History MTT - Y11

Edexcel 9-1 History GCSE
Medicine Through Time

Revision Sheets
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TURN TO PAGE 47 ONWARDS FOR EXAM TIMINGS, EXAM TECHNIQUE, MODEL
ANSWERS AND EXAM QUESTIONS.
Key Topic 1 – Medicine in Medieval England 1250-1500
Background Information
- About 90% of England’s population lived in the countryside with many working in the fields, growing and
harvesting crops for wealthy landowners.
- Much sickness/disease because of lack of food and hard physical labour.
- 10% of people lived in towns and cities, but overcrowding and lack of drains meant diseases spread
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easily.
-Homes were heated by open fires, leading to lung diseases.
-Almost 50% of the population died before reaching adulthood.

-Lack of scientific knowledge in medieval England.
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-Purging the digestive system to remove food was seen as a way of rebalancing the humours (as it was
thought the humours were created from the foods eaten). This was done by giving the patient either
something to make them vomit (an emetic), or a laxative or enema to clear out anything left over in the
body. Emetics usually consisted of strong and bitter herbs like scammony, aniseed and parsley.
Sometimes they contained poisons like black hellebore, so it was best to vomit them up quickly.
- Remedies were given to the sick made from herbs to drink, sniff or bathe in e.g aloe vera, mint,
camomile and rose oils, tamarind, almonds, saffron, butter, absinth, turpentine and corals.
-Sometimes the ingredients were expensive and difficult to find e.g a common remedy mixed and sold at
this time was theriaca. This was a spice-based mixture that could contain up to 70 ingredients, including
quite common things like ginger, cardamom, pepper and saffron, but also some unusual ingredients like
viper flesh and opium.
-Different foods were prescribed to encourage the balance of the humours e.g blanc mangier, made from
chicken and almonds was given to invalids because the ingredients were warm and moist.
-Bathing to ease aching joints, steam out impurities, and dissolve blockages in the humours. Various
plants and herbs were added to the bath water to help e.g people suffering from bladder stones were
advised to stir in mallow and violets.
-Some remedies were based only on superstition e.g those suffering from paralysis were advised to boil a
fox in water and then bathe in it! This was because it was thought that the quick and nimble properties of
the fox would be transferred to the patient through the bath water. Also hanging a magpie’s beak around
your neck to stop toothache!
c) Preventing disease
- The Role of the Church- argued that the best way to prevent disease was to lead a life free from sin.
Praying, going to confession and offering tithes to the Church meant any minor sins were quickly forgiven.
-Hygiene guidance was set out in a list of instructions known as the regimen sanitatis e.g bathe
regularly (only rich could afford a private bath. Public baths existed where you paid a fee. Poor swam in
rivers), live away from animals. It first appeared in the work of Hippocrates, and later by Galen and Arabic
scholars like Avicenna.
-People did wash their hands before a meal to avoid illness and they tried to make sure their homes
smelled sweet and fresh, too. Floors were swept regularly and rushes were laid down to soak up any
mess. Sometimes sweet smelling herbs, like lavender, were spread with the rushes to keep the air free of
miasmata.
-Diet – people were encouraged not to eat too much and purging was done regularly e.g vomiting and use
of laxatives.
Purifying the air – to keep it free from miasmata e.g by spreading sweet herbs, such as lavender.
Sometimes this might be carried as a bunch of flowers (posy), or placed inside a decorative piece of
jewellery called a pomander (a large locket, which would be worn around the waist).
Local authorities also tried to tackle miasmata outside of the home, putting into place measures to keep
towns clean. For example, they tried to make sure there were no rotting animals left lying around and
pulled down or cleaned particularly smelly public toilets.
d) Medieval ‘medics’
-Women did most of the treatment at home, caring for the sick and mixing remedies themselves. Women
also acted as midwives: evidence from medieval sources suggests that only women attended births.
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- Physicians (term doctor not used until 17th century) –were trained at new universities which were set
up across Europe, including Oxford, Cambridge, Paris, Bologna, Montpellier and Padua. Medicine
became more professional with a medical degree taking between 7-10 years to complete. They were
expensive as there were so few of them e.g only 100 in England in 1300. Royalty and the very wealthy
often employed a physician full time. Others paid for them when they needed them.
- The main role of a physician was to diagnose illness and recommend a course of treatment. Less
educated people such as midwives, apothecaries or barber surgeons treated the patients after diagnosis.
-A physician’s consultation was based on 3 stages;
1. The physician would look at a sample of the patient’s urine, faeces and blood, all of
which would be collected and sent to him.
2 He would consult the astrological charts under which the patient was born and at the
time they fell sick.
3 Based on this, and the humoural tendencies of the patient (whether they were naturally
sanguine, choleric, phlegmatic or melancholic), the physician would create a course of
treatment which was then given by less educated midwives, etc.
-Some clergymen were physicians and were not allowed to carry out bleeding of patients.
-Apothecaries mixed herbal remedies and ointments. They had a good knowledge of the healing power
of herbs because they studied books such as Materia Medica and had knowledge passed down to them
by family members. They were not seen as skilled or knowledgeable as physicians as they only mixed the
remedies prescribed by the physicians but they were much cheaper and so widely used.
Differences between physicians and apothecaries
-Apothecaries prescribed poison/physicians did not.

-Physicians had to swear a Hippocratic Oath before practising medicine in which they agreed to always
do the best for a patient but apothecaries did not have to do this.
- Many apothecaries were involved in alchemy and the supernatural, providing amulets and charms for
patients who wanted something extra to cure a disease. This was frowned upon by the Church and, since
many physicians were also priests, this meant that the gap between physicians and apothecaries became
even wider.
-Barber Surgeons =the least qualified medical professionals in England. Since good barbers had sharp
knives and a steady hand, they regularly performed small surgeries as well, such as pulling teeth and
bleeding patients.
- Until 1307, barber surgeons advertised their services by putting a bowl of blood in their shop windows;
after that, they displayed the sign of a bandaged, bloodied arm, which later became the red and white
striped barber pole still used today.
-In Europe some surgeons were highly trained because some physicians were encouraged to study
surgery alongside medicine, so many learned their skills at university. As surgery was usually based on
experience rather than knowledge learned from books it was often of a higher quality. In medieval
England, a skilled surgeon could set a broken limb, remove an arrow or even successfully remove
cataracts from the eyes.
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e) Caring for the Sick

Hospitals- increased during the medieval period e.g there were 1,100 hospitals by 1500 e.g Bury St
Edmund’s had six hospitals to cater for lepers, the infirm and the old. The city had a shrine famous for its
healing powers and therefore attracted a lot of sick people.
-One of the most famous early hospitals was St Bartholomew’s in London founded in 1123.
-Many hospitals did not actually treat the sick but offered hospitality to travellers and pilgrims (which is
how hospitals got their name).
-30% of the hospitals in England were owned and run by the Church with the rest funded by the rich
through endowments (money left in a will to set up a hospital).
- Medieval hospitals were good places to rest and recover but did not aim to cure disease. The space
would have been kept very clean and the bed linens and clothing of the patients changed regularly. It was
a large part of the nuns’ duties to do the washing and make sure everywhere was kept clean. This meant
that, for people not suffering from terminal disease, hospitals were probably quite successful. Patients had
to share beds.
- Infectious or terminal patients were often rejected from hospitals, as prayer could do nothing for these
people. However, patients who had a chance of recovery were able to see the altar and even participate
in Church services from their beds, to help with the healing of their souls.
The home -the vast majority of sick people were cared for at home by the women in the family. They
grew plants to help with healing such as marigolds and clover.
Part 3 - Case Study: The Black Death 1348-1349 (named by Victorian historians)
-Reached England in 1348 at the port of Melcombe in Dorset. Had hit Sicily in 1347 and then spread
throughout England killing rich and poor.
-It was the bubonic plague and arrived in England on the rats which infested ships. The bacteria was
carried by fleas that lived on the rats. It spread to humans through flea bites and on the air.
-Symptoms – buboes (pus filled swellings in the armpit or groin), high fever, sneezing, coughing up
blood, chest pains and breathing problems.
-Most victims died within 3-5 days. -In London, 200 people were being buried every day. It is estimated
that a third of the population of England died with a higher death rate in towns and ports.
-After this outbreak, the plague returned every 10–20 years for about 300 years but did not kill as many as
during the Black Death.
Causes of the Black Death

1. Religious and Supernatural Causes –many believed God was punishing people for their sins by
sending the Black Death.
-Astrologers saw an unusual positioning of the planets Mars, Jupiter and Saturn in 1345 which they saw
as an omen something huge was going to happen.
2. Natural Causes –people believed breathing in impure air (miasma) affected the body’s humours. This
could have been created by earthquakes or a volcano.
3.Scapegoats –ordinary people could not make sense of the Black Death and so looked for scapegoats
to blame e.g the Jews were blamed on mainland Europe (but not in England because they had already
been expelled).
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Treatments of the Black Death

1. Supernatural Treatments - confess your sins and pray to God for forgiveness.
2. Natural Treatments
 Physicians tried bleeding and purging but this failed and led to a quicker death.
 Use of herbs like aloe, myrrh, theriaca.
 Get rid of bad air by lighting a fire and boiling vinegar.
 Physicians or surgeons lanced (cut off) the buboes – and when they burst, some people
survived.
BUT NO CURE FOUND. Today can be treated with antibiotics.
Preventing the Black Death

1. Supernatural Means –pray to God, fast, go on pilgrimages, make offerings to God, flagellate (whip
yourself) to show God you were sorry for your sins. Large groups of flagellants could be seen chanting
and whipping themselves in London.
-Church ordered services and held processions every day to try and please God and stop the Black
Death.
2. Natural Means
- Leave the towns and cities where the air was foul. Avoid visiting family/friends who had the plague.
-Carry flowers or herbs to smell and block out the foul air.
-Stop bathing as it was believed this opened the pores to take in the miasma.
-Ringing hand bells to keep the air moving around them to remove the miasma.
3. Government Action
- Quarantine (sick had to stay in certain areas to stop them from spreading the disease to the healthy)
laws were put in place to try to stop people from moving around too much. This was a new idea and
did help stop the spread of the plague.
-People who had just moved into an area had to stay away from everybody else for 40 days, to ensure
they were not carrying the disease.
-Authorities started to quarantine houses where the plague had broken out.
-Banning preaching and religious processions was considered to stop large crowds of people
gathering.
-Street cleaning took place e.g in April 1349, King Edward III ordered the Mayor of London to have the
‘filth lying in the streets removed’ and the city cleaned. In Newcastle the streets were paved to make it
easier to keep them clean. This was extended throughout the country with fines introduced for
throwing litter and butchers punished for putting blood and animal remains in the streets. They had to
dispose of the animal waste outside the town/city walls.
-Latrines (public toilets) were built in some towns such as Norwich and London.
HOWEVER IGNORED BY RICH AND THE CHURCH WHO HAD MORE POWER THAN LOCAL
GOVERNMENT.
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Key Topic 2 – Medical Renaissance in England 1500-1700
What was the Renaissance? -This means rebirth.
-New ideas led to traditional beliefs being challenged e.g Reformation weakened the Catholic Church
which led to developments in science with a doctor working in Padua called Vesalius carrying out
dissection which proved that Galen’s work on anatomy was wrong.
-Development of the printing press meant ideas could spread more quickly.
Part 1 – Ideas about the Causes of Disease and Illness
-Continuities with Medieval Medicine

1. Belief in miasmata – as a cause of disease. Bad, impure air was caused by rotten vegetables,
decaying human/animal bodies, human waste.
-Changes with Medieval Medicine
1.Theory of the Four Humours rejected by Paracelsus, a Swiss scientist and medical professor.
-In the 16th century, the Theory of the Four Humours was rejected by some physicians because disease
was seen as separate from the body, which needed to be attacked. New chemical treatments started to
appear, boosted by the popularity of alchemy.
-A medical textbook Observationes Medicae was published in 1676 by Thomas Sydenham, an English
physician. This argued that illness was caused by external factors, rather than the four humours.
2. Theory that disease was caused by seeds in the air put forward in a book called ‘On
Contagion’ published in 1546 by Girolamo Fracastoro, an Italian physician.
3. Theory that blood circulated around the body. This idea was published in England in 1628 by
the scientist William Harvey and rejected Galen’s belief that blood was made in the liver.
4. Understanding of the digestive system developed by a Flemish physician, Jan Baptiste van
Helmont. People stopped believing disease was caused by eating the wrong things. Urine was no longer
seen as an accurate way of diagnosing illness.
5. New microscopes were being developed, allowing scientists to magnify parts of the body, etc. In
1665, a book called Micrographia, produced by Robert Hooke, an English scientist and head of
experiments at the Royal Society. This showed detailed drawings e.g of a flea from a magnified image.
First observation of bacteria was seen in 1683 by Dutch scientist Antony van Leeuwenhoek when
bacteria scraped from teeth was seen using a powerful microscope in 1683.
-Why did medical discoveries during the Renaissance only have a small impact in
the period 1500-1700?
1. Lack of proper medical instruments – e.g microscopes meant few people saw medical evidence so
stuck to old theories.
2. No real improvements in how to treat illness and disease although an improved understanding of
human anatomy
3. Ordinary people still believed in the Theory of the Four Humours.
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Importance of Changing Ideas during the Renaissance
-The period saw the growth of science which challenged old, established ideas e.g scientists like Galileo
and -Copernicus were challenging
Royal Society the authority
paid for translations of the Church
of European andtexts
scientific offering
andrational explanations
encouraged for things
its members to
happening.
write their reports in English instead of Latin, and in simple terms to make it more accessible.
- By-the All
endmembers hadcentury,
of the 17th to provide the Royal
doctors Society with
and scientists had alots
copy of their
of new submissions
ideas about the which
causeswas placed
of illness
in a reference library.
and disease even though this had little impact on the medical treatment of ordinary people.
Improved
-New
2. Ideas communications
a) Printing Press – created in 1440 by Johannes Gutenberg, a German goldsmith meant new
 Theory of the Four Humours rejected by doctors and scientists (but believed by
ideas could spread quickly and literacy increased. It meant text no longer had to be copied by
ordinary people).
hand, so fewer mistakes and no longer reliant on the Church so people could criticise Galen.
 Huge improvements in the understanding of human anatomy.
 Physicians
Part 2- Approaches to now understoodand
Prevention thatTreatment
urine was not directly related to a person’s health.
 Physicians studied their patients more carefully.
1. Changes  in Treatment
Influence of Church declined e.g people did not believe God caused disease (unless a
huge epidemic).
 Astrology
a) Transference less popular-
– which meant focus or
that an illness onascientific
disease rather than
could be supernatural
transferred (althoughelse
to something ordinary
e.g if
people still wore charms).
you rubbed an object onto a boil or cut, the disease would transfer from you to the object. Idea you
could get rid of warts by rubbing them with an onion – through transference, the warts would ‘transfer’
-Continuities
to the vegetable!
Another example
 Miasma = patients withthat
-The idea a fever usedwas
disease to sleep
spreadwith
by abad
sheep in the
smells andbedroom,
evil fumes hoping that their
continued.
fever would transfer to the animal!
What changes helped medical progress during the Renaissance?
b) New Herbal remedies – e.g from New World
1. -Sarsaparilla
Growth of usedScientific
to treat Thinking
the Great Pox
-Ipecacuanha from Brazil, later known just as ipecac used as a cure for dysentery
-Cinchona
- Humanism bark, –from
lovePeru, in treating malaria.
of learning/reading of classical scholars e.g 590 editions of Galen’s works were
-Tea, coffee, nutmeg,
published. cinnamon,the
Also questioning tobacco usedoftothe
teachings seeChurch
if they e.g
hadGod
any did
impact on diseases.
not cause disease.
Thomas
-SomeSydenham
physicians=believed
‘the English
that Hippocrates’.
herbal remedies found in individual countries could cure diseases that
came from that country.
- He was a well-respected doctor in London in the 1660s and 1670s.
- He moved
c) Chemical Curesaway from the
-emerged withidea
the of The Theory
growth of the Four Humours which argued that a patient’s
of alchemy
disease was personal to them and stated that diseases could be categorised into different
-Growth groups.
of iatrochemistry (medical chemistry) where people began to look for chemical cures for
diseases instead of refused
- Sydenham relying on herbs
to rely onand bloodletting.
medical Inspired
books when by the scientist
diagnosing Paracelsus.
a patient’s illness but carefully
- ‘The Pharmacopoeia Londinensis’ was published by the College
observed the symptoms and treated the disease causing them (rather than of Physicians in 1618, containing
the medieval method
2,000 remedies e.g using salts, metals and minerals and 122 different chemical preparations including
of treating each symptom separately).
mercury and antimony.
-The- book
Hestated
developed several new
that antimony could treatments
be used intosmall
tackle the diseases
doses to encouragehe identified
sweatinge.g rejected
which thepurge
would
‘sweating’ method for treating smallpox and replaced it with airy bedrooms,
the body of disease and in larger doses to encourage vomiting. However as it was poisonous on its light blankets and cold
own,
drinks. He also used cinchona bark from Peru to treat malaria which contains
a compound called antimony potassium tartrate was made and used to cure Louis XIV of France of quinine which is still
typhoid fever
used into 1657.
treat malaria today.
2. Continuities
- Work of thein Treatment
Royal Society- set up in London in 1660 (at Gresham College) to promote the use
a) Many people still believed
of scientific experiments in and
the ‘Theory of the Four
share scientific Humours’
knowledge. and so
Its motto used
was the old
‘Nullius intreatments of
verba’ = ‘Take
nobody’s
bleeding, wordand
purging for sweating
it’ showing the importance
aimed of individual
at re-balancing scientific research.
the humours.
- Given
b) Old Herbala remedies
Royal Charter by King
continued to Charles
be used IIand
in 1662
were (he promoted
often chosen the development
because of science)
of their colour or shape.
which encouraged
E.g yellow herbs, such rich peopleand
as radish to donate
saffron,money
were usedfor scientific research.and smallpox was treated
to treat jaundice
- Published
with first–ever
the ‘red cure’ scientific
drinking journal,
red wine, called
eating red‘Philosophical
foods and wearing Transactions’
red clothes.in 1665 with letters,
reports
c) Failure aboutserious
to treat experiments and such
diseases observations by European
as syphilis scientists.
which spread widelyStill published
across Europetoday e.g
at this time.
350th
d) Belief thatanniversary
the King couldin 2015.
cure diseases e.g 1660-1682 92,000 visited the court of King Charles II
hoping he could cure them of the skin disease called scrofula.
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Why was Vesalius so important?

- Inspired others to carry out their own dissections and even challenge his theories
- Anatomy now became an important part of medicine. Doctors and medical professors now carried
out dissections-not just surgeons.
- Caused huge controversy because argued Galen had got so much wrong.
- Encouraged others to make medical progress
6. Continuities in Medical Care

a) Apothecaries continued to mix remedies and surgeons continued to carry out simple operations
during the Medical Renaissance for those people who could not afford a physician.
b) Training courses for physicians hardly changed with the medieval period.
c) Most learning came from books not practical experience.
d) University medical lectures continued in Latin.
e) Limited opportunities to carry out dissection because not enough dead bodies to dissect and not
enough anatomy theatres at universities.
7. Changes in Care of the Sick

a) Hospitals –now treated and cured people rather than just offering food and shelter.
-People got better in hospital because;
- given a good diet

- received a visit from a physician i.e hospitals had contracts with doctors, who would visit the
patients sometimes as often as twice a day, to observe the symptoms and prescribe treatments
- medication – many hospitals had their own pharmacies and an apothecary to mix the medicines.
BUT DISSOLUTION OF THE MONASTERIES BY HENRY VIII IN 1536 LED TO THE CLOSURE OF
MANY HOSPITALS IN ENGLAND.
b) Pest Houses
-One change in hospital care in this period was the appearance of hospitals that specialised in one
particular disease as people now believed that disease was contagious (but didn’t understand how). This
meant that new types of hospital began to appear that catered only for people suffering from plague or
pox known as pest houses, plague houses or poxhouses.
-These new types of hospital provided a much-needed service as it reduced the risk of people spreading
contagious diseases (Traditional hospitals would not admit patients who were contagious).
8. Continuities in Care of the Sick

a) Most people cared for at home
b) Women continued to play an important role in the care of the sick including the rich e.g Lady Grace
Mildmay (1552–1620), who kept detailed notes of the healing and treatment she carried out. Some
women were prosecuted by the London College of Physicians for practising medicine without a licence.
They continued to use simple herbal remedies to purge the body or cure a particular ailment. These
women were popular with ordinary people because they were much cheaper than going to a licensed
physician or apothecary.
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Part 3- Case Study 1- William Harvey

a) Who was he?
-Born in 1578. Studied medicine at Cambridge and then at Padua.

-In 1615, he became a lecturer of anatomy at the College of Physicians, and by 1618 he was one of the
royal doctors for King James I and later King Charles I.
-Harvey had a keen interest in dissection and observing the human body, in order to improve his
knowledge of human anatomy. He taught his students that it was important to observe the body and
believe what they saw, rather than believing what had been written in classical texts. This idea was also
followed by Thomas Sydenham, who would work on this theory later that century.
b) Circulation of Blood Theory

-Harvey was particularly interested in blood.
-He was taught at Padua about Vesalius’s theory that the veins of the body contained valves, which was
proof that the blood in those veins flowed towards the heart.
-Using dissected bodies, Harvey saw the evidence e.g when he tried to pump liquids through the veins the
other way, it did not work. This proved that the blood only flowed towards the heart, contradicting
what Galen had taught about the blood.
- Harvey’s research involved dissecting human corpses and cutting open cold-blooded animals,
which had a much slower heartbeat, to observe the movement of their blood while they were still alive.
-Harvey proved that arteries and veins were linked together into one system. He tied a tight cord
around somebody’s arm, cutting off the blood flow in the artery leading into the arm. Because the artery in
the arm is deeper than the veins, loosening the cord a little bit allowed blood to flow into the arm but
stopped it from flowing out and the veins swelled with blood.
-Harvey’s theory was that blood must pass from arteries to veins through tiny passages that were invisible
to the naked eye. Today they are called capillaries.
-Galen had suggested that blood flowed from one side of the heart to the other through invisible pores in
the walls of the ventricles. He also said that veins carried both blood and pneuma*, which was picked up
in the lungs, while arteries carried just blood.
-Harvey’s theory criticised both of these ideas. He showed that the veins carried only blood. He proved
that the heart acted as a pump just as the new mechanical fire pumps did.
c) Factors which helped William Harvey
- Individuals and institutions

Vesalius had proved that Galen was wrong, which made it easier for other scientists and physicians to do
the same.
-Harvey was employed by Charles I as his personal physician showing he was highly regarded and
meaning his theory about the circulation of blood became widely known.
-Decline of the power of the Church allowed Harvey to be critical of Galen’s teachings.
- Science and technology

Inspired Harvey e.g the pump used when fighting fires made him think about how the heart worked.
-Attitudes in Society
People looking for rational and scientific explanations.
d) Why was William Harvey significant?
-He wrote a book called ‘An Anatomical Account of the Motion of the Heart and Blood in Animals’ in
1628 which is regarded as the beginning of modern physiology.
-Harvey encouraged other scientists to experiment on actual bodies e.g Harvey had proved that the liver
did not digest food to create blood. Harvey had proved that blood circulated, instead of being absorbed to
provide nourishment for the body.
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 Plague doctors wore costumes with hooked, birdlike masks containing sweet-smelling herbs to
ward off the miasma. Birds were meant to attract disease, so it was thought that the disease
might be attracted to the bird shape and leave the patient.
 Physicians cloaks were covered in wax so blood and pus could not soak into it.
-Other healers used;
 Herbal remedies e.g nutmeg, sugar

 Tobacco used to drive away the miasma.
 Plague water
 Soaked coins in vinegar when buying food.
Increased government action
-Charles II issued a set of instructions to stop the spread of the Plague. These were sent to officials
in every city who had to make sure they were followed.
-Public meetings, fairs and large funerals were banned. Theatres and taverns were closed.
-Streets were swept and kept clean.
-Barrels of tar were set alight on street corners and filled with sweet smelling herbs to ward off the plague.
-40,000 dogs and 200,000 cats were killed because they were seen to be spreading the disease.
-Mayor of London sent watchmen door to door to identify who had the plague and then placed the victim
in quarantine for 28 days or take them to the pest house. A red cross was placed on the victim’s door and
the words ‘Lord have mercy on us’. Food would be brought to those in quarantine by local officials.
-Carts collected the dead bodies
6. Continuities in Preventions of the Great Plague
-Natural remedies using traditional English herbs such as mint and rosemary. Also, strong smelling
herbs such as lavender hung in doorways to ward off the Plague.
-Pray to God for repentance and fast as punishment for sins.
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Key Topic 3 – Medicine in Britain 1700-1900
BACKGROUND
-By 1700, Church had lost much of its power and influence.
-Enlightenment began in 17th century- looking for rational explanations.
-Scientific Revolution which began in the Renaissance continued but in this period, it was all about new
theories rather than discrediting the ones of Galen, etc which had taken place in the Renaissance.
-Huge movement of people from the countryside to the new cities during the Industrial Revolution which
became affected by killer diseases such as smallpox.
Part 1 – Ideas about the Causes of Disease and Illness
1.Continuities about the causes of disease and illness
-Miasma caused the spread of disease and illness. This idea of spontaneous generation continued to be
popular where rotting material created microbes which led to miasmata.
-Spontaneous generation remained a popular theory until 1870, championed by the famous doctor Dr Henry
Bastian.
2. Changes in ideas about the causes of disease
a) Louis Pasteur and the Germ Theory
-Louis Pasteur = a French scientist used microscopes to show microbes in wine and vinegar which turned
them bad.
-He printed his Germ Theory in 1861. It stated;
 Air is full of living microorganisms called germs
 Microbes in the air cause decay
 Microbes can be killed by heating them
 Microbes are not evenly distributed in the air.
-Pasteur argued germs could be causing decay in the human body. In 1878 he published his ‘Germ Theory
of Infection’.
-Pasteur proved spontaneous generation was wrong because he argued decay was caused by microbes
which were present in the air.
BUT PASTEUR HAD LITTLE IMPACT IN BRITAIN AS MANY PEOPLE DID NOT BELIEVE THERE WAS A
LINK BETWEEN GERMS AND DISEASE.
b) Robert Koch and Bacteriology = a German scientist who proved that different germs cause different
diseases.
-In 1882, Koch found the bacteria which causes tuberculosis and published his findings which could be
used to identify different disease-causing microbes;
 Microbe is present in every case of the disease
 Microbe can be taken from the body and reproduced into a pure culture (bacteria grown under
controlled conditions).
 Disease can then be reproduced in test animals using that culture.
 Microbe can be taken out of the animals and reproduced to start a fresh culture.
-In 1883, Koch discovered the microbe that caused cholera and proved that it was spread in water supplies
in India where cholera had broken out.
-Koch developed the idea of growing bacteria in a petri dish using agar jelly which made it easier to see
under a microscope and then using industrial dyes to make the bacteria easier to see.
-Koch won the Nobel prize for Medicine in 1905 and his methods are still used today.
-His work inspired other scientists who discovered the microbes which caused diphtheria, meningitis,
pneumonia, tetanus and the plague.
-KOCH PROVED THAT THE MICROBE CAUSED THE DISEASE AND SO IT WAS THE MICROBE WHICH
HAD TO BE REMOVED.
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Key Topic 3 – Medicine in England 1700-1900
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What improvements did Nightingale make to the Scutari hospital in the Crimea?
 Floors, beds and walls were scrubbed clean

 Nurses were organised to treat 2,000 wounded men
 Clean bedding and meals were provided.
RESULT = Mortality rate dropped from 40% to 2%.
Nightingale returned to Britain a hero in 1856.
What impact did Nightingale have in Britain?
-Design of hospitals – pavilion plan = larger windows and larger rooms leading to greater ventilation. Also
isolation wards to stop the spread of infectious diseases. Built from materials which made them easier to
clean e.g tiled floors, painted walls.
-Nursing became respectable and a profession – e.g some of the Nightingale nurses were members if
the middle class and nurses were now skilled and highly trained.
-Training of Nurses – set up a nursing school called the Nightingale School of Nurses in 1860 at St
Thomas’s Hospital in London.
-Wrote ‘Notes on Nursing’ in 1859 which explained the importance of training and the role of the nurse.
How had hospitals changed by 1900?
1. Separate wards to stop the spread of infectious diseases from those needing surgery.
2. Operating theatres
3. Very hygienic with antiseptics used to eradicate germs
4. Highly trained doctors and nurses
5. Hospitals now places where the sick should be treated.
b) Improvements in Surgical Treatments
-1700 (start of period)
-Problems with surgery =bleeding, infection and pain e.g surgery had to be performed quickly before the
patient died of pain, shock or bleeding to death. Even if the patient survived the operation, they could die of
infection because environment was not sterile (often operations conducted in people’s homes).
-Most common form of surgery was amputation
1.Development of Anaesthetics (deal with pain)
-Use of ether as an anaesthetic was discovered in America but could make patients vomit and cough and
was highly flammable.
-James Simpson and Chloroform- Professor of Midwifery at Edinburgh University discovered chloroform
could make people pass out and therefore not feel pain (tried it on his friends). Became popular e.g Queen
Victoria took it during child birth. It allowed more complex surgery to take place.
-Simpson was the first person to be knighted for his services to medicine.
BUT some risks/side effects e.g an overdose of chloroform could kill and could cause heart failure. Also now
more complex surgery could take place- more risks of infection and bleeding. This meant the period 1850-
1870 is sometimes known as the ‘Black Period’ of surgery because there was an increase in deaths.
2. Development of Antiseptic Surgery (deal with infection)
-In the past surgery took place in dirty conditions with unwashed instruments. This meant even if a patient
survived an operation, they might die from infection such as gangrene and sepsis.
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-Joseph Lister and Carbolic Acid
-Lister was a Scottish surgeon inspired by Louis Pasteur and his germ theory.
-He identified that infected wounds were rotting and worked out that microbes in the air could cause this, just
as they caused Pasteur’s wine and vinegar to go off!
-Lister discovered carbolic acid could clear bacteria from a wound following an operation on a patient with a
broken leg in 1865. Lister covered the wound in a bandage soaked in carbolic acid and the wound healed.
-Lister then sprayed operating rooms with carbolic acid during operations.
-Lister published his results in the ‘Lancet’ medical journal – recording 11 different ways carbolic acid had
been used successfully in surgery.
MANY DOCTORS SLOW TO ADOPT ANTISEPTIC SURGERY. Carbolic acid dried the skin and left an odd
smell so they argued incorrectly that it was actually harmful.
Impact of Lister and Antiseptic Surgery – by 1900 operating theatres spotlessly clean, surgical
instruments steam cleaned, surgeons wore clean gowns, rubber gloves and face masks.
Opposition to use of Anaesthetics and Antiseptics
1. Anaesthetics allowed deeper surgery which meant death rate increased because of bleeding so
some surgeons believed anaesthetics must be bad.
2. Victorians thought providing pain relief was going against God’s will.
3. Fear that unconscious patients were more likely to die than those who were awake and screaming.
4. Surgeons reluctant to admit that germs caused infection because then they had to accept
responsibility for the deaths of previous patients because of dirty instruments, etc.
3. Changes in the Prevention of Diseases
CASE STUDY -EDWARD JENNER AND SMALLPOX VACCINE
Problem of Smallpox
-Terrible killer disease in the 18th century with epidemics in 1722, 1723, 1740-42. London suffered 11
epidemics of smallpox in 18th century e.g in 1796 over 3,500 people died in the capital.
-People had noticed that those who suffered from a mild form of smallpox and survived never caught the
disease again. This led to some people being inoculated against the disease, which involved a doctor
rubbing pus from a smallpox scab into a cut of a patient to inoculate them against the disease (not always
successful). ONLY THE RICH COULD AFFORD TO BE INOCULATED e.g Thomas Dimsdale became a
very rich man when he inoculated Catherine the Great of Russia and her children against the disease.
Who was Edward Jenner?
-Doctor from Gloucestershire who had practiced medicine at St George’s Hospital in London when he was
younger.
-He became very interested in smallpox inoculations which had not been successful -studied 1,000 cases.
-Jenner worked in the countryside and so had treated many dairy maids who had contracted cowpox (skin
disease similar to smallpox causing red blisters on the skin). He noticed when there were smallpox
epidemics that those who had contracted cowpox before did not get it.
Vaccination– Jenner infected an 8 year old boy James Phipps with cowpox in 1796. Six weeks later he
tried to infect the same child with smallpox but the boy did not catch the disease. Jenner infected other local
people with cowpox and recorded his findings in “An Enquiry into the Causes and Effects of Variola
Vaccinae” in 1798. He named this technique ‘vaccination’ after the Latin word ‘vacca’ meaning ‘cow’.
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Key Topic 4 – Medicine in Britain 1900-Present Day
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Part 2: Treatments
a) Antibiotics ‘magic bullets’
By 1900, doctors understood that the body produced antibodies to fight diseases that had previously
infected it. Progress could be made if artificial or chemical antibodies could be produced that would attack
the infection without harming the body.
Syphilis – was a killer throughout history
-Paul Ehrlich (German scientist) tested as many arsenic compounds as he could to find a cure for syphilis.
By 1907, he had tested over 600 compounds, but had not found a cure.
-In 1909, a Japanese scientist named Hata retested all of the arsenic compounds and found that compound
number 606 cured syphilis. The drug, named Salvarsan 606, was the first ‘magic bullet’.
Prontosil – kill bacterial infections
-Gerhard Domagk (German scientist) discovered that a bright red dye called Prontosil killed bacterial
infections in mice in 1932. Domagk used Prontosil on his own daughter, who had developed blood poisoning
and she was cured!
-Scientists at the Pasteur Institute in Paris discovered that Prontosil worked by preventing the bacteria from
multiplying in the body. This made it possible for the body’s own immune system to kill the bacteria. These
drugs are called bacteriostatic antibiotics.
Penicillin seen as most important antibiotic ever! (see case study later on).
-Penicillin was different to Salvarsan 606 and Prontosil as it was created using microorganisms, not
chemicals.
Streptomycin was discovered by American scientist Selman Wakston in 1943.
This antibiotic was so powerful that it was even effective against tuberculosis, which had previously been
thought to be incurable.
During the 1950s and 1960s, even more antibiotics were discovered.
Situation Today- hunt is on for new antibiotics because some bacteria have developed a resistance to the
antibiotics we have (over prescribed) which means they may stop working.
b) Impact of Science and Technology

-Scientists have developed a huge range of medicines to treat specific diseases and help those suffering
from incurable diseases such as diabetes and some cancers.
- New drugs have to be tested and trialled over a period of several years to avoid mistakes such as the drug
thalidomide which was used in the 1960s to treat pregnant women suffering from morning sickness. The
drug caused birth defects.
-Technology means that pills can be mass produced which means they are more widely available.
-Capsules mean drugs dissolve in the stomach so work better.
- Hypodermic needles allow the precise dose of a drug to be introduced directly into the bloodstream.
-Insulin pumps for young people suffering from diabetes deliver insulin without the need for injections.
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e) To what extent have there been changes in the Care of Patients?

1900
-Most care carried out by women in the home.
-Doctors had to be paid for and so were only called in the case of serious illness.
1948
-NHS huge improvement because medical care free at the point of service.
Part 3- Preventions
a) Role of the Government has increased the prevention of disease
Why?
- An understanding of what causes disease

- Preventions which work now it is understood what causes disease e.g
 Vaccinations
 Laws which improve the environment e.g Clean Air Act/adding fluoride to the water supply
to reduce tooth decay.
 Lifestyle campaigns aimed at raising awareness e.g drink driving, smoking, HIV & AIDS
(charities also do these campaigns e.g British Heart Foundation to try and get people to
stop smoking).
-Vaccination Programmes
Before the Second World War, local government was responsible for vaccinations not central government
which meant vaccinations were not widespread.
Diphtheria Vaccination Campaign 1942

-3,000 children a year died from diphtheria.
- In 1942 (during the Second World War) the first national vaccination campaign took place against
diphtheria. This was very successful and diphtheria is no longer a problem in Britain.
Polio Vaccination 1956

-Polio is a very contagious disease that causes paralysis. In the early 1950s, 8,000 cases of polio were
reported every year in Britain. The vaccination was developed in the USA by Jonas Salk.
-It has been very successful, with the last case of a person contracting polio in the UK was in 1984.
-Other vaccines are aimed at protecting unborn children e.g rubella because if a pregnant woman catches
German measles it can harm the foetus.
-Some vaccines target diseases that can lead to other diseases e.g the HPV vaccine protects women
against infection from a sexually transmitted disease that has been linked to cervical cancer.
-Controversy about vaccinations

Some people resent government intervention and choose not to vaccinate their children. A lack of trust in
the medical profession has led to fears that vaccines are unsafe. While vaccination is the best way to
prevent the spread of dangerous epidemic diseases, the government cannot force everyone to vaccinate.
-Government Legislation to Prevent Disease and Illness
-Clean Air Acts of 1956 and 1968 were passed as a result of very bad smog in London in 1952. This was
heavy fog caused by air pollution because at this time everyone burned coal to heat their homes leading to
smoke and soot in the air. The smog could cover London for a number of days. The Clean Air Acts solved
the problem.
- Laws are still passed today to reduce air pollution e.g cutting harmful car emissions.
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However, the US government saw the benefits of the drug and funded 21 pharmaceutical companies to
begin mass producing it in 1942. In 1943, British pharmaceutical companies also started to mass produce
the drug.
-By D-Day, in June 1944, there was enough penicillin available to treat all Allied casualties (2.3 million
doses).
What factors were important in the development of penicillin?
1. Institutions e.g US government who funded Florey’s research for five years. This enabled him to
develop methods to mass produce the drug.
2. Technology allowed the mass production and storage of penicillin in vast quantities.
3. Attitudes in society- many soldiers had died from simple infections in the First World War. This
could not be repeated in the Second World War. The public were told very little about clinical trials
so as to maintain morale.
4. Science Scientists were able to observe how penicillin attacked staphylococcus bacteria and this
enabled them to modify it to attack other types of bacteria.
5. Individuals. Florey and Chain built on the work of Fleming. All three were actively looking for a
chemical treatment for disease and illness. Florey also refused to patent the drug, saying that it
should be available for everybody. This meant that developing it didn’t cost as much money.
Success of Penicillin
-Penicillin is effective in treating diseases caused by a certain family of bacteria.
-Penicillin is also used to prevent infection, particularly with patients who have had teeth extracted.
-The development of penicillin led scientists to look for other moulds that could be used to fight bacterial
infections – such as streptomycin, which was the first drug found to be effective against tuberculosis.
- 1945 Dorothy Crowfoot Hodgkin, a scientist at Oxford University, identified the chemical structure of
penicillin. This allowed scientists to work on producing synthetic versions to treat specific diseases.
BUT some bacteria are now resistant to penicillin. Bacteria can mutate to resist attack from penicillin
mould. The first penicillin-resistant strain of bacteria appeared in 1942. Pharmaceutical companies continue
to work hard to develop new forms of penicillin and other antibiotics that will kill off the bacteria.
CASE STUDY 2 – The Fight against Lung Cancer -20 th Century disease
-Lung cancer is the second most common cancer in the UK affecting people over the age of 40, particularly
those aged 70–74. 40,000 people are diagnosed with it each year.
-Most lung cancers are caused by external factors e.g 85% of cases are people who smoke, or have
smoked. Chemicals in the air, such as radon gas, have also been blamed.
-A small number of people develop lung cancer for no apparent reason.
-Lung cancer is seen as a modern disease because there were very few cases of lung cancer discovered in
the 19th century but his had increased to 10% by 1918 and 14% by 1927.
- In 1950, the British Medical Research Council published a study that showed that the rise in lung cancer
was linked to cigarette smoking.
-Deaths from lung cancer peaked in 1973 with 26,000 deaths of men. The death rate among women also
continued to rise until the 1990s.
- As it is often not diagnosed until advanced;
 Only 1:3 people live for as long as a year after diagnosis.
 Only 10 per cent live for more than five years.
This compares very badly with survival rates from other cancers where 50 per cent live for at least ten years
after diagnosis.
What problems are there in the diagnosis of lung cancer?

-It is often not detected until it is already very advanced meaning it cannot be treated.
-Patients often mistake their symptoms for other diseases.
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-There is no national screening programme for lung cancer, so people are not routinely tested to see if they
have it. This is because the tests are not accurate enough to outweigh the negative effects of the screening
(for example, exposure to radiation during an x-ray scan).
-Diagnosis is also difficult, although technology has led to improvements in this area.
How has technology helped in the diagnosis of lung cancer?
-In the past X-rays were taken to diagnose lung cancer but these were not detailed enough to provide an
accurate diagnosis.
-Today, patients are given a CT scan which creates a detailed picture of the inside of the body. Patients are
injected with a dye before the scan takes place as this makes the lungs easier to see on the scan.
-In those cases where the lung cancer does not look very advanced, the patient will be given a PET-CT
scan. This is like a CT scan except a small amount of radioactive material is injected into the body instead
of dye which helps identify cancerous cells in the body.
-In those cases where the lung cancer appears more advanced the patient will be given a bronchoscopy
where a tool called a bronchoscope is passed down into the patient’s lungs, where it collects a sample of the
cells for testing.
-Treatment plans are then drawn up based on the findings above.
How is science and technology used to treat lung cancer?
-Where lung cancer is diagnosed early, the tumour and infected part of the lung can be removed (even a
whole lung can be removed as you can live with only one lung)!
Transplants
-Cancerous lungs can be replaced with a transplant from a healthy donor.
Radiotherapy
-Is where concentrated waves of radiation are aimed at the tumour to try to shrink it. Small tumours can be
treated this way instead of with surgery. Larger tumours can be prevented from growing bigger using
radiotherapy. Either beams of radiation are directed at the tumour from outside the body, or by placing a
small piece of radioactive material directly next to the tumour using a very thin tube, called a catheter,
radiotherapy can take place.
Chemotherapy
-During chemotherapy, patients are injected with many different drugs. These shrink the tumour before
surgery, prevent the cancer from reoccurring, or provide relief from the symptoms of lung cancer when
surgery is not possible.
Lung cancer patients are now more likely to be treated using a range of the strategies above e.g surgery to
remove the tumour and then have radiotherapy and chemotherapy to tackle any remaining cancerous cells.
Genetic research
-Scientists have been studying the genes of lung cancer sufferers in order to help doctors prescribe more
effective treatments e.g some chemotherapy drugs work better in lung cancer patients whose tumours have
a certain genetic mutation. This shows the benefits of different treatments for different patients rather than
one treatment for all. This idea of tailoring treatments to a person’s DNA is a growing field in medical
research known as pharmacogenomics.
How has the government tried to prevent lung cancer in the British population?
-At first the government took little action when it was realised smoking was linked to lung cancer in 1950.
-This was because although by 1950 smoking related deaths cost the NHS £165 million a year - the
government earned around £4 billion from the tobacco tax and there were thousands of jobs in the
tobacco industry in the UK.
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BUT the government realised they had to intervene because lung cancer is such a huge killer. There are two
main ways the government has reduced deaths from lung cancer;
1. Forcing people to change their behaviour by passing laws
-2007 -the government banned smoking in all workplaces. People were no longer allowed to smoke in
pubs, cafés, restaurants or offices.
-2015 – smoking ban was extended to cars carrying children under the age of 18. There is significant
evidence to suggest that second-hand smoke has a negative impact on health, particularly among children.
Although many still argue that a smoking ban is an attack on personal choice, others argue that it is not the
choice of the child to be exposed to the smoke. Therefore, the government stepped in to protect their health.
- 2007, the government raised the legal age for buying tobacco from 16 to 18. They did this to try to reduce
the number of teenagers who smoke.
-Increased taxation on tobacco products was introduced to encourage people to stop smoking e.g
average price for pack of 20 cigarettes in UK = £10 (largely made up of tax)
2. Trying to influence people to change their behaviour
- 1965- Ban on cigarette advertising on television
-2005- Complete ban on cigarette advertising (including sponsorship of major sporting events e.g Grand
Prix).
-The government has produced many campaigns to advertise the dangers of smoking over the past
decades e.g the impact of pregnant women smoking, the number of chemicals included in cigarette smoke
and statistics about the health impacts and the diseases caused by regular use.
-Children are taught in school about the dangers of smoking.
- 2012- all cigarette products in shops are covered so as to discourage young people from smoking.
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Historic Environment: The British Sector of the Western Front 1914–18
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Historic Environment: The British sector of the Western Front 1914–18
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TIMINGS OF PAPER 1 – 1 hour 15 minutes exam
Section A: British Sector of the Marks Timing

Western Front
Question 1
Describe 4 5 mins
Question 2a)
Utility 8 15 mins
Question 2b)
Follow up 4 5 mins
Section B: Medicine through Time Marks Timing

1250-Present Day
Question 3
Comparison of similarity or 4 5 mins

difference
Question 4
Explain why 12 15 mins
Question 5 or Question 6
Essay 16 + 4 SPAG = 20 30 mins
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How to Structure the Exam Questions
Section A: Historic Environment – The British Sector of the Western

Front
Question 1: Describe two features of……….. (4 marks)
Structure = 2 sentences for each feature
Sentence 1 = a general statement
Sentence 2 = supported by factual detail
Timing = 5 minutes
Question 2a): How useful are Sources A and B for an enquiry into…
(8 marks)
Structure = 2 paragraphs
Paragraph 1 – How Source A is useful/backed up by own knowledge/how it is not
useful
Paragraph 2 – How Source B is useful/ backed up by own knowledge/how it is not
useful
Timing = 15 minutes
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Question 2b): How could you follow up Source A to find out more
about……. (4 marks) Timing = 5 minutes
Detail in Source A that I would follow up:
Here you give a direct quote from the source that you would like to know more about.
Question I would ask:
Write a question about the area you have identified.
What type of source I could use:

Think about what type of source you would need to examine to answer the question.
How this might help answer my question:

Explain how this source would answer the question
EXAMPLE
An interview with a soldier who was wounded in the First World War.
“when I woke up in the early hours of the morning I thought, ‘Oh my God. My leg’s gone.’
They’d guillotined it off without saying a word.
Why did the doctor amputate his leg?
Medical articles written by doctors who worked on the Western Front
It would explain that before the Thomas Splint, men with compound leg fractures lost a
great deal of blood, leading to gangrene and amputation.
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Question 3: Explain one way in which……………was similar/different
……………………………………………….. (4 marks)
Structure = 1 paragraph in which one similarity or difference between two time
periods is discussed with specific factual detail from both time periods to explain the
similarity or difference.
Timing = 5 minutes
Time Span = Can be over any time periods
Example
Explain one way in which ideas about the treatment of disease were different in
the 17th century from ideas in the 13th century. (4 marks)
Question 4: Explain why …………………………………… (12 marks)

Structure = 3 paragraphs which link
Timing = 15 minutes
Time Span = At least 100 years
Example
Explain why there was rapid change in the prevention of smallpox in the period
c1750–c1900.
(12 marks)
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Question 5 or Question 6: Statement and then ‘How far do you
agree…………..’? (16 marks + 4 SPAG)
YOU CHOOSE EITHER QUESTION 5 OR QUESTION 6
Structure = 5 paragraphs which includes a brief introduction, linking paragraphs that
also refer to the question and a conclusion which argues for one reason and then tries to
link in all others.
Timing = 30 minutes
Time Span = At least 200 years
Plan your answer by drawing a table in rough
Agrees with the statement Disagrees with the statement
Example
‘The Theory of the Four Humours was the main idea about the cause of disease in the
Middle Ages.’ How far do you agree? Explain your answer.
You may use the following information in your answer:
• university training
• Galen’s ideas.
You must also use some information of your own. (16 marks + 4 for SPaG)
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Model Answers and Exam Tips for Paper 1 (2018 Paper)
1. Describe two features of blood transfusions on the Western Front during the First
World War. Exam tip = 2 sentences for each feature
(4)
One feature of blood transfusions on the Western Front was that techniques
were developed during the war to stop blood clotting during transfusion to the
patient. In 1915, a British doctor called Geoffrey Keynes added a device to
regulate the flow of blood into the bottle meaning soldiers could be
successfully treated on the Western Front.
Another feature was that blood could now be stored and stockpiled, for
example before the Battle of Cambrai in 1917. Doctors Lewisohn and Weil
found that by adding sodium citrate, blood could be stored for 2 days, whilst
Rous and Turner increased storage for up to four weeks by adding a citrate
glucose solution to blood.
Exam Tip = first sentence is quite general Exam Tip = second sentence gives precise factual detail
2 (a) Study Sources A and B.

How useful are Sources A and B for an enquiry into the treatment of battle injuries by
medical staff on the Western Front? Explain your answer, using Sources A and B and your
knowledge of the historical context. (8)
SOURCES – THE 3 STEPS
Exam Tip
Provenance
When analysing the utility of each

source start with provenance(bit at the
top which gives author, date, etc) then Content
content (what is written or shown in
the source)and finally context (own
relevant knowledge) Context
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Step 1 = PROVENANCE – Photograph was taken during the war. It tells us this was a
British casualty clearing station. Not sure why photo has been taken. Could be to raise
morale as men are being treated.
Source A: A photograph showing a British casualty clearing station on the Western

Front, c1916. Step 3 - CONTEXT
Step 2 – CONTENT Casualty clearing stations
-Shows basic were step 3 in the Chain of
facilities/treating Evacuation where triage
wounded soldiers took place. The men here
outdoors look like the walking
wounded. As war
-Appear to be minor progressed they became
injuries just requiring more important, performing
bandages. surgery as it was realised if
men were not operated on
-Appears very clean-
quickly they could develop
possibly propaganda?
gangrene.
Step 1 = PROVENANCE – first-hand account by a trained nurse about her experiences.

Her diaries so no reason to lie. Published many years later in 2012 so affects utility as
cannot be questioned. Only her opinion.
Source B: From ‘A Nurse at the Front, the First World War Diaries of Sister Edith
Appleton’ by Edith Appleton. Edith’s handwritten diaries were kept by her family until
they were published in 2012. She was a trained nurse, working at a military base hospital
in northern France. Here Edith is describing the arrival of wounded soldiers at the hospital
during the early days of the Battle of the Somme, 1916.
Step 2 – July 4
CONTENT Wounded! Hundreds upon hundreds, some on stretchers, some being carried, and
-“Hundreds
some walking – and all covered from head to foot in mud. We had to deal with large
upon numbers of horribly bad wounds. Some were crawling with maggots while others
hundreds”- were stinking and full of gangrene. One poor lad had been shot in both eyes. Three
shows scale of men had died on the way to the hospital and two died before they could be treated.
casualties July 8
The surgeons are amputating limbs and boring holes into skulls at the rate of 30 a day.
-Serious nature
July 13
of wounds
I fear one boy may not get better. He has pneumonia caused by a lump of metal in his left
“stinking and
lung and I suppose they will not be able to operate on him.
full of
gangrene”
-Showing
futility “they
will not be able Step 3 – CONTEXT
to operate on -Huge casualty rate at start of the Battle of the Somme e.g 57,000 British casualties on
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him”. first day with 20,000 dead. Fact wounds have gangrene shows infection set in because
not treated quickly enough. Explains the amputations.
The 3 steps can be identified in the model answer below;
Source A provides useful evidence about the treatment of battle injuries by medical staff
on the Western Front as it is a photograph of a British casualty clearing station taken in
1916. It clearly shows a number of soldiers being treated by nurses and an orderly for
seemingly minor injuries, requiring bandages for wounded heads, arms and feet. Indeed,
casualty clearing stations played an important role in the chain of evacuation and were
found between 7-12 miles from the front line. Medical staff operated a system of triage
and this photograph is clearly showing a group of walking wounded who were probably
later sent back to the battlefield. More serious injuries would be treated by trained doctors
in the tent shown in the photograph with operations increasingly taking place at casualty
clearing stations to treat infected wounds before gangrene set in. However, the source is
not useful because it is unclear why this photograph has been taken. Despite the filthy
conditions on the Western Front, everyone in this picture appears to be spotlessly clean
meaning it could have been taken for propaganda purposes to reassure the public back in
Britain that the wounded were being properly cared for in France and Belgium.
Source B provides useful evidence about how medical staff on the Western Front treated
battle injuries as it comes from the handwritten diaries of Edith Appleton, a trained nurse
who worked at a base hospital in France during the war. She describes the horrific
number of casualties seen in the early days of the Battle of the Somme stating there were
“Hundreds upon hundreds” of wounded men who were “crawling with maggots…stinking
and full of gangrene”. Indeed, there were 57,000 British casualties on the first day of the
Battle of the Somme with 20,000 British dead. By the time many of these wounded men
had reached her base hospital, their wounds had already become infected which explains
why the “surgeons are amputating limbs and boring holes into skulls at the rate of 30 a
day”. This shows the huge pressure placed on the medical staff of the RAMC who had to
deal with a range of different and very serious injuries. Appleton’s evidence appears
reliable because it was written in her diary and she has no reason to lie. Indeed she
writes honestly, “I suppose they will not be able to operate on him”. However, the casualty
rate in the early days of the Battle of the Somme was much higher than at other times
during the war and so the horrific picture described here does not really reflect the work
done at the base hospitals. Also, the diaries are the opinion of one person and as they
were published in 2012 we cannot interview Edith Appleton for an accurate picture of her
whole time in France during the war.
Exam Tip
Step 2 –Content
Include embedded quotes from
written sources and things you can
see in pictures/photographs.
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2b) Study Source A.
How could you follow up Source A to find out more about the treatment of battle injuries by
medical staff on the Western Front? In your answer, you must give the question you would
ask and the type of source you could use. Complete the table below. (4)

The photograph seems to only show the treatment of minor injuries.

Where and how were more serious injuries treated?

Medical records of the RAMC

These would give evidence about wounded soldiers, their treatment and whether they
survived surgery.
Exam Tips
2b) Follow Up Question

1. Make sure you read the question so you are
following up a relevant point.
2. If the source is written include an embedded quote
for the detail you want to follow up.
3. Make sure the question you ask in the second part
can be answered by a different source i.e. you can’t
interview a doctor from the war because they will
be dead.
4. Make sure the source would have been around
during the war e.g no internet, television or even radio.
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3. Explain one way in which care in hospitals in the years c1250–c1500 was different
from care in hospitals in the year’s c1700–c1900. (4)
One way in which care in hospitals in the years 1250-1500 was different to that in the
years 1700-1900, was that in the medieval period patients were not treated but offered
food and a comfortable bed whilst centuries later, patients could expect to be treated
for their diseases. Indeed, 30% of medieval hospitals were run by the Church with
untrained monks and nuns giving comfort to the sick who shared beds. However, as a
result of the work of Florence Nightingale, nursing had become a skilled profession by
1900 with separate hospital wards to stop the spread of infection and aseptic operating
theatres manned by highly skilled doctors offering patients treatment for their diseases.
Exam Tip
Question 3
1. Start by identifying the similarity or difference between the two
time periods.
2. Give specific facts about the earlier time period.
3. Then give specific facts about the later time period.
4. Explain why there was progress in the prevention of illness in the year’s c1700–
present. (12)
You may use the following in your answer:

• Public Health Act 1875
• healthy lifestyle campaigns
• You must also use information of your own.
See model answer on the next page
One reason why there was significant progress in the prevention of illness in the period 1700
to the present day was because of an increase in government intervention in public health. 54
This began during the period 1700-1900 as large numbers of people moved from the
countryside to the industrial cities, living in overcrowded slum conditions where diseases
spread quickly. A series of cholera epidemics from 1831 and the ‘Great Stink’ in London in
Exam Tip – Make sure you link at the start of each paragraph and refer
to the question.
EITHER
55
5. ‘There was little progress in understanding the cause of disease in the year’s
c1250–c1700.’ How far do you agree? Explain your answer. (16+4)

• the Great Plague in London, 1665
• Thomas Sydenham
In some ways it can be argued that little progress was made in understanding the cause of
disease in the period 1250 to 1700 with a strong belief that miasma caused disease and
the Church’s reliance on the classical idea of the ‘Theory of the Four Humours’. However,
the growth of scientific thinking with the work of Thomas Sydenham and the Royal Society
meant that some progress had been made in the causes of disease by 1700.
When the Black Death struck England in 1348 it was believed the disease was caused by
a miasma of bad air created by the rotten vegetables, human waste and decaying human
and animal bodies which littered towns throughout the country. This idea had been passed
down from classical times in the texts of Hippocrates and Galen, leading to the Romans
building their settlements away from swamps to avoid miasmic diseases such as malaria.
During the Black Death, people tried to get rid of the bad air by lighting fires and boiling
vinegar. Indeed, by 1665 with the outbreak of the Great Plague in the reign of Charles II, it
was still believed that miasma caused the disease, showing very little progress had been
made in understanding the causes of illness. By this time, people believed the miasma
was released from the stinking streets of London in summer as a vapour. Barrels of tar
were set alight at street corners and the newly discovered tobacco was used to drive away
the miasma. Sweet smelling herbs like lavender were used to ward off the vapours just as
they had in the medieval period and prayers were given to ask God for forgiveness.
Indeed, it was the power of the church and religion which explains why little progress was
made in understanding the cause of disease in the period 1250 to 1700. In the medieval
period, a largely illiterate population accepted the church’s teachings that disease was
God’s punishment for those who had committed sin. During the Black Death, the Church
ordered people to fast, pray to God and flagellate to show repentance for their sins.
Although the Reformation reduced the influence of the Church in the years 1500-1700,
many poor people believed the Great Plague of 1665 was again a result of God punishing
man’s wickedness, which hindered scientific progress. Furthermore, it was the Church who
ensured a heavy reliance on the classical works of Hippocrates and Galen and their
‘Theory of the Four Humours’ which claimed illness and disease was caused by an
imbalance of the humours and the seasons. The Church encouraged monks to copy their
texts in Latin to give to the new medical universities where they were studied by
physicians. This was because both Galen and Hippocrates believed in the human soul
which was an important part of Christianity. However, by the 16th century although most
people still believed in the ‘Theory of the Four humours’ a small group of scientists and
physicians had begun to seek more scientific explanations for the cause of disease.
This development in scientific thinking took place because of a decline in the influence of
the Church caused by the Reformation and was boosted by the invention of the printing
press in 1440 by Johannes Gutenberg, a German goldsmith. It allowed new ideas to
spread quickly amongst scientists and physicians, who were no longer tied to the classical
texts translated by monks. A Swiss scientist called Paracelsus was one of the first to reject
the Theory of the Four Humours as he saw disease as being separate from the body His
56
work was improved further by a London doctor Thomas Sydenham who is known as ‘the
English Hippocrates’. He argued against the idea put forward in the Theory of the Four
Humours’ that a patient’s disease was personal to them and argued that diseases could be
categorised into different groups. He reached this conclusion based on careful
observations of a patient’s symptoms, developing new treatments to tackle diseases such
as malaria and smallpox. Indeed, Sydenham and other scientists and doctors were
supported greatly with the creation of the Royal Society in London in 1660 which promoted
the use of scientific experiments and encouraged sharing of ideas in its scientific journal
‘Philosophical Transactions’ first published in 1665.
In conclusion, it can be seen that whilst there was little progress in the understanding of
what caused diseases amongst the majority of the population, there was significant
progress amongst a small group of educated scientists and doctors encouraged by King
Charles II. The Royal Society encouraged the sharing of scientific ideas and the printing
press allowed this to spread even further leaving only the uneducated masses to believe in
the ‘Theory of the Four humours’ and God’s judgement.
Exam Tip
Essay Question
1. Brief introduction setting out what
you will write about.
2. 3 linking paragraphs which also refer
to the question
3. Conclusion where you reach a
judgement
Sample Exam Questions

57
Section 1 Question Types – The British sector of the Western Front,
1914–18:
Example 1
1. Describe two features of Casualty Clearing Stations. (4 marks)
2. Source A: From Harvey Cushing’s ‘A Surgeon’s Journal 1915–18’, published in

1936. This work included extracts from the journal kept by Cushing, an American
surgeon. Here he is describing the conditions under which he is working during the
battle of Passchendaele on August 19 1917.
My prize patient, Baker, with the shrapnel ball removed from his brain, after
doing well for three days suddenly shot up a temperature to 104 last night
about midnight. I took him to the operating theatre, reopened the perfectly
healed external wound, and found to my dismay a massive gas infection of the
brain. I bribed two orderlies to stay up with him in the operating room, where
he could have constant thorough irrigation over the brain and through the track
of the missile [passing a warm saline solution along the path taken by the
shrapnel to prevent infection]. No light except candles was permitted last night.
Source B: Photograph of a mobile x-ray unit taken in 1917.
2a) Study Sources A and B. How useful are Sources A and B for an enquiry into the
treatments that were available for wounded soldiers on the Western Front? Explain your
answer, using Sources A and B and your own knowledge of the historical context.
(8 marks)
58
2b) Study Source A. How could you follow up Source A to find out more about the
treatments that were available for wounded soldiers on the Western Front? In your
answer, you must give the question you would ask and the type of source you could use.
Complete the table below. (4 marks)
Example 2
1. Describe two features of aseptic surgery in the early 20th century. (4 marks)
Source A: From the diary of E.S.B. Hamilton, 19 August 1916. Hamilton had been in
France for over a year at this time, as part of the Field Ambulance. At the time of this diary
entry, he was working at an Advanced Dressing Station on the Somme.
The dugout [of the ADS] is awfully overcrowded both night and day and it is
impossible to get it cleaned or aired. [There were] something like 800 people
through here in about thirty hours the day before yesterday. This is far too much
work for the personnel [of] three officers and about 115 men. Result [is] a lot of
the men are done up and the officers seedy and depressed.
59
Source B: A photograph of an Advanced Dressing Station. This was taken in August
1916 at Pozieres Ridge, which was part of the Somme campaign.
2a) Study Sources A and B. How useful are Sources A and B for an enquiry into the
treatment of the wounded at Advanced Dressing Stations (ADS’s) on the Western Front?
Explain your answer, using Sources A and Band your knowledge of the historical context.
(8 marks)
2b) Study Source A. How could you follow up Source A to find out more about the
treatment of wounded soldiers at ADS’s? Complete the table below. (4 marks)
60
Example 3
1. Describe two features of the support trench system on the Western Front.
(4 marks)
2. Source A: From an account by Reverend Leonard Pearson, who was the army
chaplain at Casualty Clearing Station 44 during the Battle of the Somme (1916).
I spent most of my time giving anaesthetics. I had no right to be doing this because
I had no medical qualifications, but we were simply so rushed. We couldn’t get the
wounded into the hospital quickly enough and the journey from the battlefield
was simply terrible for these poor lads. It was a question of operating as quickly as
possible. If they had to wait their turn in the normal way, until the surgeon was
able to perform the operation with a doctor giving the anaesthetic, it would have
been too late for many of them. As it was, many died. We all simply had to help
and do anything that was needed.
Source B: From the diary of Oswald Robertson, written on 30 November 1917. He

was an army surgeon working on the Western Front during the First World War.
Men were horribly mutilated – many were dying when brought into the ward. All
the beds were full and we began putting stretchers on the floor. Blood everywhere
– clothes soaked in blood, pools of blood in the stretchers, streams of blood
dropping from the stretchers to the floor. My rubber apron was one solid red
smear. All we could do was try to stop the bleeding and get the patients as
comfortable as possible. I could only transfuse an occasional patient. The majority
had to take their chance and go through the operation as best they could.
a) Study Sources A and B.

How useful are Sources A and B for an enquiry into the problems involved in
performing operations on the Western Front? Explain your answer, using Sources A
and B and your knowledge of the historical context. (8)
b) Study Source B.
How could you follow up Source B to find out more about the problems involved in
performing operations on the Western Front? Complete the table below. (4)
61
Section 2 Question Types –Medicine Through Time 1250-Present Day

Question 3 Types
Explain one way in which people’s reactions to the plague in Britain were similar in the
fourteenth and seventeenth centuries. (4)
Explain one way in which ideas about preventing the plague were different in the 14th
and 17th centuries. (4)
Explain one way in which ideas about the causes of disease were similar in the
fourteenth and seventeenth centuries. (4)
Explain one way in which treatments for illness were similar in the fourteenth and
seventeenth centuries. (4)
Explain one way in which ideas about the treatment of disease were different in the
17th century from ideas in the 13th century. (4)
62
Explain one way in which people’s reactions to epidemics of disease were similar in
the seventeenth and nineteenth centuries. (4)
Explain one way in which people’s reactions to the epidemics of disease were
different in the seventeenth and nineteenth centuries. (4)
Explain one way in which ideas about the causes of disease were similar in the
seventeenth and nineteenth centuries. (4)
Explain one way in which ideas about the causes of disease were different in the
seventeenth and nineteenth centuries. (4)
Explain one way in which understanding of the causes of illness was similar in the late
nineteenth and twentieth centuries. (4)
Explain one way in which understanding of the causes of illness was different in the late
nineteenth and twentieth centuries. (4)
Explain one way in which understanding of the causes of disease and illness was
different in c1750 from the present day. (4)
63
Question 4 Types
Explain why there was continuity in ideas about the cause of disease during the period
c1250–c1500. (12)
• the Church
• Galen
Explain why there was little change in the care provided by hospitals in the period
c1250–c1500. (12)
• ideas in the Church

• herbal remedies.
Explain why there was continuity in the way disease was treated in the period
c1500–c1700. (12)
• the Great Plague

• attitudes in society.
Explain why there were changes in the way ideas about the causes of disease and
illness were communicated in the period c1500–c1700. (12)
• the printing press

• the Royal Society.
Explain why some changes took place in medical knowledge during the period 1500–
1700. (12)
64
 Growth of scientific thinking
 Printing press
 You must also use information of your own.
Explain why there was little change in methods of treating and preventing disease
during the period c. 1500– c. 1700. (12)
 People believed in superstition

 Theory of the Four Humours very popular
Explain why there was rapid change in surgical treatments in the period c1700–c1900.
(12)
• chloroform
• Joseph Lister.
Explain why there were so many medical breakthroughs in the nineteenth century. (12)
 Role of the individual

 Development of technology
Explain why there were changes in understanding of the cause of disease during the
period 1700– 1900. (12)
 Pasteur’s germ theory

 Development of technology
65
Explain why there was both continuity and change in treatments for sickness during
the period 1700– 1900. (12)
 Role of Florence Nightingale

 Most people treated at home by women
Explain why there was rapid change in the prevention of smallpox after 1798. (12)
• inoculation
• the government.
Why has there been such rapid progress in medicine since 1900? (12)
 Development of genetics
 Technology
Explain why there have been changes in understanding the causes of illness during the
twentieth century. (12)
 Development of genetics
 Improved technology
Explain why there have been changes in methods of preventing illness during the
 Increased role of government

 Scientific understanding
66
Explain why there have been changes in methods of treating illness during the
 Creation of NHS
 Discovery of penicillin
Explain why there was rapid change in the treatment of illness in Britain during the
 magic bullets
 high-tech treatment
Explain why there was rapid progress in disease prevention after c1900. (12)
• government intervention
• vaccinations.
67
Question 5 & 6 Types
‘The Theory of the Four Humours was the main idea about the cause of disease in
the Middle Ages.’ How far do you agree? Explain your answer. (16+4 SPAG)
• university training
• Galen’s ideas.
• You must also use some information of your own.
‘Hospital treatment in England in the period from 1250 to 1500 was very rare’. How
far do you agree? Explain your answer. (16+4 SPAG)
• charity hospitals
• care in the home.
‘There was little progress in medicine in Britain during the Renaissance period
(c1500–c1700).’ How far do you agree? Explain your answer. (16 + 4 SPAG)
• the work of William Harvey

• bloodletting and purging
‘Individuals had the biggest impact on medical training in the 16th and 17th
centuries’. How far do you agree? Explain your answer. (16 + 4 SPAG)

• Vesalius
• the printing press.
• You must also use some information of your own.
‘Jenner’s vaccination against smallpox was a major breakthrough in the prevention

of disease in Britain during the period c1700–c1900.’ How far do you agree? Explain
your answer. (16+4 SPAG)

• cowpox
• cholera
68
• You must also use information of your own
‘The role of the Church was the main reason why there was so little change in
medicine in the Middle Ages.’ How far do you agree? Explain your answer.
(16+4 SPAG)
• Influence of the Church
• Lack of science and technology
‘Vesalius’s work on anatomy was a major breakthrough in medical knowledge

during the period 1500– 1700.’ How far do you agree? Explain your answer.
(16+4 SPAG)
• Publication of ‘The Fabric of the Human Body’
• Lack of bodies for dissection
‘Harvey’s discovery of the circulation of the blood was a major breakthrough in

medical knowledge during the period 1500– 1700.’ How far do you agree? Explain your
answer. (16+4 SPAG)

• Publication of ‘An Anatomical Account of the Motion of the Heart and Blood in
Animals’
• Doctors still believed in Galen’s theories
‘There was rapid change in ideas about the causes of illness and disease in the
period c1700–c1900’. How far do you agree with this statement? (16+4 SPAG)
• Spontaneous generation
• Louis Pasteur.
‘Germ theory was the most significant medical breakthrough in the 1800s.’ How far
do you agree? Explain your answer. (16+4 SPAG)

• Development of bacteriology
69
• Government more interested in prevention rather than cause of disease
‘There was rapid progress in methods of preventing disease between 1700 and
1900.’ How far do you agree? Explain your answer. (16+4 SPAG)

• Role of Jenner
‘Jenner’s vaccination against smallpox was a major breakthrough in the prevention

of disease during the period 1700– 1900.’ How far do you agree? Explain your answer.
(16+4 SPAG)
• Role of Jenner
‘Simpson’s use of chloroform as an anaesthetic was a major breakthrough in

surgery during the period 1700– 1900.’ How far do you agree? Explain your answer.
(16+4 SPAG)

• Role of Simpson
• Bleeding caused by complex surgery
‘The development of penicillin was a major breakthrough in the treatment of

illnesses during the twentieth century.’ How far do you agree? Explain your answer.
(16+4 SPAG)

• Penicillin
• Creation of NHS
‘The discovery of DNA was a major breakthrough in medicine during the twentieth
century.’ How far do you agree? Explain your answer. (16+4 SPAG)
70
• DNA
• Development of antibiotics
‘There was no progress in understanding the cause of disease between 1250 and
1800.’ How far do you agree? Explain your answer. (16+4 SPAG)

• Miasma
• Punishment from God
‘Pasteur’s germ theory was the most important turning point in understanding the
causes of disease and illness.’ How far do you agree? Explain your answer.
(16+4 SPAG)

• Pasteur’s germ theory
• Genetics
71

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Edexcel 9-1 History GCSE

Medicine Through Time

- Much sickness/disease because of lack of food and hard physical labour.

-Homes were heated by open fires, leading to lung diseases.

-Almost 50% of the population died before reaching adulthood.

Key Topic 1 – Medicine in Medieval England 1250-1500

-A physician’s consultation was based on 3 stages;

Differences between physicians and apothecaries

-Apothecaries prescribed poison/physicians did not.

e) Caring for the Sick

Causes of the Black Death

Treatments of the Black Death

BUT NO CURE FOUND. Today can be treated with antibiotics.

Preventing the Black Death

What was the Renaissance? -This means rebirth.

Part 1 – Ideas about the Causes of Disease and Illness

-Continuities with Medieval Medicine

-Changes with Medieval Medicine

3. Ordinary people still believed in the Theory of the Four Humours.

Key Topic 2 – Medical Renaissance in England 1500-1700

Why was Vesalius so important?

6. Continuities in Medical Care

7. Changes in Care of the Sick

- given a good diet

8. Continuities in Care of the Sick

Part 3- Case Study 1- William Harvey

-Born in 1578. Studied medicine at Cambridge and then at Padua.

b) Circulation of Blood Theory

c) Factors which helped William Harvey

- Individuals and institutions

- Science and technology

d) Why was William Harvey significant?

-Other healers used;

 Herbal remedies e.g nutmeg, sugar

Increased government action

-Streets were swept and kept clean.

-Carts collected the dead bodies

6. Continuities in Preventions of the Great Plague

-Pray to God for repentance and fast as punishment for sins.

Part 1 – Ideas about the Causes of Disease and Illness

1.Continuities about the causes of disease and illness

2. Changes in ideas about the causes of disease

a) Louis Pasteur and the Germ Theory

 Floors, beds and walls were scrubbed clean

RESULT = Mortality rate dropped from 40% to 2%.

Nightingale returned to Britain a hero in 1856.

What impact did Nightingale have in Britain?

How had hospitals changed by 1900?

b) Improvements in Surgical Treatments

-1700 (start of period)

-Most common form of surgery was amputation

1.Development of Anaesthetics (deal with pain)

2. Development of Antiseptic Surgery (deal with infection)

-Joseph Lister and Carbolic Acid

Opposition to use of Anaesthetics and Antiseptics

3. Changes in the Prevention of Diseases

CASE STUDY -EDWARD JENNER AND SMALLPOX VACCINE

Who was Edward Jenner?

Syphilis – was a killer throughout history

Prontosil – kill bacterial infections