Medicine Through Time

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Paper 1 – Medicine Through Time, c.1250-presentPaper 1British Thematic Study:Medicine ThroughTimec.1250-presentName .1

Paper 1 – Medicine Through Time, c.1250-presentMedicine Through Time – Revision ChecklistHow well do I know each topic?4567Medicine in the Middle Ages, c.1250-1500Ideas about the causes of diseaseReligious explanations; the role of astrology; miasma; Hippocrates,Galen and the Four HumoursWhy did Hippocrates and Galen have such a big influence?The role of the Church; the importance of book learning; the lack ofalternativesIdeas about the treatment of diseaseReligious and supernatural treatments; humoural treatments; remedies;hospitals and the home; the roles of medics9Ideas about the prevention of diseaseReligious preventions; advice on health and lifestyle; purifying the air10Case study: The Black Death, 1348Causes, treatments and prevention11Topic Test – Theme 1: Medicine in the Middle Ages14 Medicine in the Renaissance Era, c.1500-170015Ideas about the causes of diseaseReligious explanations and the role of the Church; miasma; the fourHumours; new ideas and the role of Thomas Sydenham16Why were new ideas able to be shared more easily?The printing press and the role of the Royal Society17Ideas about the treatment of diseaseTransference; herbal remedies and the New World; chemical cures;hospitals and pest houses; the roles of medics19Important individualsAndreas Vesalius and William Harvey20Ideas about the prevention of diseaseLifestyle advice; purifying the air; the role of the government21Case study: The Great Plague, 1665Causes, treatments and preventions22Topic Test – Theme 2: Medicine in the Renaissance 2

Paper 1 – Medicine Through Time, c.1250-present25Medicine in the 18th and 19th Centuries, c.1700-190026Ideas about the causes of diseaseSpontaneous generation; Pasteur, Koch and germ theory; miasma28Ideas about the treatment of diseaseChanges to hospitals and the role of Florence Nightingale; Simpson,Lister and improvements in surgery; herbal and patent remedies31Ideas about the prevention of diseaseJenner and vaccination; the role of the government33Case study: Cholera in London, 1854The role and impact of John Snow35Factors affecting progressIndividuals; the role of the government; attitudes in society; science andtechnology36Topic Test – Theme 3: Medicine in the 18th and 19th Centuries39Modern Medicine, c.1900-present40Ideas about the causes of diseaseGenetics and DNA; lifestyle and health factors; modern diagnosis42Ideas about the treatment of diseaseMagic bullets; antibiotics and the discovery of penicillin; modern drugs;improvements in surgery; the impact of the NHS45Ideas about the prevention of diseaseMass vaccinations; government legislation; lifestyle campaigns47Case study: Fighting Lung Cancer in the 21st CenturyDiagnosis, treatment and prevention48Factors affecting progressTechnology; science; attitudes in society; government; individuals; war49Topic Test – Theme 4: Modern Medicine52Key individuals Produced by J. Harris, Sir Harry Smith Community College3

Paper 1 – Medicine Through Time, c.1250-presentTheme 1:Medicine in the Middle Ages,c.1250-15004

Paper 1 – Medicine Through Time, c.1250-presentBackground: Much knowledge from the Roman Empire had been lost during theDark Ages (c.410-1066).Most people at this time worked in agriculture and few could read.Catholicism was the religion of England and the Church had a majorinfluence over everyday life. Everyone attended church regularly andpaid a tithe (like a tax) to the Church.There was little scientific thought or curiosity - instead people lookedto the works of Classical thinkers Hippocrates (Ancient Greece) andGalen (Ancient Rome).Ideas about Causes of Disease Religious ExplanationsBecause there was no formal education, ordinary people learnt from the Church. TheChurch taught that disease was a punishment from God for those who had committed a sin,or a test of faith from the Devil. Because people were taught that God controlled everyaspect of the world, it was easy to believe that he sent illness too. AstrologyPeople believed that astrology (the alignment of the stars and planets) also had aninfluence on disease. During diagnosis, physicians would consider star charts, when apatient was born, and when they fell ill.The Church traditionally disliked the use of astrology, but began to accept it more after theBlack Death, when it had been very popular. Because God was believed to controleverything – including the planets and stars – it might be argued that the influence ofastrology was, by extension, the influence of God. MiasmaA miasma (plural: miasmata) was bad air that was believed to be filled with harmful fumes.Both Hippocrates and Galen had written about miasmata, which they said came fromswamps, corpses and other rotting matter. The Four HumoursThe theory of the Four Humours said that the body was made up of four elements(‘humours’) – blood, phlegm, black bile and yellow bile – which must be balanced in thebody. It was believed that illness was caused by these humours being out of balance.5

Paper 1 – Medicine Through Time, c.1250-presentThe humours were linked to the seasons (e.g. winter wetand cold too much phlegm) and personality traits ( too much yellow bile). Each humour wasalso associated with a star sign.The Theory of the Four Humours was created by AncientGreek physician Hippocrates, and developed by AncientRome physician Galen. Galen added to it with the Theoryof Opposites, which suggested that the humours could berebalanced by applying the opposite.For example, someone with too much phlegm (cold) couldeat something hot, like a pepper.Why did Galen and Hippocrates have such a big influence?There are 3 key reasons why ancient thinking was so popular during the Medieval period: The influence of the ChurchGalen’s ideas were promoted by the Church because he believed in the soul, whichfitted in with their beliefs. Since the Church controlled all books and education, theirtexts about Galen were the only ones widely taught. The importance of book learningMost people could not read, so a good physician was considered to be someone whowas widely read, not someone who had lots of hands-on experience. A physician whowas not well-read on Hippocrates and Galen would have struggled to find work. The lack of alternativesThere was little scientific evidence to support any other theories. Dissections weremostly illegal, because the Church said that bodies must remain whole for the soul to goto heaven. This meant that people couldn’t experiment and see the workings of thebody for themselves.Dissections of criminals were occasionally allowed. If anything was found whichdisagreed with Galen’s book, it could simply be explained away because the body wasthat of an imperfect criminal.The printing press was invented in 1440, allowing scientific knowledge to be spreadfaster and more easily, but it wouldn’t have a large impact until the Renaissance period.6

Paper 1 – Medicine Through Time, c.1250-presentThe religion of England during the Middle Ages was . Mostpeople believed the Church’s teaching that disease was sent by God as afor sin, since the Church controlled books andeducation. Another popular belief was that the alignment of theinfluenced disease, or that it was caused by bad air knownas .A key idea at the time was the theory of , which hadbeen created by Greek physician Hippocrates, and later developed by. The theory stated that the body was made up of four keyelements (blood, phlegm, black bile and yellow bile) and that illness wascaused when these were .Approaches to Treatment Religious TreatmentsPeople often turned to religion to help treat disease, since Godwas believed to be one of the key causes of illness.Common religious treatments included prayer, fasting, paying fora special Mass (a Catholic church service) and pilgrimages.It was believed that doing these things would remove sin andshow faith to God, so that he would remove your illness. Supernatural TreatmentsUsing charms and amulets and chanting incantations (spells or charms) was believed toward off diseases and heal symptoms.Astrology also played a part in treatment. Physicians would look at star charts andhoroscopes during diagnosis, and different operations could only be carried out at certaintimes, depending on the position of the stars. Humoural TreatmentsMany treatments involved trying to restore the balance of the Four Humours. Blood-letting (phlebotomy): Methods including cupping, leeches and cuttinga vein.Purging: Patients were given emetics (to make them vomit) or laxatives (toempty the bowels). Apothecaries sometimes also gave poisons to purge thebody.7

Paper 1 – Medicine Through Time, c.1250-present Theory of Opposites: The ‘opposite’ would be applied to an excess humour.For example, too much blood (hot and wet) could be fixed by eatingsomething cool such as a cucumber.Urine was examined to check the balance of the humours. A physician wouldcheck the colour, smell and even taste.RemediesHerbal remedies to drink, sniff or bathe in were often used. Common ingredients includedaloe vera, mint and saffron. A theriaca was a common spice-based mixture containing manyingredients, and used for many different illnesses.Bathing was advised to draw in heat and help clear blockages in the humours. Plants andherbs were often added to the water. HospitalsThe number of hospitals increased during the Middle Ages. Many were owned and run bythe Church in monasteries. Others were funded by endowment, where a wealthy personhad left money in their will for the setting up of a hospital.Most hospitals concentrated on hospitality – caring for ill people – rather than treating andcuring them. They were generally clean and were good places to rest and recover, but didnot employ physicians or surgeons.Infectious or terminal patients were often rejected, since there was nothing that could bedone for these people. HomeThe majority of people would have been treated at home. Women would be responsible forcaring for relatives. This involved making them comfortable, feeding them and mixing herbalremedies. They often grew ingredients themselves. MedicsMedical advice cost a lot of money, but it was available for those who could afford it. Therewere three types of medic: Physicians were trained at university and learned the works of Galen. Theirjob was to diagnose illness and recommend a treatment, but they didn’t treatthe patient themselves. They were very expensive. Barber surgeons carried out small operations such as bloodletting. Theirknowledge was based on experience, not what they’d read in books. Apothecaries mixed herbal remedies. They were disliked by physiciansbecause they were cheaper, and because they sometimes gave poison, whichwent against the Hippocratic Oath.8

Paper 1 – Medicine Through Time, c.1250-presentUrineA university-trained medic who diagnosedbut did not treat disease.GalenA type of spice-based herbal remedy,containing many different ingredients.PhysicianA legacy left behind by a wealthy person.Many hospitals were funded this way.BloodlettingThe physician from Ancient Rome whodeveloped Hippocrates’ 4 Humours theory.TheriacaEndowmentThis was examined as part of the diagnosis tocheck for an imbalance of humours.A word meaning “spells” or “charms”. Thesewere used as a supernatural treatment.IncantationsAn example of a humoural treatment – itaimed to restore the body’s balance of blood.Approaches to PreventionSince treatments could be hit-and-miss, it was far safer to avoid getting ill in the firstplace. Religious approachFor most people, the best way to prevent disease was to lead a sin-free life. Regular prayer,confessions and offering tithes were believed to remove sin and avoid punishment fromGod. LifestyleHygiene and diet advice was provided by physicians in a set of instructions called theRegimen Sanitatis. Keeping clean by bathing was important (linked to the idea of miasma),and public baths called stewes were available for free.What you ate was believed to affect the humours in the body. Eating too much wasdiscouraged, and many people would regularly purge themselves to avoid digestiveproblems. Purifying the airPeople purified the air by carrying sweet herbs (such as lavender) or a bunch of flowers (aposy). There was some action from local government, who tried to tackle miasmata bykeeping towns clean. For example, they tried to make sure no rotting animals were left lyingaround.9

Paper 1 – Medicine Through Time, c.1250-presentCase Study: The Black Death 1348In 1348 a new plague, the Black Death, reached England. Itwas spread by fleas and the main symptom was large, painfulbuboes. Most victims died within a few days, and around athird of England’s population died in all. When it came tocauses, treatment and prevention of the plague, peoplegenerally applied the same knowledge they had about illness.CausesTreatmentsPreventionsReligious and supernatural:Many thought the plaguewas God deserting mankind.Religious and supernatural:People prayed andconfessed their sins,although many acceptedthat if it was God’s will foryou to get the plague, it wasinevitable that you woulddie.Religious and supernatural:People prayed, madepilgrimages and whippedthemselves (self-flagellation)to show how sorry theywere.There had also been anunusual positioning of theplanets in 1345, which somethought was a bad sign.Humoural treatments:Bad air:Physicians tried standardMiasma was the main cause treatments like purging andassociated with the Blackbleeding, but these did Surgeons sometimeslanced (pierced) the buboes,People thought it was spread and occasionally theseby breathing in impure air,patients would survive.which may have originatedfrom poisonous fumesPurifying the air:released by a volcano orBonfires and sweet-smellingearthquake.herbs were recommended toward off bad air.Herbal remedies:These were used, but likehumoural treatments, weremostly ineffective.Purifying the air:One of the main ways ofprevention was to carrysweet herbs, to preventmiasma. People also ranaway to escape the bad airin towns, but this onlyhelped to spread the plague.Common beliefs:Some physiciansrecommended doing joyfulthings as a protection.Government action:The government brought inquarantine laws, but theywere hard to enforcebecause local authorities hadlittle power - rich peoplemoved around freely and theChurch ran as normal.10

Paper 1 – Medicine Through Time, c.1250-presentSolve these anagrams:THE ITThis was a sum of money paid by everyone to theChurchIMAGINERESISTANTA set of instructions on hygiene, diet and lifestyle.SEW SETThe name of the public baths in medieval times.GALEN IS LETOFF ALLA bunch of sweet-smelling flowers, used to wardoff miasma.This measure of isolating people with the plaguewas ignored by many during the Black Death.This means to whip yourself, and was a commonmethod of trying to prevent disease.IM A SAMMost people thought that this caused disease.YOPSNEAR QUAINT Doctors followed the ideas of Hippocrates and Galen. They believed illness was caused by animbalance of the Four Humours.The Church was very influential. People believed that disease was sent by God as apunishment for sins.Doctors studied star charts because the movement of the planets was believed to affectpeople’s health.A common belief was that miasma (bad air) caused disease.Medical advice was given by physicians, surgeons and apothecaries, but most people wouldbe treated at home.When the Black Death hit in 1348, people did not know what caused it or how to treat it, sothey tried to apply their existing ideas about illness.Topic Test - Theme 1: Medicine in the Middle Ages1. Name 2 ways in which the Church had an impact on people’s everydaylives.2. What was the theory of the Four Humours?11

Paper 1 – Medicine Through Time, c.1250-present3. Who first came up with the idea of the Four Humours?4. Explain 2 other beliefs about the cause of disease in medieval times.5. Give 3 reasons why the Classical ideas of Galen and Hippocrates wereso popular.6. In the eyes of medieval people, what made a good physician?7. Name 2 treatments that were based on the idea of the Four Humours.8. What was meant by the “Theory of Opposites”?12

Paper 1 – Medicine Through Time, c.1250-present9. Give 2 differences between a physician and a barber surgeon.10. Who ran many of the hospitals in medieval times?11. Give 2 examples of ways in which people tried to prevent disease.12. What were herbal remedies?13. What was believed to be the main cause of the Black Death? What dowe now know was the real cause?14. Give 3 examples of ways in which people tried to avoid catching theBlack Death.13

Paper 1 – Medicine Through Time, c.1250-presentTheme 2:Medicine in the Renaissance,c.1500-170014

Paper 1 – Medicine Through Time, c.1250-presentBackground: Renaissance means “re-birth”. There was a reborninterest in Classical thinking, architecture and art.It was a time of renewed interest in learning, and awillingness to challenge old ideas.Society became more secular. This meant that peoplewere more willing to look for scientific explanations forthings, rather than religious or supernatural ones.During this period the Reformation took place inEngland – Henry VIII broke from the Catholic Churchand closed the monasteries. This led to a decline in thepower of the Church.Ideas about Causes of Disease Religious ExplanationsMost people now recognised that God did not send disease, although in desperate times ofepidemics (such as the Great Plague 1665) they still turned to religious explanations.Humanism was on the rise – this was a way of thinking that broke away from religious orsupernatural explanations, and believed that humans could make up their own minds aboutthe world. AstrologyThough not as popular as before, people still believed that astrology influenced disease.Some blamed the 1665 plague on unusual planet alignments that had occurred in Octoberand November 1664. MiasmaMost people still believed that miasmata caused disease. A miasma could be caused byrotting food, decaying corpses, excrement or any other smelly, dirty place. The Four HumoursAlthough many top physicians were now challenging Galen’s ideas, most ordinary peoplecontinued to believe that illness was caused by an imbalance of humours.Therefore, most physicians also stuck to the Four Humours theory, even if they werebeginning to doubt it. Patients were paying physicians to treat them, not experiment.15

Paper 1 – Medicine Through Time, c.1250-present New Ideas and DiscoveriesThere were some new discoveries which began to suggest alternative causes of disease.Antony von Leeuwenhoek observed “animalcules” under a microscope, although he did notknow that these were bacteria, or that they caused disease.An Italian physician, Girolamo Fracastoro, theorised that disease was caused by seedsspread in the air. These ideas were close to the truth, but had very little impact at the time.Thomas Sydenham (“the English Hippocrates”) refused to rely on medical books. Instead, hebelieved that physicians should closely observe the patient and record their symptoms.In his book Observationes Medicae (1676), Sydenham said that illness wascaused by something external, not internal factors like a person’s diet orhumoural balance.Sydenham correctly said that measles and scarlet fever were separatediseases, even though he couldn’t identify the individual microbes thatcaused each. This laid the foundations for future individuals to take a morescientific approach to medicine.Why were new ideas able to be shared more easily? Printing pressNew ideas about medicine could be spread more quickly due to the invention of the printingpress.Books were no longer copied out by hand in monasteries, which m

Astrology People believed that astrology (the alignment of the stars and planets) also had an influence on disease. During diagnosis, physicians would consider star charts, when a patient was born, and when they fell ill. The Church traditionally disliked the use of astrology, but began to accept it more after the

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