SHP History: Medicine Through Time

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In order to succeed at SHP GCSE History Medicine paper you will need a clear conceptual understanding of the following:

CHRONOLOGY and THE PERIODS OF HISTORY. These need to be learnt and referred to in exam answers.
THE FAMILY OF CONCEPTS LINKED TO CHANGE viz. change, continuity, progress, regress, and the Factors of Change. These are essential to understanding why change occurs and why it doesn't at particular moments in history
SOURCE EVALUATION SKILLS viz. and understanding of motive, bias, utility (usefulness), reliability, provenance proof, and support. A critical understanding of these issues underpins the work of all historians.

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 19^th 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 19^th 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

Why was Roman public health so good?
Why was there so little progress in medicine in medieval times?
Why was there so much progress in our understanding of anatomy and physiology during the Renaissance?
Why was public health so poor in early Industrial Britain?
What factors were important in Fleming's discovery of penicillin?
What factors were important in Florence Nightingale's contribution to nursing?
Explain the factors which allowed the Egyptians to learn more about anatomy and physiology
What factors were important in the discovery of X rays?
What factors were important in Jenner's discovery of a vaccination against smallpox
Construct tables or diagrams which identify the general Factors of Change for each of the periods of History.

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 19^th and 20^th 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 19^th 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.

SOURCE EVALUATION SKILLS

Where the source evaluation questions appear vary from board to board. However the following types of question are very common across all examining boards

Does source A prove that "��"
Does source B support Source A
How useful is source C to an historian studying "��"?
What are the limitations of source D?
Which is the most useful source if you were studying "��"
Which is the most reliable source?

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 19^th 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;

Bias - though sometimes biased sources are excellent at helping us understand peoples ideas, viewpoints and attitudes
Reliability/Motive - why did that person say that? Has the photograph been staged? Why are newspaper cartoons perhaps lacking reliability
What the sources DON'T tell you

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

For more guidance attempt the past papers section. For online support use Ask a Teacher (below)