range of private health insurance schemes providing treatment for women, children and those men who weren’t covered by the National Insurance Act
• after the death of 3000 children from diptheria the government offered free immunisation

Question 223

How had the Second World War affected medicine and public health?

Answer 223

• Many became aware of the effects of poverty on health as children evacuated and were found to have nits or skin infections and weren’t used to running water or proper toilets
• It created the desire to set up the National Health Service (NHS)
• Food was rationed cutting down on fats and sugars and people were encouraged to eat vegetables

Question 224

Overall, what was the government’s role like in the early 20th century?

Answer 224

The government intervened in a wide range of public health issues although local authorities were often responsible for actually carrying out many of the measures.

Question 225

When was the NHS set up?

Answer 225

In 1948

Question 226

What led to the setting up of the NHS?

Answer 226

• There had been a need to organise hospitals and staff during WW2 and this had worked successfully
• The Beveridge Report in 1942 identified disease as a problem for the government to deal with after WW2
• Significant medical breakthroughs meant that much more could be done for the sick
• By the mid-20th century there was more acceptance that the government was involving in people’s lives
• During WW2 when children evacuated, people of the countryside were shocked to see how they’ve been grown up and wanted to create a ‘New World’

Question 227

What was the role of Aneurin Bevan in the setting up of the NHS?

Answer 227

He overcame opposition based on the cost of the NHS from the British Medical Association. Doctors were afraid they would lose money snd their independence by being employed by the government. Bevan promised consultants in hospitals that they can still treat private patients but also issued pamphlets telling the public to check if their doctor is part of the NHS. This made doctors think that they would lose patients if they didn’t join and put pressure on them.

Question 228

What did the NHS offer? What were used to pay for these?

Answer 228

• the right to see a GP and to be referred to a hospital
• treatments by dentists and opticians
• health care for pregnant women and yound children
• ambulances and emergency treatment
• health care for the elderly
• 1000 new operating theatres and additional equipment
• blood transfusion service
• ambulance service

Taxes

Question 229

Overall what was the impact of the NHS on society?

Answer 229

It was extremely important for improved access health care for all. People not covered by the National Insurance Act could get treatment at an early stage of an illness therefore a better chance of recovery and access to professional nursing care. Thid benefitted the poorest the most. Everything was free until 1951 when precription charges were introduced as the expense of running the NHS was much higher than expected.

Question 230

How has the government played a role in emphasising the prevention of disease since 1930s?

Answer 230

• development in vaccines, cervical cancer 2008
• government campaigns and laws on health issues such as smoking
• government promotion of healthy diets
• better disposal of rubbish and treatment of sewage
• laws to reduce air and water pollution such as 1956 Clean Air Act dealing with smog
• laws to improve working conditions eg. health and safety regulations about asbestos in workplaces
• provision of environmental health officers to inspect restaurants, cafes .etc.
• strict laws on food safety in 1900 after outbreaks of salmonella .etc.

Question 231

What was the government’s action on smoking?

Answer 231

• In 1962 the Royal College of Physicians called for a ban on tobacco advertising
• The government began taxing cigarettes heavily
• Since 1971 packets of cigarettes have carried a health warning
• In 2004 it was reported that 1 in 6 deaths were due to smoking
• In 2005 a ban was placed on most forms of tobacco advertising
• Smoking in public was banned in 2006 in Scotland and 2007 in England and Wales

Question 232

How has communication played an important role in government campaigns?

Answer 232

• Messages on products
• Posters
• TV campaigns

eg. HIV/AIDS slogan - ‘AIDS: don’t die of ignorance’ Many believe this is why death rates have reduced due to AIDS

Question 233

How are private companies being involved in public health?

Answer 233

The provision of water is their responsibilty but they’re reluctant to change old pipes or repair them due to costs

Question 234

Overall what is public health like from 1900 to the present day?

Answer 234

Throughout the 20th century, but particularly in the second half, the government took on an increasingly active role in attempts to prevent ill health and in educating people to take more responsibility for their own health. There has been an increased involvement of private companies in public health.

Question 235

What significant roles is the pharmaceutical industry playing?

Answer 235

• employed and financed scientists and researchers to find other cures and remedies
• used and developed technology and industry to mass-produce remedies
• used advertising to make people aware of their products and buy them

Question 236

What problems have arose due to pharmaceutical industry?

Answer 236

• to earnprofit different versions of the same drug is sold, eventhough tested these produce side effects
• drugs used to change people’s bodies maybe ‘playing God’
• using embryos may be seen as murder by religions

Question 237

How could the rising cost of the NHS cause a problem?

Answer 237

• People live longer so more likely to develop problems requiring treatment
• Improvements in medicine mean people expect a range of treatment
• New drugs can treat many conditions but costs are high
• Treatment more complex so equipment more expensive
• Staff costs high with better trained doctors and nurses