Chapter 3: Extension study: Medicine and public health from Roman Britain to c1350
3.1 The Romans and approaches to medicine
Exam practice question 1 (page 17)
The Romans believed that disease was caused by an imbalance in the Four Humours. They believed that the body was made up of black bile, yellow bile, blood and phlegm, and that too much or not enough of one of these would cause illness. A fever, for example, showed that you had too much blood. This belief was developed by Galen from the work of Hippocrates, an Ancient Greek doctor.
The Romans also believed that bad air could cause disease. They thought it was important to build cities and settlements away from swamps and marshes. This would have helped them avoid diseases like malarias which were caused by mosquitoes, but they didn’t understand why.
The Romans also believed that dirt and sedentary lifestyles caused disease, because they encouraged the population to bathe regularly and exercise in the bath house. However, they would not have understood why this kept people healthy.
In some ways the influence of Hippocrates on Roman medicine was extremely important. Hippocrates’s teachings included the theory of the four humours, which taught that the body was made up of four elements and too much of one of these would cause illness. He also taught the importance of clinical observation: watching a patient very carefully and keeping detailed notes of their symptoms and how their illness progressed. This was very important in Roman medicine because both of these theories were used by Galen. Galen had been a doctor at a gladiator school but he ended up in Rome treating the emperor’s family. Therefore he had a huge influence on Roman medicine, and because Hippocrates had a huge influence on him, that meant that Hippocrates also had a big impact.
However, Galen did change Hippocrates’s ideas in some ways. For example, he added to the theory of the four humours to focus treatment on balance – the idea of not just removing too much of one humour, but adding something when there wasn’t enough. For example, if somebody was suffering from a lack of blood, they might be treated with hot chilli. The Romans also had some of their own ideas about medicine and the causes of disease; for example, they thought bad air caused disease and they had a particularly strong focus on public health. This didn’t have anything to do with Hippocrates.
However, overall I would say that the influence of Hippocrates was particularly strong in Roman medicine, because Galen used a lot of his theories in his own work.
Exam practice question 3(page 18)
In some ways the Romans had a significant impact on medicine in Britain, because they brought new methods with them to Britain from Rome. For example, they introduced the Theory of Four Humours which was a new way of diagnosing and treating disease. Before this, there isn’t much evidence of any collective understanding of what caused disease and the population had relied mainly on herbal remedies. More herbal remedies were used under the Romans, who brought knowledge and new plants with them from other parts of the Empire. Unfortunately this also meant that new diseases came to Britain.
The Romans built hospitals and brought over trained doctors, but these would really only have been for the legionaries who were stationed there, so this would not have had a huge impact on medicine in Britain.
Perhaps the biggest long-term impact the Romans had on medicine was to introduce Christianity. This was because the Church had a massive influence on and role in medicine for more than a millennium after the Romans left.
3.2 Approaches to public health before 1350 Exam practice question 1(page 20)
The Romans improved public health in Britain to a great degree after they conquered the country in AD43. They built aqueducts to ensure clean water was supplied to their troops and forts, and this was shared by the local population who also benefited from the supply. They also created a system of sewers to remove dirty water and waste from populated areas, to keep people healthy.
Furthermore, they used the clean water in the bath houses they built. These were built to a Roman design and to begin with they were mostly used just by the Romans. However, they were made available for everybody to use for a very small sum of money and over time more of the local population began to use them too.
These developments were very significant because before the Romans there wasn’t really any focus on public health, but their new methods and buildings showed the native population how it was done.
Exam practice question 2 (page 21)
When the Romans left Britain it was difficult for their progress in public health to continue. This was because they took their knowledge and expertise with them. For example, there were no longer any engineers left who knew how to build or maintain aqueducts. This meant that when these structures broke they couldn’t be fixed, and so over time there was less provision for clean water. The local population used the stone from the bath houses and other structures to build their own homes as there was less emphasis on public health. The new rulers of Britain did not think it was as important as the Romans had. By 1350 there were some quite serious public health problems in towns, where the lack of fresh water and drainage was a problem. The government were not willing to donate funds to fixing this problem. Therefore, the Romans’ progress was not maintained.
However, some things that the Romans did, did have a long term impact. For example, in the Middle Ages some towns still offered public toilets and baths, in the form of stewes where the public could go and wash. The Romans had been careful not to build near swamps and the idea that bad air could cause disease was still popular.
However, I wouldn’t call any of these things progress. The Romans made considerable headway during their stay in Britain but after they left this was not continued. In a way it was less important because there were less large settlements, but public health did not really become a key focus for government again until the nineteenth century. Therefore, I agree with the statement.
3.3 The impact of religion Exam practice question 1(page 23)
The Church played an important role in care of the sick during the Middle Ages because they believed that it was part of their Christian duties. Therefore many monasteries and convents provided hospitals. They would look after people, give them a bed to sleep in, food to eat and pray for them to recover. They filled a gap in provision because they looked after people who didn’t have family members who could care for them.
However, the hospitals would not admit people who had infectious diseases, such as the plague. They mainly looked after the elderly, the disabled, or people suffering from non-contagious diseases such as leprosy. There were very rarely doctors in attendance. Therefore, hospitals provided by the Church were more like rehab units where people could rest and build up their strength, or where they went to die. The sick would not go there for treatment.
Overall, the Church played an important role in caring for people, but not in caring for people who were really sick.
Exam practice question 2 (page 23)
On the one hand, ideas about the causes of disease did not change. This was because people in the Middle Ages still followed the ideas of Galen. Galen was a Roman doctor who had invented the theory of the four humours. The Church liked this theory because it fitted in with what the Bible taught, and so it continued to be used even after the Romans left. Because the Church controlled all the universities, all doctors were taught the theory. Therefore, people in the Middle Ages still believed disease could be caused by an imbalance in the humours.
Furthermore, people in the Middle Ages believed disease could be caused by bad air. This is an extension of what the Romans believed: they would not build their settlements near swamps where there was ‘bad air’ because they believed diseases would be caught more easily. This belief was not quite the same by the Middle Ages, but the idea was still around.
However, some ideas about the cause of the disease did change. This was because the Church became more powerful and taught that God sent disease as a punishment. People believed this particularly during the Black Death, when they would whip themselves to try and make up for their sins. Although the Romans believed the gods could send disease, they thought this was a result of curses instead of sin. People in the Middle Ages often looked for astrological causes of disease by checking the alignment of the planets. This was completely different to Roman beliefs.
Overall, I would say that ideas about the cause of disease developed from the Romans: they were mostly quite different by the Middle Ages, but often had their root in Roman beliefs.
3.4 The impact of government and war
Exam practice question 1 (page 24)
In some ways medicine and public health changed a lot between the Romans leaving Britain and 1350. In particular, public health changed. The bath houses and aqueducts which the Romans had built steadily decayed because there were no engineers to maintain them. The stone was sometimes taken and used in other building projects and there was a lot less emphasis from the government on cleanliness and hygiene. Public health problems increased after the population of some major towns like London and York began to grow. Therefore, after the Romans left Britain there was a real change in public health, and it wasn’t a positive one.
However, in some ways it stayed the same – particularly in medicine. This is because the Church liked the teachings of Galen and promoted them in their universities. Galen had been a Roman doctor and his ideas about the human body being perfectly designed fitted in with the teachings of the Bible. Therefore, doctors continued to use the theory of the four humours and Galen’s teachings on anatomy, amongst other things, until well past 1350. Some things did change. For example, the Church taught that God sent disease; but the teachings of Galen still formed the largest part of the work of the doctor.
Therefore, I think that public health changed a lot between the Roman withdrawal from Britain and 1350, but not a great deal changed in medicine.
Chapter 4: Medicine and treatment c1350–c1750
4.1 Medicine at the time of the Black Death Exam practice question 1(page 26)
The Black Death was a problem in Britain from 1350 onwards because nobody knew what caused it. There was no understanding of the causes of disease or how it was spread, which meant that it spread very quickly and there was no satisfactory cure. Large numbers of the population died and in some places there weren’t enough people left alive to bury the bodies of the plague victims.
The disease was spread by fleas carried by rats that arrived in Britain on trading ships. However, nobody knew this and therefore people tried all sorts of things to avoid catching the Black Death. The most common of these was prayer, to ask God for forgiveness so he would spare you. Burning barrels of tar to drive off the bad air which was thought to spread the disease was also common. Unfortunately these things didn’t work very well and so the Black Death continued to be a problem in Britain.
4.2 Ideas about the causes of disease: the influence of the past Exam practice question 1 (page 27)
The theory of the four humours was very important in medicine until around about the Renaissance era, when new discoveries proved it was wrong. The reason it was so popular was because it fitted in with the Church’s ideas about what caused disease; therefore it was used by doctors to diagnose and treat illnesses in the Middle Ages, as well as in the Roman era, when it was promoted by Galen. The Theory taught that the body was made up of four elements and that an imbalance in these caused illness. There was no real understanding of what caused illness until Pasteur came up with his Germ theory of Disease. This meant that the theory of the four humours was really important because, even though it was entirely wrong, it filled in a gap in medical understanding.
Exam practice question 2(page 27)
Galen’s work influenced medicine in the Middle Ages because the Church approved of what he taught. For example, he taught that the different parts of the body fitted together into a well-designed whole, which agreed with the Bible’s teachings that man was made in God’s image. Additionally, the Church supported the theory of the four humours. Because of this, bleeding was a common cure used by physicians to treat all kinds of ailments.
Furthermore, the Church controlled all medical training. This meant that they controlled what was taught to trainee physicians, and they only taught Galen. Therefore, Galen’s work had a heavy influence on medicine in the Middle Ages.
4.3 The impact of the Renaissance on medicine Exam practice question 1(page 28) Art and printing were important in improving medical understanding during the Renaissance because they helped doctors and medical professors to share their discoveries and research more efficiently with each other. Printing made it easier and cheaper to mass produce copies of medical research and send it further afield, therefore improving communication among doctors from across Europe. For example, Vesalius’s book “One the Fabric of the Human Body” contained information about the mistakes in the works of Galen and was sold very widely among medical professionals.
Art also had an impact because it helped to create more realistic and lifelike images of the human body. Vesalius’s book had over 200 illustrations in it which were drawn from dissections he had carried out on the human body. This was different from the past, when artists had drawn in a more two-dimensional style and rarely from life. This meant that there were a lot more accurate portrayals of the human body available to doctors, who used this to improve their understanding of anatomy.
4.4 Medical Megastars: Vesalius and Harvey Exam practice question 1(page 31)
The work of Vesalius was very important because it provided new information for doctors and medical students. Before Vesalius, doctors worked with Galen’s teachings which were based on animal dissections. However, Vesalius was able to dissect human corpses and correct some of Galen’s mistakes. For example, Galen had taught that the human jawbone was made up of two pieces, like a pig’s; however, Vesalius was able to demonstrate that it was only one.
These discoveries were particularly important as Vesalius shared them. Because he lived during the Renaissance, Vesalius was able to have his detailed drawings of the human body printed into books which were sent across Europe. The drawings were so detailed that they are sometimes still used in medical text books today.
However, Vesalius’s work did not have an impact straight away. It was very important in helping doctors to understand the anatomy of the human body better, but this did not have an immediate impact on medicine and treatment because it did not help doctors to diagnose or cure diseases.
Exam practice question 2(page 31)
Vesalius was able to prove Galen wrong in the sixteenth century because there was a lot of change going on, during the Renaissance. One of the biggest changes was in technology. Printing had been invented and it was cheap and easy to publish books. This meant that once Vesalius had carried out his research, he was able to share it with lots of other doctors and medical students, which helped to convince a lot of people that Galen had been mistaken.
Another factor that helped Vesalius was changes in art. It has become fashionable to draw bodies from life, which meant that anatomical drawings became much more realistic and backed up Vesalius’s discoveries about Galen’s mistakes, for example the idea that blood moves through holes in the heart.
A third factor that helped Vesalius was a change in beliefs. The Church became less powerful after the Reformation and this made it possible for Vesalius to acquire and dissect dead human bodies. Galen had not been able to do this and so it was the most important factor in helping Vesalius to prove him wrong. It would not have been possible before, when the Church was more powerful.
Exam practice question 3 (page 31)
Harvey’s discovery of the circulation of the blood eventually proved to be very important. However, it took a long time for his theory to be accepted and this meant that for a long time the discovery had limited impact. This was because understanding that blood circulated around the body didn’t give doctors any new ways to treat their patients and therefore Harvey’s ideas weren’t widely used. Doctors continued to bleed their patients in accordance with what they had been taught during their training and continued to follow the teachings of Galen. It wasn’t until microscopes were developed and people could see the smaller blood vessels that attitudes changed towards the teachings of Galen that his work started to have more of an impact.
Chapter 5 Medicine and treatment c1750–1900 5.1 Medical Megastars: Jenner and vaccination Exam practice question 1(page 33)
Source A shows that vaccination was not popular at first and that people thought having the vaccination would cause them to sprout cow heads or become deformed. This shows a very negative attitude towards vaccination. However, Source B shows that attitudes have changed significantly because now vaccination is so popular that GPs have run out of it. This means that lots of people must have wanted the flu vaccine, showing a significant change in attitude from source A.
5.2 Medical Megastars: Pasteur and Koch Exam practice question 1 (page 35)
There was a massive change in people’s understanding of the causes of disease between 1350 and 1900.
In 1350 most people believed that disease was sent as a punishment from God, for their sins. Another belief was that the body was made up of four different elements, or Humours, and an imbalance in these led to illness. A third belief was that disease could be caused by bad air, which wasn’t too far from the truth, but people couldn’t explain why. This was because there was a lack of technology and people were unable to see germs or bacteria. People continued to believe this for many centuries and it wasn’t really until the nineteenth century that there was a major change.
By 1900, the understanding of the causes of disease had moved on to a great degree. Developments in science and technology led to the creation of microscopes. This allowed Louis Pasteur to observe the impact of microbes and so developed the germ theory of disease. This had become widely accepted by 1900 and represented a massive change in people’s understanding. Microbes responsible for specific diseases were identified and cures and vaccines started to be developed.
Therefore, there was a complete change in the understanding of the cause of disease between 1350 and 1900.
5.3 Improvements in hospitals and medical training Exam practice question 1 (page 36)
The training of doctors changed a lot during the period 1350-1900. This was mainly due to a change in beliefs and attitudes. At the beginning of the period, the Church controlled medical training and insisted that Galen be taught to all medical students. They banned dissection of human bodies, which meant that doctors could only go on what they learned from Galen’s books.
Over time, beliefs changed and science became more important. During the Renaissance, doctors like Vesalius challenged the authority of the Church by carrying out human dissections and sharing his work. As new technology such as the printing press and the microscope became more available, medical students were able to access lots of new ideas rather than relying on the old ones. Surgeons like John Hunter encouraged their students to carry out their own experiments and observations. This led to a more scientific understanding of illness.
By the nineteenth century, medical students were completing part of their training in teaching hospitals which gave them hands-on experience before they qualified.
Therefore, the training of doctors changed between 1350–1900, because there was a move from a religious to a scientific focus in training, and from a theoretical understanding to a practical one.
Exam practice question 2(page 37)
There were several factors responsible for the improvement of medical treatment in hospitals 1750–1900.
One of these was the increased interest and action of the government. During the nineteenth century their attitude changed from one of ‘laissez-faire’ to an increased interest in medicine and willingness to get involved in improving the health of the population. They introduced a Poor Law which meant that local tax payers were responsible for funding new hospitals and asylums. This made medical treatment more widely available, thus improving it.
Individuals like Louis Pasteur and Florence Nightingale played a big part in improving hospitals. Pasteur’s development of the germ theory gave hospitals a greater awareness of the link between dirt and disease, which led to cleaner hospitals. Nightingale had worked hard to improve training for nurses and the hospital buildings, which led to an improved standard of medical treatment.
Finally, there had been a big change in people’s attitudes during this time period. There were a lot of social reformers who put pressure on the government to improve standards of living among the poor. This led to them getting more involved and passing laws to make hospitals more available and of a higher standard.
5.4 Medical Megastars: Florence Nightingale and Elizabeth Garrett Anderson Exam practice question 1(page 39)
Elizabeth Garrett Anderson had a big impact on the role of women in medicine because she was the first woman to train and qualify as a doctor. After she had done this, it became easier for other women to follow in her footsteps.
When Garrett Anderson trained, women were not allowed to attend university and she had to train privately. She could not register with any of the medical Colleges which meant she could not practice medicine, until her father took one of them to court to force them to allow it. In 1865 she finally set up her own medical practice, and nine years later she helped to set up a School of Medicine for Women. This made it possible for women to train to become doctors and in 1876 the government passed a law which said women must be allowed to register as doctors.
Garrett Anderson not only showed that it was possible for women to become doctors, inspiring others like Sophia Jex-Blake, but she also made it easier for women to train and qualify by setting up her own training facility and lobbying the government. Therefore, she had a hugely positive impact on the role of women in medicine.
Exam practice question 2 (page 39)
The role of women changed a lot between c1350 and c1900.
In 1350, women were quite heavily involved in medicine, but not in an official capacity. They acted as midwives and attended births; local wise women would provide herbal remedies and advice on curing illnesses; and nuns took a big part in care of the sick, because hospitals were usually in convents or monasteries. However, the nuns didn’t have any medical training and would have mostly acted as nurses and said prayers for the people in the hospital. Women could not officially become doctors because they were not allowed to attend university.
By 1900 this had changed quite a lot. There was a school for women who wanted to practice medicine, set up by Elizabeth Garrett Anderson - the first qualified female doctor in England. Nursing had become more professional after Florence Nightingale set up a school to train nurses. Therefore, the role of women was much more professional by 1900. I don’t think it is true to say that they had a much larger role in medicine, because in 135- most people would have been cared for at home by women. However, the role of women in medicine was more official by 1900 as they were allowed to train and qualify as doctors or nurses.