History Changes In Health & Medicine, c.500 to Present Day

Question 1

1. Causes of illness and disease - Medieval Era

Describe how poverty
was a cause of illness

Answer 1

• Most people in medieval england depended on their fields for food. By 1300 the population of England was about 4.75m, largest it had every been.
• 25% of rural families had enough land to support themselves. 40% of rural families had to buy some/all of their food.
• Often farm work had to be supplmented by wage labour in order to make enough money to survive.
• As landowners were enclosing more and more land for sheep, much of the country’s wealth came from wool trade - paid work was hard to come by. ( Therefore most people were poor )
• People would eat bread and pottage, a new kind of stew made from beans, peas & oats, with herbs. Poaching penalty’s existed & child manutrition was high.

Question 2

1. Causes of illness and disease - Medieval Era

Describe how famine
was a cause of illness

Answer 2

• Famines were very deadly. For example, in 1069, William the conqueror, angry with continuing Anglo-Saxon rebellion, destroyed a whole swathe of land & his men poured in salt, preventing anything from growing. Thousands died.
• The worst Famine is Europe was in 1315-17 when torrential rain ruined planting and harvesting for 3 years. The poor harvest was compounded by the death of animals from disease & a shortage of fodder.
• Most of the seed grain was eaten, so crops couldnt be sowed even when conditions improved in 1318, so the effects of the famine rumbled on until 1324-25. Estimated 10-15% of Englands population died during this Famine.

Question 3

1. Causes of illness and disease - Medieval Era

Describe how Medieval Warfare was a cause of illness

Answer 3

• There is a suggestion that an epidemic killed many otherwise healthy males in the Viking army winter camp at Repton in Derbyshire in 873-74.
• At the start of the Medieval Era, armies were relatively small, meaning fewer deaths. This changed later on, Edward I often called out 10,000 calvary & 30,000 infantry in his wars with Wales & Scotland. At the battle of Townton, in 1461, around 22,000-28,000 soldiers died fighting.
• Wars were also dangerous if you were in a besegied town, city or castle. If you held out too long or didn’t surrender, once the attacking army broke in, inhabitants were often killed or driven off with nothing.
• Villages, farms and towns were often left with little to no food as armies that provisioned themselves as they travelled needed enourmous amounts of food, which they stole.

Question 4

1. Causes of illness and disease - Medieval Era

Describe the issue of Accidental deaths

Answer 4

• Maud fraus was killed by a large stone accidently dropping on her head at Montgomery Castle in Wales in 1288. At Aston, Warwickshire in October 1387, Richard Dousyng fell when a branch he had climbed broke & he broke his back and died.
• Storing crops over the winter brought their own problems. ‘Saint Anthony’s Disease’, for example, was caused by a fungus growing on stored in damp conditions. Once the rye was ground into flour & baked into bread, those who ate it developed painful rashes.

Question 5

1. Causes of illness and disease - Medieval Era

Describe what made towns so unhealthy in the Medieval Era

Answer 5

• There was little regulations on what you could or could not build. Houses were crowded together & sanitation was very limited. Improvements depended on the corperation that ran the town & most wanted to keep costs as low as possible.
• Homes were also unhealthy, floors were covered in straws which were rarely changed. This was the perfect breeding ground for rats, mice, lice & fleas. There were few windows, & usually smoke from a wire would have to leave through a whole in the roof. Only the rich could afford windows & chimmneys, so homes were dark & smoky.
• Towns were unhealthy since there so many people living together & there were few regulations about building or waste removal. Clean water was also short in supply often taken from streams that were contaminated. Rubbish accumulated in streets until the water washed it away.

Question 6

1. Causes of illness and disease - Medieval Era

A) Describe the effects of the Black Death
B) Describe what people thought caused the Black Death

Answer 6

A) In 1348 a ship docked at Melcombe in Dorset, bringing with it the Black Death. Its impact was devastating. In some places whole villages were wiped out.
- In 1348-49, its estimated 50-66% of the British population died.

B) Different ideas were
- Bad smells, from an overflowing privy or rotting food, corrupting the air
- The 4 humours are out of balance in each victim
- God is angry with the victims, they aren’t praying enough
- Jews have poisoned for wells & springs.

Question 7

1. Causes of illness and disease - Early Modern

Describe;
A) The biggest killer diseases in this period
B) The dangers of the Plague

Answer 7

A) The biggest killer diseases in the Early modern period were; ‘fever, consumption, teeth, griping in the guys, and convulsions.’ The very descriptions show how little surgeons & physicians new about the causes of such diseases.

B) In 1604, 30% of the population of York died in an ourbreak of the plague. In 1665 around 100,000 people died of plague in London ( Nearly 25% of population ).
- Wealthy people fled the city for their country houses until the plague left, but it many cases it only spread the plague.

Question 8

1. Causes of illness and disease - Industrial period

Describe the impact brought by industrialisation on health

Answer 8

• In Bethnal Green, in 1842 richer people lived on average to 45, while laboures till 16. In Manchester 57% of children died before age 5. Social survey show often a whole family lived in 1 room.
• Contagious diseases, such as typhoid, typhus, diarrhoea, smallpox and TB spread rapidly in overcrowded conditions. Bad conditions shown by Rickets spread, caused by calcium defiency and lack of fresh air & sunlight.
• Young boys were forced to clime up chimmneys came in contact with soot & gases, Percivall Pott, an English surgeon, identified scrotal cancer in many of these boys.
• Young girls making matches at factors developed ‘phossy-jaw’ caused by the fumes. Part of their jaw would be eaten away or glow in the dark. It also caused brain damage.
• Coal miners developed pnuemoconiosis, a disease of the lungs, caused by inhaling dust below grounds. Machines in new textile factories rarely had guards with few regulations.

Question 9

1. Causes of illness and disease - Industrial period

Describe the issue of;
A) Cholera
B)Typhoid fever

Answer 9

A) The cholera epidemics of 1831-32, 1848, 1854 and 1866 were perhaps the biggest concerns. Cholera is a bacterial infection caused by ingesting contaiminated food/water.
- Originated in Bengal, India & slowly spread acroos trade routs.
- 1831-32: 50k deaths, 1848: 60k deaths, 1854: 20k deaths

B) Typhoid is caused by poor sanitation & lack of cleanliness, had killed people since Ancient Greece & was especially noticeable in armies. Industrial cities, being hard to keep clean, was a ferile place for typhoid. Prince Albert died in 1861.
- 1897-98in Maidstone, Kent a typhoid outbreak infected 1800/34,000 people & killed 132. Over 200 reports in first 8 days.

Question 10

1. Causes of illness and disease - 20th Century

Describe the impact of the Spanish Flu

Answer 10

• In 1918, a flue pandemic spread worldwide, estimated 20-40million people died as a result & originated in China. Said to have infected 20% of world’s population & was most deadly for 20-40 year olds.
• The mass troop movements in 1918 after the end of WW1 helped spread the disease worldwide. The Uk gov.t imposed censorship about the spread, but newspapers reported on the 7million deaths in Spain.
• In a few months in the UK around 280,000 people died. Up to 20% of those infected died. Australian troops were staioned at Sutton Veny in Wiltshire from 1915-19, and there was a military hospital there.

Question 11

1. Causes of illness and disease - 20th Century

Describe the fight agaisnt AIDS & it’s impacts.

Answer 11

• AIDS was first identified in 1981 in USA where it was seen large numbers of homosexual were dying. In 1983, it was seen a viral infection was attacking the immune system.
• By 2014 it’s estimated that 40million people have died from AIDS, & another 40million living with it. In the UK there are over 100k people living with AIDS and it’s thought that 25% of them have no idea they have the disease.
• It’s thought AIDS originated among primates in Africa, people don’t die of AIDS but from catching simple infections due to a weakned immune system.
• AIDS is usually cause by:unprotected sex with someone who has the disease; by sharing hypodermic needles; by contaminated blood transfusions; & from mother to child during pregnancy or breast feeding.

Question 12

1. Causes of illness and disease - 20th Century

Describe the reactions to AIDS

Answer 12

• Some belive it is a religious issue, caused by God’s punishment to us, others believe it could be spread by touching while others thought those with AIDS should be isolated.
• Others have set up charities, like the Governments World Health Organisation, have spent millions on awareness campaigns to slow the spread of the disease. Some people argue, theres no need for anyone to catch AIDS.
• Some people see the story of AIDS as a pessimistic one. New disease and epidemics are always going ot break out, and science and technology are not always going ot be able to control them.
• Others see AIDS in a more optimistic light. Yes, it is an epidemic that has killed millions but the gov.t and internation organisation are working hard together to control the spread of disease and will find a cure.

Question 13

3. Attempts to treat and cure illness & disease - Medieval Era

Describe how;
A) Herbal medicines
B) Bleeding
were used as a cures in medieval england.

Answer 13

A) Herbal remedies:
- Herbal medicines often contained ingredients such as honey and a mixture of other plants that we know today do help.
- Treatments would be written down in ‘Herbals’ which included ingredients needed and prayers to say while collecting them ( to increase effectiveness )
- Some recipies would only work when picked at certain times of day, ( e.g. a full moon ).
- Remedies were often closely guarded family secrets

B) Bleeding:
- Most favoured way of fighting illness, and restore balance of the 4 humours.
- This was either achieved by ‘cupping’ or leeches. ( Monasteries showed monks bled almost 8 times a year! )
- Illness had been said to been caused by having to much blood.

Question 14

3. Attempts to treat and cure illness & disease - Medieval Era

Describe how;
A) Urine in diagnosis
B) Zodiac charts
were used as cures in medieval england.

Answer 14

A) Urine in diagnosis
- Urine was a vital diagnosis tool for doctors in the mediavel era
- Physicians would look carefully at the colour & compare it to a chart. ( He might smell/taste it to decide whats wrong with patients )
- Many patients today still have to submit a urine sample to treatment.

B) Zodiac Charts
- Charts like these would tell physicians which parts of the body were linked to which astrological sign, indicating what might cure a patient.
- Might also tell him what the best time to carry out treaments were, and when to pick certain ingriedents for treatment.
- Some ingredients picked at the wrong time might cause more harm than good.

Question 15

3. Attempts to treat and cure illness & disease - Medieval Era

Describe the role of Barber surgeons & leeches in acting as cures to illness.

Answer 15

1. Barber Surgeons
- These were surgeons with little to no experience/training that could; pull teeth, mend broken limbs, carry out bloodletting & cut hair ( Could also carry out surgeries ).
- They may sometimes combine their trade with an apothecary, producing herbal medicines to varying degrees of succesfullness.
- These were the only medical professional available to alot of people

2. Leeches
- Leeches have been used in medicine for over 2500yrs, they slowly suck out blood, as a natural form of bloodletting.
- Their saliva contains a natural anti-coagulant that also anaesthesis the wound area.
- It was thought leeches only removed ‘bad’ blood and left ‘good’ blood in the body.
- They were used way past the medieval period, even until 19th century. Still used today.

Question 16

3. Attempts to treat and cure illness & disease - Early Modern

Describe the changes that occured entering the Early modern era.

Answer 16

• Many physicians wrote in English rather than Latin, to help more people.
• Herbs were used in a more coherent way than before by incorperating the doctrine of signatures.
• New ingredients started to appear from around the world; Rhubarb called a ‘wonder drug’ from asia, Tobbaco from NA by Walter Raleigh - which found many uses in herbal remedies.
• The scientific approach to medicine, which involved observations, experiments and recording results, brought new ideas to deal with illness & herbal remedies ingredients
• New studies of mental illness, ‘melancholy’ and other disciplines such as midwifery were also conducted during this period.
• Some individuals began to indentify lifestyle issues such as taking in fresh air & improved diet as ways of preventing illness.

Question 17

3. Attempts to treat and cure illness & disease - Early Modern

Describe how anaesthetics were before James Simpson introduced his ideas.

Answer 17

• Surgery had always been companied by pain, copious amounts of alcohol or opium was used to try and subdue patients, but getting right dose wasn’t easy.
• Sir Humphrey Davy was the first one to use nitrous oxide, or laughing gas as we know it. The gas became used to relieve pain in surgeries but it was difficult to control dosage.
• In 1846, Robert Liston successfully amputated a leg using ether as an anaesthetic. However, a drawback was that patients sometimes woke up mid operation.

Question 18

3. Attempts to treat and cure illness & disease - Early Modern

Describe how anaesthetics were after James Simpson introduced his ideas.

Answer 18

• In 1847, James Simpson used chloroform, after experimentations, to reduce pain from childbirth
• Chloroform induced sleepiness, dizziness and unconsciouseness, so it needs to be administrated carefully.
• While there was opposition, this was partly overcome when in 1853 Queen Victoria used chloroform while having a child, convincing people to use it.
• Finally, in the 1850s, coca leaves from SA were used to produce cocaine, used as a local anaesthetic. The use of cocain rapidly grew, especially once it could be chemically produced in 1891.
• By the end of the century surgeries no longer had to be painfull
• Anaesthetics however, did not necessarilly make surgeries safer, it was still hard to get correct doses & doctors with more time now tried more dangerous operations
• Some surgeons had higher mortality rates using anaesthetics than before, so in the 1870s, some stopped using cholorform altogether.

Question 19

3. Attempts to treat and cure illness & disease - 19th Century

Describe the role of;
A) Ignaz Semmelweis
B) Joseph Lister
In advancing medical treatments

Answer 19

A) Ignaz Semmelweis
- Sepsis had been the biggest killer post-surgery for a long time
- Ignaz was the pioneer of antiseptics in 1847, having been in charge of the maternity ward.
- Reduced mortalilty rates from 35% to 1% by making doctors wash their hands in Calcium Cholride.

B) Joseph Lister
- After the publishing of germ theory, Lister used an operating room sterilised with carbolic acid. ( Based on experiments with frogs )
- His surgical instruments were also sterlised with it, he also soaked the wound with it from time to time.
- He managed to reduce mortality in operation from 46% to 15% in 3 years.
- In 1871 he invented a machine that sprayed carbolic acid over the whole room.
- He became known as the ‘Father of Antiseptic Surgery’.

Question 20

3. Attempts to treat and cure illness & disease - 19th Century

Describe other developments that came to Aseptic surgery, including surgical clothing

Answer 20

Developments of Aspetic Surgery;
- This followed on from the work of Robert Koch who discovered in 1878 most diseases were spread by infected surfaces
- In 1881 Charles Chamberland invented a steam steriliser for medical instruments, discovering that heating them at 140C for 20mins would sterilise them
- Next step was by Gustav Neuber, a German surgeon that is recognised for having the first sterile opening theatre.
- He published a paper in 1886, setting the standards for others.

Surgical Clothing;
- William Halsted in America started his team wearing surgical gloves due to a nurse developing an allergic reaction on her hand because of carbolic spray.
- He then asked the Goodyear Rubber company to make special thin gloves.
- Berkley Moyniham became the first in britian to wear gloves during a surgery, and later made a point of always changing his clothes for surgical gowns b4 entering sterile theatres.

Question 21

3. Attempts to treat and cure illness & disease - 20th Century

Describe the role of Mary Curie in the development of radiation

Answer 21

• Describe as the most famous female scientist of all time, won the noble prize of 1903 and 1911.
• She was born in poland, working as a governess. She and her husband were the first to discover and isolate radium and polonium
• These radioactive elements played a key role in destorying tissue, and thus opened up a way of treating cancer. Her 1911 Noble prize was earned as she discovered a way to measure radiation
• She also played a leading role in developing mobile X-ray units during WWI, making diagnosis and treatment of injured soldiers quicker & easier.

Question 22

3. Attempts to treat and cure illness & disease - 20th Century

Describe the role of Fleming, Florey and Chain regarding antiobiotics.

Answer 22

1. Role of Alexandar Fleming;
- During WWI Fleming observed that antiseptics could not prevent infections, so he decided to find something that could kill the microobes that caused infections
- In 1928, he noticed a mould - pencillin - growing on one of his petri dishes. He also noticed staphylocci around the mould had been killed off.
- That was how pencillin started, Fleming published these results in 1929, but could not get enough funds to develop the drug.

2. Role of Howard Florey & Ernest Chain:
- In 1937, these 2 working at Oxford Uni, began to research pencillin after seeing Flemings research on it.
- They overcame the difficulty of producing enough drugs. They first experimented on mice ( 1940 ) then humans ( 1941 ).
- Their first trial, a policemen badly infected died 5 days after their store of drugs ran out, proving it worked.

Question 23

3. Attempts to treat and cure illness & disease - 20th Century

Describe the use of pencillin and the impact it had.

Answer 23

• WWII provided a big incentive for the development of pencillin & in 1943 it was used for the first time on allied troops in North Africa, to huge success.
• American and Britian both produced large amounts of pencillin, saving many lives in 1944 and 1945.
• After the war ended it was widely used to treat many disease like; bronchitis, impetigo, pneumonia, tonsilitis, syphilis and others.

Question 24

3. Attempts to treat and cure illness & disease - 20th Century

Describe the role of Christian Banard along with the development of different types of surgeries

Answer 24

1. Christian Banard
- In 1967 the world’s first heart transplant operation was undertaken in Cape Town, South Africa. ( Patient lived for 18 days )
- There were 2 main problems; The availability of replacement organs, and rejection of transplant.
- This was largly solved with the development of immunosuppressant drugs, such as cyclosporine.

2. Developments of different surgeries
- 1952 - The first kidney transplant surgery.
- 1961 - The first British implanted pacemaker was developed, along with heart bypass surgery
- 1972 - Introduction of Hip replacement surgery, brining mobility back to many people.

Question 25

# ***3. Attempts to treat and cure illness & disease - 20th Century*** Describe the development of advances in **Cancer treatment** and **surgery**.

Answer 25

- Throughout much of the **20th century**, radiation therapy has been used to **treat cancerous** cells, becoming more refined as time goes on. - This has been supplemented with **Chemotherapy**, the use of powerful drugs to kill **cancerous cells**. - This has become **widespread** since **WWII** and is often used for cancerous cells that **cannot** be reached via **surgery**. ***Surgery Development:*** - Surgery can also be used to remove **cancerous growths**. ***Mastectomy*** or **lunge transplants** are the most common ways of surgery used today to fight cancer. - Surgery is always seen as a gamble, as it is quite common for the cancer to return. - With **scanning techniques** and **fibre-optic** micro cameras, it's possible to 'see' inside a **patients body** without **major surgery**. ## Footnote **Mastectomy** - Removal of a woman's breasts.

Question 26

# ***3. Attempts to treat and cure illness & disease - 20th Century*** Describe & Explain the growing belief in **Alternative medicine**.

Answer 26

**Reasons for Alternative medicine:** - Controversies like the **thalidome** case, where a medicine prescribed for **morning sickness** & **nausea** in pregnant woman caused babies to be born with **missing limbs**. - Also some people may just not be able to **afford** medical professionals **Alternative Medicine:** - Treatments such as **hydrotherapy, aromatherapy, hypnotherapy and acupuncture** became popular in some quaters - Many of them were based on **old, traditional treatments** using herb's and 'pure' treatments designed to work in harmony with the body. - **Acupuncure** is a traditional **chinese method** of treating illness by **sticking needles** into various parts of the body, tapping into the **natural flow of energy** in the body. - Prince Charles has been a supporter of **Homeopathy**, claming in a speech that it is **'rooted in ancient traditions'** the ideas of balancing our bodies mind and soul. - The **British Medical Associaton** described homeothapy as **witchcraft**.

Question 27

# **4. Advances in Medecical Knowledge - Medieval Period** What are examples of medical care/ideas in early human history?

Answer 27

- There is evidence of successful operations carried out with flint tools in the Stone Age - The Indus Valley civilisation were well aware of the importance of clean running water and sewers; there is even a structure identified as a huge public bath house in Mohen, Daro dating from arond 2500 BC - The Greeks had asclepions (places of healing) that were Asclepius', the god of healing, temples - Bath houses and heating can be found in most Roman towns, for example, Vinderlanda in Northumberland

Question 28

# **4. Advances in Medecical Knowledge - Medieval Period** Why was there a lack of progress in medical knowledge after the Romans?

Answer 28

- A lot of the medical knowledge seemed to have been 'lost' during the Dark Ages after the Romans left - Muslim writers (e.g Iba Sina) played an important translating the language of Anicent Greece and Rome into Arabic that eventually passed on to Western Europe

Question 29

# **4. Advances in Medecical Knowledge - Medieval Period** What is Hippocrates and Galen's contributions to medecine?

Answer 29

- Doctors still take the hippocratic oath today and 60 texts of medecine are attributed to Hippocrates - Galen was a follower of Hippocrates. Although prevented from working on people, Galen believed dissection was the best way to discover the inner workings of the human body - Galen also placed great emphasis on listening to a patient's pulse as a diagnostic tool

Question 30

# **4. Advances in Medecical Knowledge - Medieval Period** Why did the Church and Universities widely accept Galen's ideas?

Answer 30

- Galen's work arrived in Europe via Islamic texts and beliefs - The first translations were made in Salerno, Italy, the first medical university dating around AD900, and rapidly became accepted as university medical texts - Church leaders decided that his ideas fitted with religious beliefs as he frequently talks about 'the Creator' - Galen's ideas spread rapidly around Europe and became accepted as medical orthodoxy

Question 31

# **4. Advances in Medecical Knowledge - Medieval Period** Describe the four humours

Answer 31

- The belief made by Hippocrates that the body contains blood, phlegm, black bile and yellow bile - To remain healthy, a body must keep the four humours in balance

Question 32

# **4. Advances in Medecical Knowledge - Medieval period** Describe the influence **alchemy and astrology** had on medicine.

Answer 32

***Alchemy:*** - Alchemy was closely linked to science, they searched to turn **base metals** ( lead ) into **gold** - Alchemists would also search for the **'elixer of life'**, so that people could live forever. - Many of them were monks - Alchemists were the first to produce **hydrocholoric & nitric acid**; they identified new elements such as **antimony and arsenic**, paving the way for the new science of chemistry. ***Astrology:*** - It was believed the movement of stars influenced peoples personalities and inner working. **( leading to study of the stars )** - By the end of 1500s, physicians in many europian countries were required to calculate the **position of the moon b4 any procedures**. - Believed medicine would only be effcient if collected at the **right cycle of the moon.**

Question 33

# **4. Advances in Medecical Knowledge - Medieval period** Describe the role of the **Church** in developing **medical knowledge**.

Answer 33

- The church was **central** to most peoples lives, meaning their attitudes to medicine **mattered** alot. - Church encouraged; **praying for deliverance from illness, offering could buy indulgences, going on pilgrimages**. - The church set up schools where they taught the ideas of **Galen and Hippocrates** - The church teaching **Galen's** ideas limited medical knowledge as Galen's ideas were based on **animal dissections**, not **human**.

Question 34

# ***4. Advances in Medical Knowledge - Early Modern*** Describe the shift away from **Galen's** ideas when going into the **Renaissance period**.

Answer 34

- Many of Galen's works were re-translated from Arabic into Greek and Latin. By **1525** his works were published and he was regarded the front of **medical knowledge**. - However, the more artists and surgeons did dissections and studied **anatomy**, they noticed **differences** between what Galen said to their work. - Gradually opinions grew to challenge Galen, This led to the **medical world splitting**, those who support Galen and those who don't - Those who were actually doing **dissections** disagreed with Galen, this was the first iteration of the **scientific method**. - Discoveries like **microscopes** allows doctor too look into human anatomy in much more detail

Question 35

# ***4. Advances in Medical Knowledge - Early Modern*** Describe the role **Vesalius** had in advanced **medical knowledge**.

Answer 35

- He was an appointed professer that carried out **his own dissections**, believing **human anatomy** was the key to understand the **human body** - In **1543**, he published *De humani corpois fabrica libri septem* which completely **changed views** on medicine. - Vesalius challenged Galen's views, giving much more **detailed and accurate views** on the human body, he also actually dissected humans. - His work was very influential as it gave doctors knowledge of **human anatomy** and encouraged them to investigate critically & **challenge ancient authorities**.

Question 36

# ***4. Advances in Medical Knowledge - Early Modern*** Describe the role of **Pare** in advancing **medical knowledge**.

Answer 36

- Began his work as an **appreantice barber-surgeon**, possibly the most famous **16th century** user of **scientific method**. - At the siege of Milan in **1536**, he ran out of oil for cauterizing wounds. He made a mixture of **egg yolk, turpentine and oil of roses** for cauterizings instead, it was **much less painfull**. - He used **ligatures** to tie-off wounds after amputation, allowing wounds to heal better. - He also helped in developing **artificial limbs** for those who hand lost a hand or leg in the war

Question 37

# ***4. Advances in Medical Knowledge - Early Modern*** Describe the role of **William Harvey** in devloping medical knowledge.

Answer 37

- Harvey had been taught that **veins in the body had valves**, and **blood only pumped one way**. But no one knew how or why. - After experimenting on animals, he discovered that blood pumped in the body in a **circular motion**, leading to his famous discovery of **blood circulation** - Using **cold-blooded amphibians** ( frogs e.g. ) allowed him to see blood flowing **more slowly** and his most famous experiment was showing blood moving in a **patients forearm** - This convinced many that the heart worked as a pump, and that blood flowed in a **'one way system'**. Disproving Galen's ideas of; The liver pumping blood & bloodletting being a cure **( you could never have to much blood )** **Responses;** - Those who supported Galen were agaisnt Harvey, they argued he couldn't see **capillaries so he couldn't prove their existence.**

Question 38

# ***4. Advances in Medical Knowledge - Industrial Period*** Describe how improved knowledge of **Germ theory** advanced **medical knowledge**. **( Robert Koch & Louis Pasteur )**

Answer 38

- Beginning of 19th century, people believed **'miasma'** was the cause for disease, or imbalanced **4** humours. **Germ theory ( 1880s-90s )** changed all of this. ***Louis Pasteur:*** - Louis Pasteur was the first to link **germs to diseases**. He argued that **micro-organisms** were responsible and if we could discover them we could **develop vaccines**. - His work on **chicken cholera** led to in 1880 an effective vaccine agaisnt rabies. ***Robert Koch:*** - Koch was able to link the **particular germs** to diseases, in effect developing new science of **bacteriology** - In **1882**, he identified the specific baciulls that cause TB and in **1883 and 1884**, the one responsible for cholera, confirming the work of **John snow**. - He and students went on to find causes for; **diptheria, typhoid, pneunmonia, plague and tetaneus**. - He and team also developed a technique to **stain bacteria** for easier viewing under microscopes.

Question 39

# ***4. Advances in Medical Knowledge - Industrial period*** Describe how **Paul Erlich** contributed to advancing **medical health**.

Answer 39

- Best known for **Salvarsan 606**, developed in **1910**, the first effective treatment for **syphilis, an STD**, which was wide spread. - **Salvarsan 606** was the first of what became known as **'magic bullets'**, carefully **designed drugs** to target specific germs causing illness, with **no side-effects**.

Question 40

# ***4. Advances in Medical Knowledge - 20th Century*** Describe how; **A)** X-rays **B)** Ultrasound Contributed to advances in **medical knowledge**.

Answer 40

**A) X-Rays** - Discovered by **William Rontgen**, in **1895**, building on work from other scientists. - He discovered that radiation would pass through the body at **different rate**s, depending on whether it encountered **flesh or bone**. - He realised he could **photograph this**, leading to **X-rays being used to investigate broken bones**. - During **WW1**, X-ray units were set up to check for bullets, shrapnel and other 'foreign bodies' inside soldiers. **B) Ultrasound** - During **WW2** sound waves were used to detect german submarines, after war it was realised it could be used to 'see' inside a human , by using **high frequency sound waves**. - This didn't use radiation and produced **3D images**. Used for images of organs in the body & since 1970, checking up on **unborn babies**.

Question 41

# ***4. Advances in Medical Knowledge - 20th Century*** Describe how; **A)** MRI **B)** PET & CT Scans

Answer 41

**A) MRI** - MRI scanning uses **radio waves** to build up a **detailed picture** of organs & tissue. - It uses powerfull magnets to give a high **resolution image** allowing doctors to see areas of **disease clearly**. - Also used to check how effienct **past medication** was. - Since **1980s** this has become increasingly usefull for investigate human bodies **B) PET & CT Scans** - **PET** injects a slightly radioactive tracer into the bloodstream, allowing **3D images** of **bones & tissues** to be seen, often used to **investigate cancer** and **heart diseases**. - **CT** uses many X-ray images taken at different angles to produce a **cross-sectional image of the area** of the body, could be used to **diagnose illness**

Question 42

# ***4. Advances in Medical Knowledge - 20th Century*** Describe how the discovery of **DNA** contributed to advances in **medical knowledge**.

Answer 42

- In **1953, Crick, Watson and Franklin** published a paper about **DNA** which carries genetic information - In **1990 the Human Genome Project** set out to build a blueprint of human beings, completed in **2003** **DNA implacations:** - In **1996**, by **cloning** cells researches were able to clone **Dolly the sheep** in an attempt to 'grow' **medicines** for humans in sheep milk - By **modifiying DNA**, it has become possible to eliminate **genetic diseases**. - Already genetic enginnering has; **reverse mutations that caused blindness, stopped cancer cells from multypling and made some cells impervious to DNA**. - DNA can also be used to screen people for inherited diseases, ensuring babies aren't born with **life-threating diseases**.

Question 43

# ***6. Public Health - Historical Context of the Ancoats*** Describe the process of how the **Industrial Revolution** started and reached **Manchester**.

Answer 43

**1.** The factory system started with **Richard Arkwright's** water frame. ***( a textile machine that needed a water wheel to power it )*** **2.** He opened his first factory in **1771**. As competition grew in the development of machines for **spinning and weaving cloth.** - These developments became known as the **Industrial Revolution.** **3.** It was the development of the **Boulton & Watt steam engine (1781)** which mean that factories **no longer needed a water wheel** and therefore could be build anywhere. - This brought the **Industrial Revolution** to **Manchester.** **4.** Manchester was originally a small market town, surrounded by villages such as **Ancoats.** The first steam powered mill in Ancoats was **Ancoats Bridge Mill (1791)** and by **1816** there were **86** of such mills. - These became the model for other mill complexes.

Question 44

# ***6. Public Health - Historical Context of the Ancoats*** Describe some of the impacts the **Indutrial Revolution** had on **Manchester.**

Answer 44

**1.** The population of Manchester went from **84k** in **1801** to **391k** in **1851.** - ***It was this rise in population that led to poor living conditions.*** **2.** Manchester's cotton business **thrived** during this time period. - City become known as **Cottonpolis**, one of the **world's largest producers of textiles.** **3.** Manchester became a huge commercial centre due to excellent transport links; the **Rochdale and Ashton canals** and the **Liverpool-Manchester** railway were bringing in **American cotton.** - By **1871**, Manchester became responsible for **32% of cotton textiles produced in the world.** **4.** As a result of this growth, **people came to work in the mills and Ancoats** was described as the world's first **industrial suburb.** - The average age of a worker was **17**, the impact of all of this was that **living condition were very poor.**

Question 45

# ***6. Public Health - Key Features of Ancoats, Overpopulation*** Explain how development in the Ancoats led to **Overpopulation**.

Answer 45

**1.** It was the **development of canals** in the area which changed it into a centre for **textile industry** and other industries. - **Rochdale** canal opened in **1804**, allowing for easier access to raw cotton. **( Led to large scale building of textile mills )** **2.** One of the oldest mills was **Old Mill**. At their peak they employed **1,300 people.** There were **108 textile** mills such as **Beehive Mill** that employeed **1000s of workers** who needed to live nearby due to **poor transport.** - As a result, Ancoats became on of the most **densley populated places in Britian.** **3.** The **1841** census showed that it was common for **20** people to live in a house ment for a **single family** decades earlier. - Between **1773 and 1821**, the number of houses in the area rose from **3,446 to 17,257.** By **1850**, it was nearly **50,000.**

Question 46

# ***6. Public Health - Key Features of Ancoats, Immigration*** Explain how **Immigration from Ireland and Italy** to **Manchester** contributed to poor public health.

Answer 46

**1.** By **1851**, around **50%** of the men in the Ancoats were born in Ireland. - Many of these men came to **Manchester** seeking a better life. - However, many Irish immigrants faced **discrimination.** **2.** By the end of **1840s**, there were **4,000** Irish people living in Ancoats in less than **200** houses. - One of these areas became known as **'Little Ireland'** - Disease was **much more prevalent** due to these poor conditions. **3.** Similarly, In **1835**, thousands of Italians immigrants were met with the same fate. - **Antonio Valvona** had a business selling ice cream and was responsible for inventine a more **sanitary way** of selling ice cream. ## Footnote **Manchester's death rate** ( 1849-51 ); 33 per 1000 **Elsewhere;** 22 per 1000

Question 47

# ***6. Public Health - Reasons for poor health*** Explain how **Overpopulation & poor water quality** contributed to **poor public health.**

Answer 47

**1.** The housing built in the Ancoats was very **poor quality** due to **overpopulation.** - Businessmen would try to fit **as many houses on rectangles of land** due to lack of rules **surrounding buildings.** - Led to houses being **2-3 story brick terraced houses, one room deep, built back-to-back along narrow cobbled streets/couryards.** **2.** The basements were **the most overcrowded and dirty** of the accomodation as they were the cheapest to rent. - Many builders added extensions, making the **overcrowding and poor conditions worse** **3.** The streets filled with overcrowded houses had no proper drains or sewers. The most common form of toilet was a ***privy midden*** - Sometimes these toilets would be shared by up to **30 families.** **4.** The shared taps on the street often had water taken from polluted sources. - **55%** of houses had **no plumbing.** - **56%** of streets had **never been cleaned** - Making the area perfect for water borne diseases such as **cholera and dysentery.**

Question 48

# ***6. Public Health - utbreaks of cholera & typhus*** Explain what led to the **development** of the **hospital** in Manchester.

Answer 48

**1.** The conditions in Ancoats led to outbreaks of diseas such as **Cholere & Typhus fever.** **2.** The existing hospital, **Manchester Royal Infirmary**, was not designed to cope with a population of this size - As a result, the dispenary was expanded to help people with **typhus fever** & a *'House of Recovery'* was later added. - ***These were still dependant on charitable donations*** **3.** A separate dispenary was established in Ancoats in **1828** & treated **13k** patients in its first **5 years.** ## Footnote **Outbreaks of infectious diseases:** - **1824** - typhus - **1832** - cholera - 675 dead - **1849 & 1851** - Tuberculosis ( TB ) - **1854** - cholera

Question 49

# ***6. Public Health - Parliamentary Legislation*** Describe how **Dr James Philip Kay** contributed to bettering public health.

Answer 49

**1.** After experiences with **1832** cholera outbreak he published a report called; - *'The Moral and Physical Condition of the Working Classes Employed in the Cotton Manufacture in Manchester'* **2.** Through gather of statistics, he blamed **overcrowding** for the outbreak of cholera. **3.** His reasearch influenced the development of the **1834 Poor Law Amendement Act** & the **1848 Public Health Act.**

Question 50

# ***6. Public Health Parliamentary Legislation*** What did the **1848 Public Health Act** achieve?

Answer 50

**1.** This law allowed local councils to **improve conditions** in their own towns if they wished to. **2.** The Act encouraged **local boards of health** to be set up to appoint a **medical officer**, provide sewers & inspect lodging houses, **3.** This all showed greater **government responsibility** for the health of the public.

Question 51

# ***6. Public Health - Parliamentary Legislation*** Describe how **Edwin Chadwick** contributed to bettering public health.

Answer 51

**1.** He was a social reformer that focused on how disease affected poverty and focused his reasearch on Ancoats. **2.** He concluded that better **ventilation and sewerage** would solve the problems causing disease. - The Poor Law Commissioners reported that **57%** of working class children were dying by **5.** **3.** His report in **1842** called *'The Sanitary Conditions of the Labouring Population'* contributed to the passing of the **1848 Public Health Act**

Question 52

# ***6. Public Health - Parliamentary Legislation*** Describe how **Friedrich Engles** contributed to bettering public health.

Answer 52

**1.** He was a **German social commentator** who had working in a mill in Manchester - He referred to conditions in Ancoats as **'hell on earth'.** **2.** He blamed high death rates on the **bad conditions workers lived in**, as well as exploitation by factory owners. **3.** In **1845** he published a book called *'The Condition of the Working Class in England'* - which was very **influencial in the debate about public health.** **4.** As a result of this criticisms, Manchester council sent **100 men** to clear out Ancoats and in **12** days they cleared out **1,900** pits **5.** Friedrich's, **Charles Rowley & Docter John Thresh's** work all led to houses in Ancoats getting **fresh water** and a **flushing toilet.** - Privies were also set up that had to be emptied by the council.

Question 53

# ***6. Public Health - Long-term impacts of Public Health Legislations*** State some of the **Long-term** impacts **Public Health** laws had.

Answer 53

**1.** The building of **back-to-back houses** was banned - **1844** **2.** Cellar dwelling were made illegal - **1853** **3.** Streets were properly paved and proper sewers installed - **1840s** **4.** New reservoirs **( large artificial lake )** were built e.g. longdale **5.** By **1914**, nearly all old courtyards & back-to-back houses were demolished **6.** The **Unhealthy Dwelling Committee** formed in **1885** tore down the worst of the slum housing.

Question 54

# **2. Attempts to prevent illness and disease** What was prevention before C.500 like? | Early methods of prevention in medieval era

Answer 54

- Hippocrates came up with the theory of the four humours. Talked about the body as a whole instead of in induvidual parts - People tried to prevent illness by living in moderation with a good diet and exercise. Arabs believed in the importance of fresh air - Much of the ancient approaches to medecine were lost in 410AD when the Romans left Britain

Question 55

# **2. Attempts to prevent illness and disease** What was the role of the church in prevention in medieval era? | Early methods of prevention in medieval era

Answer 55

- Explained that physical illness was a physical manifestation of a spiritual illness - Said that people were ill because they were living an unchristian life or were not praying hard enough - Ordered people to take processions through towns and villages to the local church, and pray for forgiveness - Some people whipped themselves in order to purify themselves in God's eye

Question 56

# **2. Attempts to prevent illness and disease** What is the role of alchemy in attempts to prevent illness? | Early methods of prevention in medieval era

Answer 56

- act of chemistry where people tried to turn lead into gold and made concoctions that were a form of medieval medecine or 'quintessence' done by repeatedly distilling water - they used strong medecines containing poisons, such as antimony or mercury, would be used to make a patient violently sick, thus being seen to prevent disease - Isaac Newton delved into alchemy where most of his experiments were to turn lead into gold but lead to many scientific experiements

Question 57

# **2. Attempts to prevent illness and disease** What attempts were made to prevent the spread of black death? | Early methods of prevention in medieval era

Answer 57

- People tried to stop themselves getting the black death: 1) said you should not bathe as it would open up the pores of the skin and allow disease to enter the body 2) bathe in urine 3 times a day 3) carrying a posy of sweet smelling herbs to stop 'bad smell' of disease - Edward lll ordered all the streets to be cleaned of filth, arguing the smell spread Black Death. Unknowingly came to a near effective method of prevention - there were so many different preventative methods because no one really knew how to stop the Black Plague - people though that defying God caused disease and that bad air caused disease

Question 58

# **2. Attempts to prevent illness and disease** What did Soothsayers and medieval doctors do to prevent disease? | Early methods of prevention in medieval era

Answer 58

- soothsayers were the very few qualified doctors in medieval England. they would collect plants and herbs, special stones etc. to help in their remedies - Mother Shipton was a famous soothsayer who prophesysed events and said when the world would end. Church would oppose this as only God could know when the wordl would end - better than a random barber surgeon to give medical advice and there was a massive lack in doctors in England

Question 59

# **2. Attempts to prevent illness and disease** How did cold water treatment attempt to prevent illness? | Application of science in 18th and early 19th centuries

Answer 59

- was widely believed that waters of places like Buxton and Bath were beneficial to health and were preventative measures as well as cures. visiting the seaside was also reccomended for keeping you healthy - the wealthy adopted this the most, with some having 'plunge pools' of cold fresh water in the garden - water would later be piped inside the house and cold water bathing indoors became the trend

Question 60

# **2. Attempts to prevent illness and disease** How was Child bed fever prevented? | Application of science in 18th and early 19th centuries

Answer 60

- childbirth was a focus for scientists as it was a very dangerous and sometimes fatal time for women - Alexander Gordon discovered that those treated by a village wisewoman rarely caught a fever but someone treated by doctors or midwives moving from patient to patient were much more likely to die - Gordon said the best way of preventing women dying in child birth was that they should wash their clothes frequently and wash their hands in chlorinated water to limit spread of disease

Question 61

# **2. Attempts to prevent illness and disease** Describe the rise of the scientific method in 18th and early 19th century | Application of science in 18th and early 19th centuries

Answer 61

- new medical inventions were created including: 1) microscope - for seeing infections 2) stethoscope - for listening to patient's breathing 3) hymograph - for measuring blood pressure - these instruments allowed better investigation of health and brought the better treatment and prevention of diseases - James Lind identified the cause of scurvy in 1753 and insisted that sailors be given a dose of lime juice/fresh fruit every day to help keep them healthy - during 18th century, many texts were written as a result of extensive scientific investigation of illnesses

Question 62

# **2. Attempts to prevent illness and disease** Describe what John Snow did to prevent cholera | Application of science in 18th and early 19th centuries

Answer 62

- John Snow carefully plotted on a street plan each and every cholera case in the area around his surgery. Within a few weeks, there had been 500 deaths on Broad Street - He noticed that the nearby brewery workers didn't catch cholera because they drank beer rather than water - he showed that the Southwark and Vauxhall Waterworks Company was taking water from sewage-polluted areas of the Thames and delivering it to homes with the increasing incidence of cholera

Question 63

# **2. Attempts to prevent illness and disease** Describe what smallpox was and how many it killed | Edward Jenner and Vaccination

Answer 63

- was an acute contagious disease caused by the variola virus. One of the world's most devastating diseases killing 30-60% who caught it pre-vaccination - for example in 1796, 35,000 were killed in a cholera outbreak and between 1837 and 1840, 42,000 were killed

Question 64

# **2. Attempts to prevent illness and disease** Desribe what Inoculation has been since 1700 | Edward Jenner and Vaccination

Answer 64

- inoculation is a method for the prevention of smallpox by deliberate introduction of material from smallpox pustules from one person into the shin of the other - Lady Mary Montagu came across it in Istanbul and introduced it to England in 1721 - when you are inoculated, a mild form of smallpox would be introduced through a scratch between finger and thumb, they then developed a mild disease but became immune to stronger version

Question 65

# **2. Attempts to prevent illness and disease** Desribe what Edward Jenner did with vaccines | Edward Jenner and Vaccination

Answer 65

- Jenner heard that milkmaids who caught cowpox never caught smallpox. He reasoned that having cowpox must give immunity for smallpox - Jenner tested on a young boy called James Phipps as he injected him with pus from sores of a milkmaid with cowpox. James developed cowpox but found he was immune to smallpox when injected with a small amount - Jenner concluded that people who got an injection of cowpox stopped people catching smallpox. He presented this in 1798 with the book, *"An Inquiry into the causes and effectsof the Variolae vaccine"*

Question 66

# **2. Attempts to prevent illness and disease** Desribe the impact of vaccination on smallpox | Edward Jenner and Vaccination

Answer 66

- people who charged £20 for inoculation saw that their livelihoods were being threatened - Many felt it wrong to inject cowpox into humans - some argued that cholera was God's punishment for living a sinful life and that we should not interfere, or limit the spread of disease - smallpox vaccine became compulsory im 1882 but not strictly enforced as government was laissez-faire - death rate decreased dramatically in 1887 so government introduced the right for parents to refuse vaccination

Question 67

# **2. Attempts to prevent illness and disease** Desribe Impact of vaccination as a whole | Edward Jenner and Vaccination

Answer 67

- In the twentieth century, vaccinations for polio, measles, diphtheria and whooping cough were made - smallpox was finally eradicated with the last case being in Somalia in 1977 - since 1800 the infant mortality rate dropped from 150 per thousand to now 4-5 deaths per thousand

Question 68

# **2. Attempts to prevent illness and disease** The MMR debate | Edward Jenner and Vaccination

Answer 68

- Dr Wakefield suggested that there was a clear link between the MMR vaccine routinely given to a young child and autism - MMR debate challenges the herd immunity theory as less than 95 percent of people will want to have a vaccine, making more and more of the population at risk - The UK vaccine payment fundwas set up to pay compensation to those badly affected by vaccines and has paid out 20 times in the last decade. shows there are some dangers to vaccines

Question 69

# **2. Attempts to prevent illness and disease** How did Pasteur, Koch and germ theory help prevent illness and disease? | Developments in bacteriology

Answer 69

- Louis Pasteur, a french scientist working in Paris, changed medecine forever - Germ theory suggested that tiny microorganisms called bacteria caused many diseases and all you had to do was prevent them - Robert Koch began to identify the specific bacteria that caused specific diseases and realised antibodies could help to destroy bacteria and build up an immunity against the disease, keeping the body free from illness - each antibody worked specifically to one bacteria and was crucial to an understanding of the body and how it fought off disease - It would have been impossible to discover germ theory without the help of a microscope because they would not be able to see microorganisms, never mind prevent them

Question 70

# **5. Patient Care - Medieval period** What was the role of the church?

Answer 70

- The main concern of medieval hospitals was the health of the soul because they were essentially religious institutions. Emphasis on care and religion rather than treatment and care - Hospitals were placed in monasteries so almost all hospitals were run by the church - Many medieval hospitals were small - containing no more than a dozen patients, some larger, such as St.Leonards in York which by 1287 could accommodate 225 patients

Question 71

# **5. Patient Care - Medieval period** What were the different type of hospitals?

Answer 71

- Hospitals were given the name because they provided 'hospitality' rather than caring for the sick - Only 10% of hospitals actually cared for the sick - Almshouses for example were equivalent of modern care homes. They offered sheltered accommodation and basic nursing but no treatment

Question 72

# **5. Patient Care - Medieval period** What were leper hospitals?

Answer 72

- Inflicted horrible deformities on victims. They had to wear special clothes, ring a bell whilst walking and couldn't marry - They were built on the outskirts of town to limit mixing with the rest of the population - They provided lodging and food but no treatment

Question 73

# **5. Patient Care - Medieval period** What were Christian Hospitals?

Answer 73

- Set up and run by the Church who got their money through offerings and dowes as well as indulgences - People who did not have serious illnesses as the main focus was to pray and attend religious services - Chaplains and priests and nuns worked there but no doctors. Aim was to try and save patients souls instead of treating diseases - Patients were expected to spend much of their day praying and confessing their sins

Question 74

# **5. Patient Care - Early modern/industrial period** Impact of closure of monasteries by Henry Vlll

Answer 74

- It resulted in the closure of many hospitals which had a dramatic impact on patient care - Charities had to bear responsibility for patient care - In London the authorities petitioned the crown to provide funds to endow hospitals such as St.Bartholomew's and St.Thomas'

Question 75

# **5. Patient Care - Early modern/industrial period** The creation of Royal Hospitals

Answer 75

- Royal hospitals were endowed through royal funds to enable them to continue to take care of the sick. It took the form of granting land which could then be rented out to provide the institution with income - St. Bartholomew's Hospital were given grants in December 1546, heped the poor in West Smithfield. - Christ's Hospital was founded in 1553 offered shelter, clothing and food to fatherless children as well as rudimental education

Question 76

# **5. Patient Care - Early modern/industrial period** The setting up of endowed hospitals

Answer 76

- Voluntary hospitals were left to the local councils to organise endowments to keep their hospitals open but did not just take place in London - In Norwich, St.Giles' hospital transformed for a religious institution into a hospital which employed medical staff including a barber, surgeon and a bonesetter

Question 77

# **5. Patient Care - Early modern/industrial period** The development of scientific enquiry and the impact of the industrial revolution

Answer 77

- In the 18th Century hospitals started to be funded by financial donations from wealthy industrialists - Royal Society was a place formed to provide opportunities to discuss ideas about medecine and to analyseand evaluate the results of experiments and trials - As new industrial towns expanded, there was an increased need for hospital provision - New wealthy industrialists became early philanthropists, funding of hospitals as they thought it was their god given responsibility to improve the lives of the poor and sick

Question 78

# **5. Patient Care - Early modern/industrial period** What was the role and function of Endowed Hospitals?

Answer 78

- Endowed Hospitals evolved from a place to provide basic care of the sick to a centre in which to treat illness that requires surgery - Their primary role was to look after the poor sick as people with money normally paid for a doctor and nurse to treat them privately - Nursing helpers undertook, manual, non-medical work. Nursing sisters were able to treat ill patients with herbal remedies and physicians performed simple surgeries

Question 79

# **5. Patient Care - 19th Century Industrial period** Describe the growth in the number of hospitals

Answer 79

- Country's population continued to grow rapidly throughout the 19th Century. In 1800, there were approximately 3000 hospitals, in 1882 this increased to 7619. For example, Great Ormond Street Children's Hospital was created - Conditions for patients in these hospitals was cramped, stuffy wards which helped infections spread quickly, wards were also never cleaned - Quality of nursing was poor; untrained nurses had reps of being dirty, ignorant and often drunk as well as being ignorant to most basic standards of hygiene

Question 80

# **5. Patient Care - 19th Century Industrial period** What was the impact of the Crimean War?

Answer 80

- It was the first war in which reporters sent back reports to newspapers in Britain using telegraphs and the public soon began reading about the awful condiitons experienced by the sick and wounded - The sick and wounded had to sleep on their own filth with uncleaned wounds etc.

Question 81

# **5. Patient Care - 19th Century Industrial period** What was Mary Seacole's impact?

Answer 81

- She opened 'the British hospital' between Balaclava and Sebastapol to treat wounded and sick soldiers - She wrote the autobiography, "The Wonderful Adventures of Mrs Seacole in many lands"

Question 82

# **5. Patient Care - 19th Century Industrial period** What was Florence Nightingale's impact in Crimea?

Answer 82

- Nightingale believed God wanted her to be a nurse. With government funding, she took 38 of the best nurses she could find to Crimea - When she arrived she found appalling conditions. 1700 wounded and sick, many suffering from cholera and typhoid, housed in filthy wards. There were not even enough beds or medical supplies - Nightingale cleaned the wards, patients were given regular washes and their bedding was changes regularly. Patients were separated according to their illness, plenty of space put between beds and fresh air circulated the wards - As a result, the death rate at Scutari changes from 42% to 2%

Question 83

# **5. Patient Care - 19th Century Industrial period** What was Nightingale's impact on the birth of modern nursing?

Answer 83

- She set up a public fund and was successful in raising nearly £50,000 in 1856 which was used to set up the Nightingale School of Nursing in St. Thomas' Hospital - In lessons she taught her pupils only to go out in pairs, they had to live in the hospital and they had to keep a diary of their work, which was inspected monthly - Nightingale had turned nurses into an essential part of patient care and treatment and professionalised nursing - By 1900, nursing schools had opened up around the country using Nightingale's ideas and in 1863 she published "Notes on Hospitals"

Question 84

# **5. Patient Care - 20th Century period** Describe the changes in government attitude to health

Answer 84

- In 19th Century, governments had typically followed laissez-faire attitude, believing it was not their place to interfere with people's lives unless they really had to - This changed with a series of Acts introduced including: **Matrimonial Causes Act** - maintenance payments to be paid to divorced women **Education provision of meals Act** - introduced free school meals - The Liberal Government between 1906-1914 broke with the past and introduced a series of reforms designed to help people who fell into difficulty through sickness, old age or unemployment - Reforms tackled areas such as the provision of education, medical inspection of pupils workers etc.

Question 85

# **5. Patient Care - 20th Century period** Describe the National Insurance Act 1911

Answer 85

- David Lloyd George laid down the first steps towards the creation of a welfare state. He proposed an insurance scheme where workers and employers contributed weekly to a central fund which was used to give workers sickness benefits and free medical care, called National Insurance Act 1911 - The National Insurance Act 1913 extended the scheme to include unemployment insurance which allowed unemployed workers to claim 7 shillings a week for up to 15 weeks - The scheme was restricted to certain trades and occupations and it did not cover families, only insured husbands. Also didn't cover mentally or chronically ill people

Question 86

# **5. Patient Care - 20th Century period** Describe the Beveridge Report and the 'five evil giants'

Answer 86

- William Beveridge was a man who helped formulate the Liberal welfare reforms of 1906-14. - The five evil giants were: Want, Disease, Ignorance, Squalor and Idleness - The Labour Government tried to deal with the five evil giants through: 1) National Insurance Act 1946 (want) 2) 1946 and 1949 Housing Acts that provided financial aid to rebuild towns and cities after WW2 (squalor) 3) 1944 Education Act provided free primary and secondary education (idleness and ignorance) 4) 1946 NHS Act provided the setting up of a free health care service for all (Disease)

Question 87

# **5. Patient Care - 20th Century period** Describe the impact of the NHS

Answer 87

- Basic idea of the NHS was the nationalisation of all hospitals, doctors, pharmacists, nurses, opticians and dentists. Was the first time every British citizen could have free medical treatment - The BMA said 90% of its members would refuse to co-operate with the NHS. - Many local authorities and voluntary bodies opposed nationalisation fearing loss of control and arguments raged over the monumental costs of it - However, over 90% of doctors had enrolled in the new shceme

Question 88

# **5. Patient Care - 20th Century period** How has the NHS changed over the years?

Answer 88

- Thatcher governments (1979-90) tried to cut costs of the NHS and encouraged people to pay for private medical healthcare - In 1998, NHS direct was introduced, providing 24-hour health advice over the phone - In 2002, primary care trusts were launched to allow for the administration and delivery of healthcare at a local level

Question 89

# ***6. Developments in public health and welfare - Medieval period*** Describe how public health and hygiene was in **medieval society** | ***Case studey of Coventry:***

Answer 89

- In **1421** mayor required that every man must **clean the street** infront of his house every **Saturday** or pay a **12 penny fine**. - Waste collection services are record in **1420**, when the council gave **William Oteley** the right to collect **1 penny** from every resident and shop, on a **quarterly basis**, for his weekly street cleansing & waste **removal services**. - The council also specified designated waste disposal locaions. By **1427**, 5 designated **waste-disposal locations** are mentioned for coventry; **Dunghill outside city limit, a pit in Little Park Street Gate, a Muckhill near the cross, a pit at Poodycroft**. - Coventry council banned waste disposal in the River Sherbourne **9** times between **1421 & 1475**. In **1421**, all latrines over the **Red Ditch** were ordered to be removed, to allow free flowing of the water.

Question 90

# ***6. Developments in public health and welfare - Early Modern*** Describe how public health and hygiene was in the **16th and 17th century**

Answer 90

- There were outbreaks of the plague in **1563 ( 17,000 deaths in London ), 1575, 1584, 1589, 1603, 1636, 1647 & the biggest in 1665**. In **Aberdeen** in **1647** the corporation passed regulations to control the plague including, **'poysonne laid for destroying mice & rattons'** - Henry VII passed a law to ban **slaughterhouses** in cities or towns. In **1532** he passed an **act of parliment** giving towns and cities the power to impose a tax to build sewers. In **1547** people were forbidden to go the toilet in the courtyards of **Royal palaces**. - After the Great Fire of London in **1666** an act of parlimant was passed. **'An Act for the rebuilding of London & for better regulation'**, was designed to **limit fire destruction** by making streets **wider**, insisting houses were **built of stone**. - In **1690** another act of parliment is passed requiring the **paving and cleaning of the streets in London** and surrounding areas, followed by further acts over the next few years requiring the removal of dung & the **cleansing of stairways**, and prohibiting the keeping of pigs in **dwelling houses**.

Question 91

# ***6. Developments in public health and welfare - Industrial period*** Describe the impact of **industrialisation** on public health in the **19th cenuty**

Answer 91

- People were moving to the cities because that was where jobs were. By **1851** more people lived in towns than in the country, and Britain was known as the **'Workshop of the World'**. - People had to live **close to where they worked**, and there were very **few building regulations**. The supply of water, gas etc was left to private companies that wanted to make a profit, so poorer people suffered. - The gov.t at the time was **laissez-faire**, meaning they didnt regulate things like **working conditions, transportation etc**. As a result working-class housing was very poor. In **1842** the average death rates of a labourer's family in **Rutland** was **38**; **17** in **Manchester**, **16** in **London**.

Question 92

# ***6. Developments in public health and welfare - Industrial period*** Describe the work of **Edwin Chadwick** leading to Victorian improvements in public health

Answer 92

- In **1854** a letter to *The Times* newspaper states, *'We prefer to take out chance with cholera rather than be bullied into health.'* showing the **struggle** of convincing the gov.t to act. - **Edwin Chadwick** was a member of the **Poor Law Commission**, set up due to the **Poor Law Reform Act 1834**. He believed people were poor due to **ill-health**, rather than idleness. He published a report in **1842** containing his influential ideas. - Chadwick was intrumental in setting up the **Health of Towns Association** in **1844**, which led to the first **Public Health Act in 1848**. First time the gov.t had legislated on health issues. Chadwick was a member of the **'Clean Party'**, people pushing the gov.t to **improve conditions** in towns. - Anyone who opposed this change was known to be the **'Dirty Party'**, with their main reason being due to the **cost** it would take to make such changes.

Question 93

# ***6. Developments in public health and welfare - Industrial period*** Describe the actions taken by the government after the **1848 cholera outbreak**.

Answer 93

- It was the **Cholera epidemic of 1848**, which killed over **52,000** people in England, that forced the government to act. They passed the **Public Health Act 1848**. Allowing local councils to improve conditions in their own towns if **they wished**. They could force towns with **high death rates** to take action and to appoint a medical officer of health. - The **Central Board of Health** was created & while being abolished **10 years later**, the Act encourages local boards of health to set up **medical officers, provide sewers, inspect lodging houses & check food offered for sale**. - By **1872** only **50** councils had **medical officers** of health. Other acts followed such as the **Sanitary Act 1866**, the **Artisans Dwellings Act 1875** & the **Public Health 1875**, which was the real breakthrough. - It brought together a range of acts covering **sewerage and drains, water supply, housing & disease**. Local councils were forced to take action & **sanitary inspectors** were added that made sure contaminated food wasnt sold. **( The Food and Drugs Act 1875 )** - London started building new sewers in **1858**, and without doubt new sewers improved living conditions & public health. The **Housing Act 1875** allowed councils to knock down poor housing and replace it.

Question 94

# ***6. Developments in public health and welfare - Industrial period*** Describe the conditions of **Bradford** & who **Sir Titus Salt** was

Answer 94

- Titus Salt worked in **Bradford** as a woolstapler, By **1850** he owned and ran **5 separate spinning** & weaving mills in **Bradford** & was the **biggest** employer in the area. queen victoria was a customer for his **alpaca cloth**. - Bradford had been growing very rapidly, from **13,000 in 1803 to 43,000 in 1833 and over 100,000 in 1851**. Conditions were very poor. In **1846**, **George Weerth** wrote *'every other town in England is paradise compared to this hole'*. - There were over **200** factory chimmneys bleching out smoke every day. **Life expectancy** for the poor at this time in Bradford was **20 years**.

Question 95

# ***6. Developments in public health and welfare - Industrial period*** Describe the work of **Titus Salt** in improving public health

Answer 95

- In **1843**, Lister invented a **wool-combing machine & thousands of wool combers were unemployed**. Titus set up **soup kitchens** to help. He was second mayor of Bradford in **1848** & tried to persuade the **council & local factory** owners to do something to improve living & **working conditions**. - He paid for his **2000** workers to have a **day out** in the country using the **newly opened railway**. In **1850** Salt took the decision to move his factories out of **Bradford** & bought a site at Shipley. Here, he built the largest mill that opened in **1853** & employed **3500**. - Salt also build a model village for his works calles Saltaire. There were over **800 houses ( no pubs )** as well as wash houses with **running water; bath houses; a hospital and more**. He also donated land for a Methodist chapel to be built. Saltaire is regarded as one of the best examples of 19th-century urban planning & is now a **World Heritage Site**.

Question 96

# ***6. Developments in public health and welfare - Industrial period*** Describe the conditions of **Birmingham** & they changed.

Answer 96

- In the **1840s & 50s** the council was controlled by **ratepayers** who resisted demands to spend money. They blocked a move to purchase the **Birmingham Waterworks Company**. They cut spending on **roads** by **50%**, resulting in **ill-built, ill-paved and always flimsy roads**. - This changed hen **Joseph Chamberlain** became mayor in **1873**. He devised what he called **'gas and water socialism'**, whereby the council would take over the gas & water companies, **improve supplied**, and use the profits to make a better place to live. He persuaded the council to borrown **£2million to buy gas companies in 1875**. - By **1879** the council had made **£165,000 profit** to spend on other projects. By **1884** they had also reduced gas prices by **30%**. Water followed in **1876**, and by **1880** the death rate in central Birmingham had dropped from **25.2 per thousand to 20.7**. - The council also obtained a **Birmingham Improvement Act in 1876** allowing it to clear **40 acres of slums** in the centre of the city, removing **9000 people**, and replace these slums with a shopping centre, art gallers & **well-paved streets**.

Question 97

# ***6. Developments in public health and welfare - 20th Century*** Describe the efforts to improve **housing & pollution** in the **20th** century. | ***P1: Identifying the Problems***

Answer 97

- When the **Boer War** broke out in **1899**, many volunteers for the army were unfit to serve. The state of these volunteers **encouraged** the investigation of **living conditions** & health of ordinary people in new **industrial cities**. **Charles Booth** published in **1889** that **35%** of London's population were living in poverty. - **Seebohm Rowntree's** researchers, in **1897-98**, interviews over **46,000** citizens of York, which he published in **1901** in, **Poverty**, a study in **Town Life**. he found that nearly **one-half** of **working-class** people lived in poverty. - In **1913 Maud Pember Reeves** published *Round about a Pount A Week*, a detailed study of the way workers with **regular jobs struggled** to exist on a wage of **£1 a week.**

Question 98

# ***6. Developments in public health and welfare - 20th Century*** Describe the efforts to improve **housing & pollution** in the **20th** century. | ***P2: Progress after the First World War***

Answer 98

- The **Housing Act 1919** proposed to built **500,00 homes 'Fit for Heroes'**, but only **half** were built. Throughout the **1920s-30s** there were subsidies for building council houses to rent to workers, and acts of parliment encouraging **demolition** of **slum properties**. - These were the first generation of houses to feature **electircity, running water, bathrooms, indoor toilets** and front and rear gardens. However, until well into **1930s**, some were being built with outdoor toilets. By **1939** over **1million houses** had been built for workers & **3million** for better-off families. - The damage and destruction during WW2 made the demand for **'affordable'** housing even greater. **Clement Attlee's** Labour government of **1945-51** built another **1million homes**.

Question 99

# ***6. Developments in public health and welfare - 20th Century*** Describe the issue of **Air Pollution** in London. | ***P3: Clean air, new towns & tower blocks***

Answer 99

- In **December 1952**, London was engulfed in the **'Killer Smog'**. Air pollution & fumes from coal fires were trapped by an anticyclone over the ctiy from **5-9th December**. Around **12,000 people died** and as many as **100,000 were taken ill**. - This led to the gov.t passing **Clean Air Acts in 1956 & 1968**. This encouraged householders to change from coal fires to cleaner gas & electricity. More attempts were seen in the **Environment Protection Act 1990** & the **Clean Air Act 1993**. Latest research shows up to **27,000 people die each year prematurely due to air pollution**. - New towns were also developed, such as **Milton Keynes and Telford**, in an attempt to move people our of dirty neighbourhoods. By **2014** over **2.7 million** people lived in new towns or cities in the UK. In the **1960s**, slum clearance took place in old towns & cities too. - Towns like **Chelmsley** Wood sprung up over night. From **1965** it was created on a greenfield site, with over **16,000** houses designed to house **50,000** people who were unable to find a home in the city. Public reactions to these towns were **mixed**.

Question 100

# ***6. Developments in public health and welfare - 21st Century*** Describe the conflict between **prevention and cures** in the **21st Century**

Answer 100

- Some people argue it is **not the job of the gov.t to encourage people to live healthier lifestyles**, others argue there is a **cost** associated with poor lifestyle choices. - Some people argue it is better to **spend money on prevention** than having to spend money on curing diseases that could be **prevented**. - **Hackney**, in London, has adopted a different approach to prevention, it has set up the **Healthier Hackney fund**. Local communities and volunatary organisations can ask for **grants to tackle health issues**. - The programme is based on the principle that organisation based in the heart of the community have **strong connections** to residents, know the issues, and often have fresh ideas for **unique projects** to deal with health issues.

Question 101

# ***6. Developments in public health and welfare - 21st Century*** Describe how the government used **Fitness drives** to better public health

Answer 101

- **Aug 2009** health secretary said, *'promoting **active lifestyles** is a simple answer to the big challenges today, It can save us money asnd ease the burden on public services.'* ***'Walking for health'*** is a campaign designed to encourage people to take more excercise, walk **10k steps a day** at a moderate pace. - You can access cheap or free swimming classes and get reduced gym membership. ***'Be Active'*** is **Birmingham City Council's** scheme to provide free leisure services to its residents. Residents are given a range of **free excercise** activities to use, **1/3rd** of the **local community** has gotten involved since it was set up in **2008**. - Research showed **3/4ths of users** were not previously members of a leisure centre, gym or swimming pool & **1/2 were overweight/obese**. Overall, for every **£1** spent on the scheme **£23** is estimated to have been **recouped in health benefits**.

Question 102

# ***6. Developments in public health and welfare - 21st Century*** Describe how the government used **Healthy eating campaigns** to better public health

Answer 102

- **'Five-a-day'** is the best known of all the gov.t's health messages, it is an attempt to get people to eat more **fruit and vegetables**. It has been proven that eating more fruit & veg **reduces your risk of heart disease and cancer**. The **Eatwell Guide**, issued in **March 2016**, is typical of **national government campaigns**, it depicts a health, balanced diet which includes; - eating at least **5 portions** of a variety of fruit & veg every day - basing meals on **potatoes, bread, rice, pasta** or other starchy carbohydrates - having some **dairy, choosing lower fat** & sugar options - eating some **beans, pulses, fish, eggs, meat** and other protiens. - choosing **unsaturated** oils & spreads - drinking **6-8** cups of fluid a day