Health and the people revision

1. Health and the people revision

2. Factors

3. Question types – Question 1 (8 marks) Source based – use source and own knowledge. Consider reliability and provenance (origin) Source A is useful for… because it says/shows… This is useful because I know that… However, it is not useful for telling us about (including specific relevant knowledge) The provenance of the source makes it more/less useful because… (Content, origin, purpose) Overall, source A is/isn’t useful because…

4. Question types – Question 2 (8 marks) Consequences of a development. Consider how significance has changed over time for top marks…… at the time, later, and today Explain what was significant about… in the development of medicine …was very/not very significant at the time because… …became more/less significant later because… …is now very/not very significant because…

5. Question types – Question 3 (8 marks) Consider two events and compare them to consider similarities or differences. Think about causes, events, developments and consequences. Compare x and y. in what ways were they similar/different? Explain your answer with reference to both. You should explain three factors The.. of X and Y were similar because they both… For example X… whereas Y… This makes them similar because…

6. Question types – Question 4 (16 marks) You need to draw on your knowledge from the whole course. You need to bring in understand from different periods. You will probably be asked about: understanding causes and cures; development of public health; development of surgery; development of medicines. You’ll be given one factor and you need to explain this factor and at least two others. Has… been the main factor of… in Britain since Medieval times? Explain your answer with reference to… and other factors.

7. Part 1 – Medicine stands still

8. Medieval Medicine • The course starts at the year AD 1000 BUT medicine during this time was based on the Ancient Greek, Hippocrates, and the Ancient Roman, Galen.

9. Can you explain why Hippocrates is regarded as such an important figure in the development of medicine?

10. Hippocrates – the 'father' of modern medicine Hippocrates and his followers firmly rejected magical and supernatural cures. He insisted that all diseases had physical causes. He encouraged doctors to observe symptoms and to look for causes based on those symptoms.

11. New Greek medical ideas As well as believing in the healing powers of Asclepius, there was also a lot of respect for other medical theories. One important Greek philosopher was Aristotle, who originally developed theTheory of the Four Humourswhich became the basis for Greek medical practice. Hippocrates developed the theory further. Despite being wrong, it was a theory which was to be widely used by doctors for nearly 2,000 years.

12. Source A: The four humours • Man's body has blood, phlegm, yellow bile and black bile. These make up his body and through them he feels illness or enjoys health. When all the humours are properly balanced and mingled, he feels the most perfect health. Illness occurs when one of the humours is in excess, or is reduced in amount, or is entirely missing from the body. • Hippocrates, 'On the Constitution of Man' (c.500BC)

13. The Theory of the Four Humours The Theory of the Four Humours was influenced by Greek ideas about balance. The Greeks believed that the world was made up of fourelements: Air Fire Earth Water Through observing the four seasons, they believed that each season must have a dominant element.

14. Each of the humours was related to a season and element: Air Fire Earth Water Spring Summer Autumn Winter Blood Yellow bile Black bile Phlegm

15. Greek doctors noted that patients’ symptoms varied with the seasons – heat rashes in summer, wet runny noses in winter. From this, they deduced that the human body was made up of four vital liquids which they referred to as ‘humours’: • blood • phlegm • yellow bile • black bile.

16. Galen and the Romans • We’ll flick over to the Boardworkspowerpoint to find out more about the Romans

17. Factors in Ancient world • War – The Roman armies spread knowledge through the countries they conquered (including Britain!) • Individuals – Hippocrates and Galen • Religion – In all times religion banned dissection. Believed gods made you sick and made you better. • Education – The Greeks were great thinkers , they encouraged logical thinking and natural solutions to causes of illness. • Trade and Communication – as trade increased, there was an exchange of ideas. • Government – the Romans introduced public health into the towns.

18. Islamic medicine • After the fall of the Roman empire, much of their progress in medicine and public health was lost in the West – the ‘Dark Ages’. • Muslim writers saved much of this knowledge, translating manuscripts into Arabic, which eventually passed on to western Europe. • Islamic hospitals in the AD900s onwards were sites of medical education and healing. • The most famous hospitals, e.g. in Baghdad, Damascus, and Cairo, had lecture rooms, pharmacies, and libraries. • Many students received practical training and observed patients. • Cleanliness was encouraged. • Hospitals often centred around fountains, and cooling breezes circulated around the wards.

19. Other aspects • Public baths • Schools and universities • No dissection – religious rules • Thought diseases could be sent by Allah • Islamic texts told Muslim doctors to try and cure patients “Oh servant of Allah, use medicine. Allah has not created pain without a remedy for it.” • Charity and caring = important in Islam • Cairo hospital AD1283, patients given money when they left so didn’t have to go straight back to work

20. Surgery • Still used idea of four humours and clinical observation • They invented distillation to prepare drugs for treating diseases and anaesthetics e.g. soaking a sponge in hashish and opium – put on patient’s face or two pieces in nostrils • Doctors had to train and get a licence, then he could have his own medical practice or work in a hospital • However, people who worked as healers didn’t have a licence but could still work • Surgery is a last resort • Emphasise knowing what is causing pain before operating. Have a plan and equipment and anaesthetics • More prepared to do surgery that didn’t involve opening the body e.g. cataracts, setting fractures etc • Dentistry – more careful and skilled and made artificial teeth from bone

21. Medieval medicine – believed causes • God – illness was punishment for sin. An epidemic (widespread disease e.g. the plague) was punishing society • God could cure disease and also provided right herbs or plants to treat it • Bad smells (miasmas). Mortality was higher in towns and cities because of close living quarters • Everyday life – many children died before 7 years old • Childbirth was very dangerous • Supernatural – witchcraft was feared. Belief in demons. • Four Humours – widest-held belief.

22. Medieval medicine – practitioners • Barber surgeon – minor operations, set broken bones, pull teeth. They served an apprenticeship before qualifying. Mostly in towns and cities but some travelled in the countryside and visiting fairs. • Apothecary – sell medicines, herbs, and spices. Apprentieship for seven years. Simples = medicine of one herb or plant. Compounds = combination. • Wise woman – wisdom and skills handed down, reasonably priced, usually knew the patient. Also acted as midwife. • ‘Lady of the house’ provided medical care for the family and labourers. • Trained doctors = hugely expensive.

23. Medieval surgery • Two groups: • University trained and licensed BUT very expensive • Barber surgeon – unqualified BUT cheaper Both groups had limited anatomical knowledge due to dissection being limited or forbidden No knowledge of germs so patients die often from blood loss or infection.

24. Diagnosis and treatment • Doctors would use urine charts to diagnose patients, they test the colour, smell and even taste of the urine. • Zodiac charts – parts of the body linked to astrological sign, so what would be needed to cure a patient. E.g. some things work for an Aries but not a Pisces. It might also tell the physician the best time to treat, and even when to pick the herbs. • They still believed in the theory of opposites(Galen) and so would use methods such as bleeding to balance the humours. • There was a huge selection of herbal remedies. Many of these have been proven to work e.g. onion and garlic kill bacteria. • There were also supernatural treatments available, such as charms and The King’s Touch (when the king would touch a person that was suffering with the disease scrofula to cure them)

25. Important individual – John Arderne • Born 1307 Trained as a surgeon and practised in London • Famous for his success rate • E.g. removing growths from inside an anus had a survival rate of over 50% - massive for medieval times • Worked as a surgeon on the battlefield • Pain killing ointment – hemlock, opium, and henbane • Speedy amputation skills • Book – the Practice of Surgery, 1350 • Advocated good bedside manner • Told doctors to trust own judgement • Charged the rich as much as he could but treated the poor for free.

26. Church’s role – help and hinder Hinder Dissection limited if not forbidden Insistence on using Galen Emphasised prayer and pilgrimage over scientific treatment Tried to control knowledge – arrest people spreading anti-Church ideas Help Set up 160 hospitals in 12th and 13th centuries Set up university schools of medicine Preserved knowledge by copying books Monks and friars acted as doctors Treated the poor for free

27. Medieval hospitals and public health

28. Monasteries Own water and drainage supplies Dirty water used to clear toilets Water for drinking was purified many times Monks emphasised hygiene One monk would be in charge of clean towels and sheets. Towns Crowded and dirty Water came from river but this had rubbish and sewage in it Cesspits emptied into river Some passed law to stop people throwing rubbish and sewage but this was hard to enforce Animals everywhere Most drank beer rather than water Hospitals Set up for different reasons e.g. poor, pregnant women (St Bartholomew's in London) or ‘poor and silly persons’ (St Mary’s) Leper houses Catered to poor Most were care homes rather than treatment

29. Factors – medieval medicine War– Armies took trained doctors to war so they gained experience on the battlefield. However war also made travel dangerous and caused the collapse of the public health system. Religion– The Christian church set up universities for doctors to train in. It also built hospitals. They also housed books in the monasteries. However, the universities did not teach the doctors to look for new ideas as they said Galen’s ideas were correct. Communications–The Crusades led to an exchange of ideas with Arab doctors. Government– There were some laws to force towns and cities to clean up. However, these were not enforced and the King had not money to pay for improvements.

30. The Black Death • In 1348, a ship brought the Black Death to England. Over 40% of the population died during the plague. The Black Death killed both rich and poor alike, swiftly and painfully. The dead were quickly buried in large communal graves. • There were two kinds of plague: • Bubonic Plague • Pneumonic Plague

31. A Case Study of the Black Death – 1348-49 https://www.youtube.com/watch?v=Lv0dKdhdRpM Causes – Use the Blue Book Cures – Use the Blue Book Pop open buboes Attach a live chicken or pigeon Drink vinegar and mercury Flagellation (whip yourself) Bleeding Pray Avoiding infection egs include praying, clean up filth, bathe in urine • Miasmas • Four Humours out of balance • God • Jews poisoning wells and springs • Planets • Earthquake in China

32. Plague – similarities and differences 14th Century (1300s) 17th Century (1665-1666) Stop all public entertainment Pigs and other animals not kept in the city Kill all dogs and cats Clear rubbish from the streets Light fires in the streets to drive away miasmas Houses containing plague victims are to be sealed up for 40 days and the door painted with a red cross No strangers in the city without a certificate of health Bodies buried after dark and not in churches or churchyards Public prayers on Wednesday and Fridays Weekly fasts (going without food) • March and pray • Burning candles • Avoid eating too much • Avoid taking baths • Avoid having sex (excitement will weaken you!) • Avoid all plague victims • Clean all filth • Carry sweet smelling herbs and spices to keep away evil smells • Attend church • Bathe in urine three times a day or drink it once a day

33. Exam checkpoint • Source A: showing Saint Elizabeth of Hungary, who was famous in the 13th Century for helping the poor and sick. • How useful is it for understanding Christian ideas about illness? Explain your answer using Source A and contextual knowledge.

34. Exam checkpoint • Source B: illustration in a 14th century book written by an abbot, recording the impact of the Black Death. • How useful is it to an historian studying the impact of the Black Death in England? Explain your answer using Source B and contextual knowledge.

35. Exam checkpoint • Compare public health in a medieval town with public health in a medieval monastery. In what ways were they different? (8 marks – q3 type).

36. The Renaissance • The Renaissance gets its name from the rebirth in interest of the classical period. • The Royal Society (a famous scientific society), was founded in this period (1660). The Renaissance saw science begin to replace explanations of superstition, astrology and religion. • Renaissance Man is important as people at the time thought that a well-educated person should have a good knowledge of science and art. Artists like Michelangelo and Da Vinci would have studied both. They would attend dissections resulting in wonderful drawings. • The return of the works of Galen and Hippocrates renewed a belief in the four humours, treatment of opposites and various herbal remedies.

37. Andreas Vesalius • http://www.bbc.co.uk/education/clips/z63n34j • Vesalius was born in 1514 and studied medicine in Paris and Italy. He was allowed to perform dissections but couldn’t look closely at the skeleton. He was so dedicated he stole the body of a criminal from the gallows. • He became professor of surgery at Padua in Italy where he performed more dissections. He wrote books on his observations including The Fabric of the Human Body in 1543. • His illustrations were carefully labelled and he used his powers of observation to point out some of Galen’s mistakes. • Galen thought that blood passed through the septum of the heart through little holes. Vesalius proved there were no holes in the Septum. • Galen believed that human jaw bones were made of two pieces. Vesalius proved it was one. • This was important as it proved Galen could be wrong!

38. Ambroise Pare • Pare was a barber surgeon born in 1510. Surgery was still a low status profession. He first worked for a public hospital and then became an army surgeon. • At the time the wound left by amputation was sealed by burning the end with a red hot iron, known as cauterisation. This was very painful. • Pare invented the method of tying off vessels with thread, known as ligatures. This was less painful, but may have caused infection as they did not yet know about germs. • Gunshot wounds were, at the time, treated by pouring boiling oil into the wound. • During one battle, Pare ran out of oil and resorted to an ointment of his own. To his surprise, these patients recovered better than the ones scalded with oil. • He received opposition to his ideas from doctors who didn’t want to listen to a lowly surgeon. However, when he became surgeon to the King of France and gained the King’s support, people started listening to his ideas.

39. William Harvey • William Harvey was born in 1578 and studied medicine in Padua in Italy. He then worked in London as a doctor and lecturer to James I and Charles I. • He realised he could observe living animal hearts in action and his findings would also apply to humans. He chose cold-blooded animal so the heart beat was slow. • In 1628, he published a book showing that blood was going around and around and NOT being used up and remade like Galen thought. He also proved the difference between arteries and veins. • Although Harvey’s discovery was useful for knowledge of anatomy and for challenging Galen, it did not radically change surgery. Bleeding continued to be performed and blood transfusions were not generally successful until the discovery of blood groups in 1900.

40. Thomas Sydenham – the English Hippocrates Believed in close observation of the patient and monitor symptoms and treatments given, in order to build up a body of knowledge and experience. Treatment for smallpox = ‘cool therapy’ – lots of fluids, moderate bleeding, keeping patient as cool as possible. Some praised his efforts, but most thought him eccentric.

41. Printing • Johann Gutenburg introduced printing to Europe in 1454. This invention helped medicine progress! William Caxton set up the first British printing press in 1476 in Westminster Abbey. • Making a single copy by hand could take weeks, months, even years to complete by a copyist. Books were therefore very rare before printing. New ideas could not be spread easily as they just weren’t written down anywhere! • The printing press changed this, and was a big factor in helping new ideas spread within the Renaissance.

42. Changes in medicine • The discoveries made by Harvey and Vesalius were important as they proved to doctors that Galen was wrong and that careful dissection and experimentation were the way to new ideas. • Pare’s use of bandaging wounds and using ointment instead of boling oil helped patients survive as other surgeons could see it working. However his use of ligatures slowed down surgery, causing problems with bleeding, and also helped spread infection as these were not sterilised. • In 1492, America was discovered. This brought a wide range of new knowledge to Europe including many new herbal treatments. Trade and communication helped here.

43. Continuity in medicine • The discoveries of Harvey and Vesalius did not make anyone healthier at the time. Life expectancy did not increase much. They hadn’t discovered new and better ways of treating illnesses. • Treatments: Herbal remedies were still widely used. It is important to remember that a number of these worked. Surgery only improved a little. • Treatments from the Four Humours were still widely used; this had not yet been disproved. • Superstitious treatments were still widely used, including charms and the famous ‘King’s Evil’, this included the king touching someone with the skin-disease, Scrofula, in order to cure them. • Trained doctors and surgeons could still treat those who could pay. The poor had to rely on family, wise women and travelling quacks.

44. Exam checkpoint • Compare medieval anatomy with Renaissance anatomy. In what ways were they different? Q3 type, 8 marks

45. John Hunter What was ‘Burking’? Named after William Burke and William Hre who committed ten murders in a few months in order to sell fresh bodies to surgeons and schools of anatomy. Surgeon and anatomist What did he spend most of his time doing? Training surgeons and dissecting bodies. Why was John Hunter accused of Burking? He always seemed to have fresh supplies of bodies! http://www.bbc.co.uk/education/clips/zcrhn39 Some pictures may be upsetting.

46. Changes in surgery • Royal College of Surgeons set up in the 1800s • Could only practice with a license • 1811 – had to attend at least one course in anatomy and one in surgery • 1813 – minimum one year’s experience in a hospital

47. Technical and Scientific advances • The microscope was invented in 1683 by Antony Van Leeuwenhoek. • The thermometer was invented by Daniel Gabriel Fahrenheit in 1709. • Physicians such as Hermann Boerhaave were stimulated into observing patients more closely and keeping accurate records. • Albrecht Von Haller, a student of Boerhaave’s investigated breathing and digestion. • Yet none of this resulted in doctors discovering the real cause of disease.

48. ‘Quackery’ • ‘Quack’ doctors in search of profit, peddled all sorts of nonsense cures. • For example, ‘piss prophets’ emphasised diagnosis by examining urine. • Others recommended useless pills or claimed that evil worms caused illness. • A German doctor Franz Mesmer claimed he could cure patients through hypnotism. • The main reason people bought from quack doctors? Desperation. • Main incredient in quack medicines was alcohol and opium.

49. Growth of hospitals • Thomas Coram opened a hospital in 1741 to acre for abandoned children – spent 10 years collecting funds • Babies chosen by lottery • Most were 5-15 and then trained for domestic or military service • Voluntary hospitals filled the gap left by abolition of monasteries. Began to treat the sick properly.

50. Factors • Individuals: People were willing to challenge old ideas. By experimenting they could prove they were correct. • Wars: Public health was made worse but developed knowledge of anatomy and treatment • Education: literacy was increasing and there were more schools. • Technology: printing helped with the spread of ideas; there were improvements in clocks, watches and pumps; more realistic artwork. • Ancient learning: renewed interest in the writings of Greek/Roman thinkers.