SHP History: Medicine Through Time
In order to succeed at SHP GCSE History Medicine paper you will need a clear conceptual understanding of the following:
CHRONOLOGY
How would you eat an elephant? Not at one sitting that's for sure! History is also huge and in order to make it more comprehensible and digestible historians tend to chunk it down into bite size pieces called periods of history or eras. Each period or era contains enough common factors/features within it to make it a useful distinction. There is however only broad consensus as to when the different periods begin and end, and it is also important to remember that within one period of history there may well be considerable changes and developments. Some periods of history e.g. PREHISTORIC TIMES has been further chunked down into sub sections - stone age, bronze age, iron age.
At GCSE level however it is sufficient to have an overview of the main periods in history with a clear idea of the relevant dates - even history examiners need dates!
The following brief outline would be a very useful table to memorise
Dates (approx) |
Periods of history |
Important individuals |
overview |
10,000 -3,000B.C. |
Prehistoric Times |
None known because of the lack of written records |
Supernatural explanations of disease (spirit world). Use of charms and magic, some herbal remedies and some primitive surgery e.g. trephinning |
400B.C. 400 A.D |
Ancient Times: Egyptians Chinese Indian Babylonian Greek Roman |
Imhotep Askelpios/Hippocartes Galen |
Settled civilisation and therefore some important progress. Egs Egyptians learnt about anatomy through religious practise of mummification. Greeks saw the first ever natural explanation of disease with hippocrates theory of the Four Humours. The Chinese developed acupuncture, Babylon developed public health systems. The Romans were able to develop public health systems across their huge Empire. In all Ancient civilisations however natural and supernatural approaches went side by side |
1500 A.D. |
Dark Ages and Middle Ages |
Avicenna Rhazes Albicasis |
Regress in Western Europe as Roman empire collapsed. Power of RC Church large barrier in the way of medical progress. In contrast Arab medicine thrived with successful medical schools in Salerno and Cairo |
1700 A.D. |
Renaissance |
Vesalius Da Vinci Pare Harvey Sydenham |
Reawakening of interest in learning and knowledge. Improved travel and reduction in influence of Church resulted in great progress in some areas of medicine, especially anatomy and physiology |
1900 A.D. |
Industrial Revolution |
Jenner Pasteur Koch Simpson Lister Nightingale Chadwick and many many more!! |
Significant public health problems caused by Industrial revolution. But significant progress in all areas of medicine e.g. vaccinations, germ theory, anaesthetics, improvements in nursing and hospitals |
2001 A.D. |
The Modern World |
Ehrlich Fleming Florey and Chain Barnard |
Use of high level technology, elimination of many diseases in wealthy areas of world. Rapid improvements in drugs and surgery, National Health services, contrasted to growing inequalities with developing countries |
Revision Suggestions
1.Convert this table into a large memory map using bright colours and associated pictures. Place it just above eye level around your desk and review it regularly - good for visual learners
2. Play "In the first place" with the information on this table! Write out separate revision cards for each period of history then plot a route around your home leaving one card attached to separate places around your home. Follow the route regularly testing yourself at each location. The association of the "place" with the information should trigger your memory in the exam room! - good for kinaesthetic learners
2. CHANGE
Many people mistakenly think that history progresses in a linear straight line as time progresses rather like the graph below
Progress/Time
Instead of this change in history follows a very jagged line, sometimes there are long periods of continuity, sometimes there is sudden and rapid progress, and sometimes there is regress (see definitions below)
Progress: when something changes for the better eg. The discovery of a vaccination for smallpox by Edward Jenner made medical treatment change for the better.
Regress: when something changes for the worse e.g. when the Pope banned dissection in 1300 A.D. surgical knowledge went into decline.
Continuity: when things stay the same for long periods or when a particular attitude or idea remains constant for a long period e.g. 1. the prehistoric way of life did not change for thousands of years. 2. Medieval doctors were who used phlebotomy (blood letting) were still basing their approaches to curing disease of the work of the Greek Hippocrates and his theory of the four Humours.
Why doesn't progress occur in a linear straight line?
To understand why you need to have an understanding of the historical factors which combine to effect change at any given period of history. The factors of change in a given period of history are the common features which characterise that period and make it distinguishable from others. The headings for these factors do not change much, but factors can be positive, negative or neutral and the combined balance of factors will indicate whether that period was one of progress, regress or continuity
Individuals Technology Education
war
communications
Economy
The basic factors of change nationalism
Government religion chance
In very simple terms in a period of history where there was a high level of education and technology, a strong government with a wealthy economy with good communications so ideas could spread easily, you would expect to find PROGRESS in the history of medicine. Whereas in a period which had no proper education system, low levels of technology, poor communications and a weak government and impoverished economy you may well find CONTINUITY or even REGRESS in the history of medicine.
IMPORTANT POINT
It is important not to get too mechanistic about this
as it is essentially a very simplified version of some quite complex processes.
However it is useful for exam purposes to remember that questions which ask you
about change, progress, regress or continuity will invariably require you
display your knowledge of the Factors of change applied specifically for that
particular period . Use the titles of the Factors as memory
triggers!
It is also important to remember that simply reciting a list of factor titles will not score many if any marks in the exam. You need specific revised material on the factors in the relevant period identified by the question.
The following tables may make useful revision cards. The first would be helpful if you were asked why prehistoric times was a period of continuity, the second why so much progress was made in the mid nineteenth century regarding germ theory by Pasteur and Koch.
Place a tick or a cross in
the middle box where appropriate
Medicine in Prehistoric Times
Factor |
Positive or negative for likely progress? |
explanation |
government |
|
No settled government/tribal nomadic lifestyle. No planning for public health etc. therefore possible |
economy |
|
Hunter gathering/poor, generally subsistence |
technology |
|
Primitive tools e.g. flints and arrow heads |
religion |
|
Belief in spirit world - good things caused by good spirits, bad things such as disease by evil spirits. Natural explanations therefore not sought. |
communications |
|
No written language communication by word of mouth and therefore ideas restricted to narrow circle |
education |
|
No schools, no written language. Skills and ideas passed on in the oral tradition |
Pasteur and Koch in the mid
Nineteenth century
Factor |
Positive or negative for progress? |
Explanation |
Economy |
|
Both the French and Prussian economies were wealthy having experienced the Industrial revolution. Pasteur was sponsored by the French wine industry to discover why wine was going bad. |
War/nationalism |
|
The Franco Prussian war 1870 created a rivalry between Pasteur and Koch. It became a matter of nationalistic pride to make the most progress in germ theory |
Technology |
|
The development of the microscope meant that for the first time ever scientists such as Pasteur and Koch were able to see microbes and thus prove germ theory |
religion |
|
Though religious belief was still important in 19th century Europe, the idea that disease could be explained "naturally" was well established, and the Church did not obstruct medical progress |
communications |
|
Means of communication such as the telegraph, trains etc had improved dramatically. Pasteur, Koch and others such as Lister were able to read about each others breakthroughs in medical journals like the "Lancet" |
education |
|
Education became an important issue in the 19th century with most people receiving some form of basic education. Pasteur and Koch both had the benefit of secular university education |
Tasks
Now use the same format to explain the following
If you want feedback send your answer to aliandy@globalnet.co.uk
Some
examples of Factors of Change in the development of medicine
NB/ you will need to apply these examples
appropriately with specific dates and details for the highest grades at GCSE
Factors helping development:
War |
Building an Empire involved WAR. The
Romans needed fit soldiers so they developed a good public health system.
Roman soldiers also provided the need for progress in battlefield surgery War wounds give surgeons like Pare (1510
1590) opportunities. Pare developed a soothing lotion to replace
cauterisation. Also developed artificial limbs and new surgical tools Crimean War (1853 -56) helps the
development of nursing. Gave Florence Nightingale the opportunity to conduct
her work in Scutari. Franco - Prussian 1871 war helps rivalry
between Pasteur and Koch. Both men's work fuelled by nationalist pride. First World War (1914-18) and blood
transfusions. War created the impetus for the application of Landsteiner's
work on blood groups and transfusions Second World War helped to develop
penicillin and plastic surgery. Penicillin first mass produced in 1942 in
response to the demand created by the casualties of War
|
Communications |
Invention of the printing press by
Johann Gutenberg 1454 and its use by Caxton in England in 1476 greatly
speeded up the spread of new "Renaissance" ideas Industrial revolution 1750 onwards Better transport; canals, roads, rail Electric telegraph and greater and
greater communication stimulates debate. Medical journals such as the "The Lancet"
allowed scientists to share and developed idea. E.G. Lister first read about
Pasteur's germ theory in "The Lancet" which led to his development
of carbolic spray in surgery in the 1860's
|
Governments |
Romans had a strong government
organisation backed up by an extensive civil service and were thus able to
develop their excellent public health system French and German governments helped
Pasteur and Koch. In the 1860s -1880's - tremendous progress in the
development of vaccinations e.g. Chicken cholera, rabies, anthrax etc. Liberal government in Britain
(1906-1916) - first social security reforms and National Insurance for health
care set up in 1911 British and American governments fund
work in penicillin - Florey and Chain 1938-1944 Labour government set up NHS 1948 - free
health care for all
|
Chance |
Pare runs out of oil 1536 - had to use a
mixture including eggs, rose oil and turpentine - proved far more effective
than boiling oil! Charles Chamberland (Pasteur's
assistant) injected chickens with weakened strain of chicken cholera by
mistake - discovered by chance then the weakened or attenuated culture had
made the chickens immune 1880. Pasteur and his meeting with the boy
bitten by a dog - developed rabies vaccination 1885 Fleming and Penicillin. Fleming noticed
by chance the bacteria killing qualities of the mould penicillin notatum by
chance in 1928
|
Religion and social attitudes. |
Egyptian religious belief in life after
death helps knowledge of the Human body. Bodies were mummified by priests increasing knowledge of
anatomy. Surgical tools also advanced. Islamic belief in looking after the sick
and the elderly Work of Christian monks in the Middle
ages - a Christian duty to look after the sick Renaissance and reformation -
questioning of RC belief by religious reformers such as Luther, Calvin and
Zwingli led to a questioning atmosphere in which more progress was possible
|
Science and technology |
Scientific observation and enthusiasm
for scientific enquiry during the Renaissance e.g. The Royal Society founded
1660. Science develops during the Industrial
Revolution allowing scientists and chemists to use technologies like the
microscope in the mid Nineteenth century. Use of science in research, chemicals
developed. Scientific and technological advances
lead to machines and materials e.g. Wilhelm Roentgen discovered X rays in
1895 Surgical technology and scientific
progress allowed for the first heart transplant operation by Christian
Barnard 1967
|
Individuals - it is very
important to know about people who made a contribution to medicine. Exam
boards often ask questions about the importance of individuals as Factors of
Chance. Therefore for each person you will need to know the period that they
came from and some clear facts about their contribution. You will also need
to describe what other factors over and above the contribution of the
individual were important for each example. Task: write a fact file on each and use
them as revision cards. If you want feedback send your fact files to aliandy@globalnet.co.uk |
Imhotep (2730BC) Hippocrates (460-377BC)
, Galen (129-199 AD), Avicenna (980-1037AD), Pare (1510-1590 AD) Vesalius (1514-1564 AD) Harvey (1578-1657 AD), Jenner (1749-1823
AD), Pasteur (1822-1895 AD) Koch (1843-1910) Lister (1827-1912), Garret-Anderson
(1836-1917) Chadwick (1800-1890), Simpson(1811-1870) Nightingale (1820-1910), Jex-Blake
(1840-1890) Beveridge (1879-1963) Fleming (1881 -1955),Florey (1898-1968)
Chain (1906-1979) Barnard (1922- ) |
Factors hindering Development
Below are some examples of when factors have hindered
progress or caused regress
War |
Barbarian
tribes attacked Rome 410AD.The Western Empire collapses and the Dark Ages
emerge. Knowledge of the ancients lost and public health systems collapsed Loss of
medical learning in the destruction of war Finance
directed away from research and care in all wars especially during 19th
and 20th century conflicts
|
Religion
|
Egyptians
were not allowed to dissect over and above the removal of soft organs. Lack
of experimental dissection for religious reasons limited what they learnt
about anatomy Religious
attitudes hindered Galen AD 161.Galen could only base his work on anatomy on
the wounds of gladiators and the dissection of animals. He therefore made
mistakes - mistakes not rectified until Vesalius in 1543 AD Later
religious groups including both medieval Christians and Muslims prevented
criticism of Galen because Galen had rejected the polytheistic Romans
religion and had come to believe in one god Religious
groups opposed the use of anaesthetics in the 19th century as they
believed pain was a "natural" part of childbirth. They were almost
exclusively men!
|
Opposition
to change (there
is always someone who opposes change!) |
Conservative
doctors opposed Galen. Opposition
to Pare's methods. Many battlefield surgeons continued to use boiling oil
because it was what they knew. Opposition
to Jenner and his smallpox vaccination 1796 - because doctors feared that
they would lose money. The public at large also feared that by being injected
with cowpox they would develop the features of cows - not until 1840 that the
vaccination was widely available Christians
oppose the use of chloroform.(see above) Opposition
to nursing improvements.E.G.The male
doctors at Scutari 1854-56 originally objected most strongly to the idea of
Nightingale and other female nurses being in the hospital Objections
to welfare state.E.G The B.M.A. feared for their members livelihoods. The
Conservative party opposed it on ideological grounds 1945-48.
|
Lack
of scientific Knowledge and technology |
Lack of
anatomical knowledge. People did
not know about germs and blood groups because of lack of technology
e.g.powerful microscopes not invented until the Nineteenth century Lack of
technical knowledge prevented manufacture of effective microscope before
this. Germ theory and the identification of blood groups therefore not
possible.
|
Governments |
Lack of
stability and organisation before the modern period (with the exception of
the Romans!) prevented progress in public health. Laissez
faire prevented action on public health problems such as cholera during the
Industrial Revolution in Britain Opposition to increased spending during the debate on the NHS in the 1940s. |
Where the source evaluation questions appear vary from board to board. However the following types of question are very common across all examining boards
You are ALWAYS given a range of sources and usually some background information too. Be aware also that source questions can emerge on other parts of the papers too!
PROOF AND SUPPORT QUESTIONS
Generally it is unlikely that one source on its own is likely to PROOVE anything much. Imagine a lawyer in court who tried to convict somebody on the basis of one piece of evidence! One or two sources may suggest a theory may be true but on their own will not prove it. Be also aware of what type of source the extract in question has come from. For instance an extract from a well researched and respected textbook may well carry more weight than a cartoon from a newspaper or a speech from a politician. Always examine the possible motive behind the source in question. Make use of the information you are given about the source, when it was written, by whom and for what purpose Be also aware of the difference between intention, instruction and reality. For instance a source which calls for improvements in public health in the 19th century, even a law, does not prove that it actually happened at that time. Be also aware that one example of progress does not prove that progress was universal at that time (Link to practice source question and mark scheme on medicine)
UTILITY OR USEFULNESS QUESTIONS
It has become a clich� amongst rather desperate History teachers that "all sources are useful it depends what is your line of enquiry"
In questions which ask you to assess the relative usefulness of 2 sources it is likely that the line of enquiry will either be so vague and broad that it is ambiguous or it will be absent entirely.
EG Which of sources would be most useful to the historian studying medicine in Ancient Greece? - your sources could be for example a diagram of the Four Humours and a prayer left at an Askelpion.
Your task in these circumstances is to point out the ambiguity of the line of enquiry and then to say what specific lines of enquiry the sources would be useful for e.g. the diagram is useful for understanding the great contribution of Hippocrates with his first ever natural explanation for disease, whereas the prayer shows that religious and superstitious beliefs and approaches to medicine and illness persisted. The sources are useful for different aspects of Ancient Greek medicine.
Factors which limit the usefulness of sources include;
RELIABILTY
Don't fall into the trap of trusting nothing and making glib statements about all sources being biased. If you want to say a source is biased explain how and why. Think of history as a mission to seek out the truth about the past which can be achieved if the historian is sufficiently skilled and critical. Analyse the actual sources presented before you and make judgements based on your knowledge of both the type of sources and your knowledge of the period. Analyse who wrote them, when they were written and with what possible motive.
Do not fall into the trap of claiming primary sources are more reliable that secondary because they are "first hand". This is both wrong and is likely to send your examiner into apoplexy! Imagine how reliable Saddam Hussein's account of the gulf War might be in contrast to that of a well researched history book by a respected historian!
For more guidance attempt the past papers section