Section 1: Medicine Through Time Theme 1: Disease and infection
1.1 Medicine in the ancient world, c.10,000BC–c.AD500 Exam practice (page 13)
1 What does Source A suggest about Ancient Greek medicine? (4 marks) Source A shows Hippocrates examining a patient and suggests that Ancient Greek medicine was based on observation and careful examination. This scientific approach led to Hippocrates being called ‘The Father of Modern Medicine’ and represented a break with the past as Hippocrates was certain that illness had natural rather than supernatural causes.
Exam practice (page 21)
2a Choose one of the important theories in the history of medicine below:
the theory of the four humours
What was the theory? (4 marks) The Greeks created and developed a new idea about the cause of disease, known as ‘the theory of the four humours’. They believed that the body was made up of four humours, which were yellow bile, black bile, blood and phlegm. They represented the four elements and in people were influenced by the seasons. To be healthy, the humours had to be in balance but if a person had too much, or too little, of any one humour, they would become ill. When a patient was ill they went to a doctor who would try to discover and fix the problem by rebalancing the four humours. For example, if he thought you had too much blood he might bleed you, or too much black bile he would prescribe a laxative. Later on doctors used the theory of opposites, which said that if a disease was caused by cold, its treatment should involve heat. The theory of the four humours was, of course, wrong. However, many good things did come from it as it was one of the first attempts at a scientific explanation for illness.
2b Which of these theories contributed more to the development of medicine? Explain your answer. (8 marks) It is not known exactly when the theory of the four humours was first thought up, or by whom. We do know, however, that a doctor named Hippocrates developed it further. He was the first man to record treatments and observations in books, and therefore the theory was passed down through generations. As people heard this theory, and began to believe that it might be true, they became less certain that all illnesses were caused by supernatural forces. This probably made other doctors want to do further research at the time.
Unfortunately, the idea wasn’t completely for the best because some of the treatments used in this theory may have been dangerous, and may have killed people. This theory dominated medicine for around 2000 years partly because, when the theory gained the backing of the Roman Catholic Church, it became the orthodox approach to medicine so it was a dangerous heresy to challenge its truth. Research into other ideas may have stopped, or considerably slowed down, so it held back progress in finding cures and developing scientific medicine. However, although it did play an important part in the future development of medicine as the theory focused attention away from supernatural, spiritually based ideas about the cause of disease and treatments, I do not think the theory of the four humours was the most important contribution that the Greeks made to the history of medicine. There are other aspects such as the Hippocratic Oath or clinical observation.
Germ theory was proved by Louis Pasteur who published his findings in 1861. He showed that germs were the cause of disease in a scientific way. He used swan-necked flasks to show that germs in the air caused liquids to go bad and then went on to show that germs caused disease in animals. This clearly disproved the previously held belief in spontaneous generation as the cause of disease and decay. In this theory, the germs that could be seen under microscopes when something went bad or rotted were the result, and not the cause, of disease. Pasteur showed this was wrong. The discovery of germ theory also started the science of bacteriology and set scientists looking for the specific germs responsible for so many killer diseases. One such scientist was Pasteur’s rival, Robert Koch. It was Koch who went on to develop the tools of the germ hunters as well as finding the germ for tuberculosis, a disease that condemned thousands to a slow death.
The implications of germ theory in the 1860s were profound and affected all areas of medicine. In the field of surgery Joseph Lister realised why hospital infections happened in otherwise successful surgery and as a result took measures to make operations safer through the use of antiseptics. In the field of public health, when governments realised that germs caused disease and illness was not due to miasma or bad air, the prevention of disease by providing effective public health facilities was given a big boost. Germ theory explained so many things such as why Jenner’s vaccination worked and why John Snow was right about cholera.
In the beginning the theory of the four humours was a great leap forward to a more rational and natural explanation of disease, but the longer it was believed, the more it became an unchallengeable orthodoxy that held back progress and a more scientific approach to medicine. On the other hand germ theory was the most important development in the history of medicine. It explained so much about disease and opened up the way for many cures. We have built modern medicine on the foundations laid by germ theory.
Exam practice (page 21)
3b. Which of these two individuals contributed more to the treatment of disease and infection?
Explain your answer. Try to refer to both individuals in your answer. (8 marks) By the nineteenth century medical knowledge had progressed to the point where doctors and scientists knew about germs but were unsure of the relationship between germs and disease. Many scientists believed in the theory of spontaneous generation, which stated that germs were the result of disease rather than the cause.
Whilst conducting experiments for the French wine industry in 1857–61 Louis Pasteur, a research chemist, managed to prove that airborne germs were causing the wine to sour. Although Pasteur’s findings were not universally accepted this was a breakthrough and Pasteur went on to demonstrate that germs were responsible for certain animal diseases, such as those found in silkworms.
Pasteur went on to build a skilled research team and, as a result of chance, one of them, Charles Chamberland, chanced upon a vaccine for chicken cholera when a batch of chickens were wrongly injected with a weakened dose of the chicken cholera germ. The process of vaccination had been known about since Edward Jenner had discovered the smallpox vaccine in 1796 but no one knew how it worked. Pasteur and his team managed to show how injecting a weakened strain of a disease built up the body’s defences so that it recognises and is able to fight off a stronger strain of the disease when exposed to it. Pasteur and his team continued to work on this technique so that vaccines against anthrax and then rabies were quickly developed.
Pasteur’s main rival at this time was a German doctor, Robert Koch. Germany had only just defeated France in the Franco-Prussian War and both men were spurred on by national, as well as personal pride. In the 1870s Koch took Pasteur’s work a stage further when he devised a technique for making germs visible using a microscope and an industrial violet dye. This was particularly important since there were those who doubted the validity of Pasteur’s work and even the existence of germs. Now, Koch had at last provided irrefutable proof of invisible, airborne germs.
Like Pasteur, Koch led a highly skilled research team and they went on to photograph and classify different germs. Koch called his work ‘microbe hunting’. In 1882 Koch and his team identified the specific germ that causes tuberculosis. Koch’s work was highly influential and other scientists such as Paul Ehrlich and Sacahiro Hata began using his methods: within twenty years the germs that cause typhoid, diphtheria and pneumonia had been identified.
I think that Louis Pasteur made the greatest contribution to the battle against infectious disease because his work provided the initial breakthrough. Although Robert Koch’s work contributed more directly to saving human lives with the discovery of the tuberculosis and cholera germs, for example, Koch would not have been able to do this work without Louis Pasteur laying the foundations of germ theory: with his work for the French wine industry and with vaccines for animal diseases.
Theme 2: Surgery and anatomy
1.4 Surgery and anatomy in the ancient world, c.10,000BC–c.AD500 Exam practice (page 28)
1. What does Source A suggest about surgical knowledge at this time? (4 marks) Source A suggests the Ancient Greeks were able to perform some surgical procedures. In the picture there is a cup that doctors would use when bleeding a patient in order to bring their four humours into balance, as well as what look like scalpels, forceps and dental pliers. This suggests that although the Greeks were more interested in the causes and cures of disease and the maintenance of good health through diet and exercise, they did not ignore surgery completely.
Exam practice (page 30)
1. What does Source A suggest about the influence of Galen on medicine? (4 marks) Source A suggests that Galen had a huge impact on medicine as it dates from 900 years after his death. This indicates that Galen (and Hippocrates) was still highly respected. The painting is on the wall of a church suggesting that Galen’s work had the support of the Christian Church. This is important since the Church controlled education in Western Europe during the Middle Ages, including the training of doctors. Galen’s books and research built upon what Hippocrates had said and by giving their approval to Galen’s work the Church ensured that it was taught and unchallenged for about 1500 years. Therefore Galen was very influential in the history of medicine.
1.5 Medieval and Renaissance surgery and anatomy, c.500–c.1700 Exam practice (page 35)
1. Which of these individuals contributed most to the development of surgery and anatomy?
Explain your answer. Try to refer to both individuals in your answer. (8 marks) Ambroise Paré and William Harvey were two of the great pioneers of surgery and anatomy in the sixteenth and seventeenth centuries. The two men were very different: Paré was a practical barber surgeon who learned his trade as his brother’s apprentice; Harvey was more academic, with degrees from Cambridge and Padua Universities.
As an army surgeon Paré developed a new treatment for gunshot wounds. The usual method was to cauterise them with a hot iron and boiling oil. This was painful and disfiguring. By chance, Paré ran out of cauterising oil as a group of wounded soldiers were admitted to his hospital. For some time he had been considering an alternative treatment based on a soothing ointment made from egg yolks, turpentine and rose oil, but had not yet tried it out. With no alternative, Paré applied the ointment to the soldiers’ wounds. His patients recovered with less pain and wounds healed better. Paré went onto use a new method to stop patients bleeding: he used ligatures made of silk threads to suture or stitch wounds and also pioneered the use of artificial limbs. His book Works on Surgery (1575) contained descriptions of his methods and detailed drawings. It became very popular and was translated into many languages in Europe and the Middle and Far East.
However, Paré did not completely remove pain from surgery. His use of anaesthetics was limited and patients felt pain as their wounds were sutured. Paré did not use antiseptics and the silk threads used for the ligature could introduce infection into the body. Although much of modern surgery may have its origins in Paré’s work, he was not particularly influential in his lifetime. Firstly, many surgeons preferred to operate at speed and found Paré’s methods fussy and slow. Secondly, most of Paré’s contemporaries had been to university and felt that they had little to learn from an uneducated barber surgeon. In any event Paré and his ideas were initially ignored.
William Harvey contributed to knowledge about the structure and working of blood in the human body. Harvey conducted a series of scientific experiments on such animals as rabbits and reptiles and discovered that blood is pumped around the body by the heart. This circulation of the blood theory disproved Galen’s idea, which had stood largely unchallenged for almost 1500 years, that the blood was a fuel that was burned up by the body. Harvey kept detailed records of his observations and experiments and these became the basis of his book, On the Motion of the Heart and Blood, published in 1628.
Although Harvey had received a university education his ideas also met with resistance. Firstly, Harvey could not explain how blood moved from the arteries to the veins as there were no microscopes available at the time powerful enough to see the capillaries. As a result Harvey’s circulation model was incomplete and challenged by those who clung to Galen’s ideas. Secondly, Harvey’s work did not help doctors cure their patients and was largely ignored as doctors continued to prescribe treatments based on the four humours. This is shown by the treatment given to King Charles II in 1685. No one would benefit from Harvey’s circulation of the blood theory until blood groups were identified by Karl Landsteiner in 1901 and blood transfusions became possible. Consequently it took at least 50 years for Harvey’s work to be accepted and taught to medical students in universities.
Comparing the contributions of Paré and Harvey to the development of surgery and anatomy, Harvey stands out. Paré made practical suggestions that directly helped patients. His work was done through trial and error and, of course, chance. Harvey, on the other hand, used a more scientific approach and was more of a Renaissance figure. Paré directly helped his patients, whereas Harvey helped other doctors and scientists, though not immediately. Harvey’s work had a long-term impact and contributed to the knowledge that doctors, scientists and surgeons use today, while Paré’s work was limited in its impact, had defects in practice and contained risks as with the use of ligatures. Harvey’s work remains valid today whereas Paré’s has long been overtaken.
Exam practice (page 35)
1. Which of these individuals contributed most to the development of surgery and anatomy?
Explain your answer. Try to refer to both individuals in your answer. (8 marks) Ambroise Paré and Andreas Vesalius were two of the great pioneers of surgery and anatomy in the sixteenth century. The two men were very different in that Paré was a practical barber surgeon who learned his trade as his brother’s apprentice. Vesalius, by contrast, was an academic having studied in both France and Italy. Paré worked as a surgeon in the French army whereas Vesalius was Professor of Surgery at Padua University.
While serving as an army surgeon Paré developed a new treatment for gunshot wounds. At this time the usual method used to treat gunshot wounds was to cauterise them with a hot iron and boiling oil. This was painful and produced ugly, disfiguring scars, although it did act against the poisoning effect of the gunshot wound. Paré doubtless learned this technique by observing other battlefield surgeons. By chance Paré ran out of cauterising oil as a group of wounded soldiers were admitted to his hospital. For some time Paré had been thinking about trying an alternative treatment based on a soothing ointment made from egg yolks, turpentine and rose oil, but had not yet tried it out. With no alternative, Paré applied the ointment to the soldiers’ wounds and found that his patients recovered with less pain and that their wounds healed more neatly. Paré went on to use a new method to stop patients bleeding. He used ligatures made of silk threads to suture or stitch wounds and also pioneered the use prosthetics or artificial limbs. His book Works on Surgery published in 1575 contained descriptions of his methods and detailed drawings of artificial hands with mechanical levers replacing the fingers. Works on Surgery became very popular and was translated from its original French into many languages in Europe and the Middle and Far East.
Nevertheless, Paré did not completely remove pain from surgery. His use of anaesthetics was very limited and patients felt pain as their wounds were sutured and in the post-operative recovery. Paré did not use antiseptics and the silk threads used for the ligature could introduce infection into the body. Although much of modern surgery may have its origins in Paré’s work, he was not particularly influential in his own lifetime. Firstly, many surgeons preferred to operate at speed and found Paré’s methods fussy and slow. Secondly, most of Paré’s contemporaries had been to university and felt that they had little to learn from an uneducated barber surgeon. In any event Paré and his ideas were initially ignored.
A contemporary of Paré, Andreas Vesalius, made his contributions to the study of the structure and working of the human body and corrected many of the long-standing errors based on the works of Galen, who had been the authority on surgery and anatomy to this point. Influenced by the Renaissance spirit of observation, enquiry and experiment, Vesalius decided to repeat Galen’s investigations into anatomy. Unlike Galen who only dissected animals such as apes, dogs and pigs, Vesalius was able to dissect human corpses and in doing so discovered several of Galen’s mistakes. For example, Vesalius discovered that the human jawbone has one part, not two as Galen had said because he had only studied apes. Similarly, the human kidneys are located side by side and not, as Galen said, one on top of the other as they are in dogs.
Vesalius’ findings, which he published in his book The Fabric of the Human Body in 1543 marked the beginning of the end of Galen’s dominance of medical knowledge, but as with Paré, Vesalius’ impact was limited in his lifetime. This was because many doctors and scientists would not accept that Galen could be mistaken. Vesalius was seen as some arrogant upstart for daring to suggest that he was. Finally, Vesalius’ work was seen as having little practical value. Doctors were unable to use Vesalius’ anatomical drawings to cure their patients and so The Fabric of the Human Body was largely dismissed.
So who contributed the most to the development of surgery and anatomy, Paré or Vesalius? Paré made practical suggestions that directly helped patients. His work was done through observation, trial and error and, of course, chance. Vesalius, on the other hand, used a more scientific approach and was more of a Renaissance figure. Paré helped his patients by relieving some of their pain for example, whereas Vesalius helped other doctors and scientists but not for some time. Vesalius’ work had a long-term impact and contributed to the knowledge that doctors, scientists and surgeons use today, while Paré’s work was limited in its impact and had defects in practice and contained risks such as the use of ligatures, which could introduce infection into the body. Vesalius was anatomically correct and his discoveries are still valid whereas Paré’s work has been superseded.
1.6 Surgery in the industrial modern world, c.1700 to the present day Exam practice (page 40)
1. Which factor has contributed most to the development of surgery in the twentieth century:
science and technology?
Explain your answer. (8 marks) Modern surgery is a complex mix of skill and high technology. Operations that were once considered risky, such as the removal of the appendix, are now regarded as routine, and today’s operating theatres are full of multi-million pound equipment, including computer-controlled breathing apparatuses, brain and heart function monitors as well as fibre-optic lasers and cameras. There are many factors that have contributed to these and other developments in surgery, among them war and science and technology.
Although war is usually seen as devastating and disruptive, throughout history there have been examples of warfare contributing to advances in certain fields, including surgery. War was common in the Middle Ages and surgeons had no shortage of wounded soldiers on whom they could practise new techniques and methods. It was during the Middle Ages, for example, when wine was first used for cleaning wounds and opium was introduced as an anaesthetic. In the sixteenth century Ambroise Paré introduced a new method of treating wounds using a soothing ointment rather than cautery irons, and although this development is normally regarded as the result of chance, Paré was working as a surgeon in the French army when the opportunity to test his idea was presented to him.
During the First World War, blood groups were identified and successful blood transfusions were first performed. Similarly, a method of storing blood for later use using sodium citrate to prevent the blood from clotting was first introduced at this time. The discovery of how to mass produce penicillin by Howard Florey and Ernst Chain was made during the Second World War, so that penicillin could be given to wounded Allied soldiers after the D-Day landings in June 1944.Techniques for plastic surgery and skin grafting were pioneered in the First World War and further developed by Archibald Macindoe in the Second World War. War has driven notable developments in reconstructive surgery – a direct result of modern-day conflicts in Iraq and Afghanistan has been the rebuilding and replacement of shattered limbs caused by improvised explosive devices.
The role of science and technology in the development of surgery cannot be ignored. Wilhelm Röntgen discovered X-rays in the early twentieth century and this enabled doctors to look deep into the human body without cutting into it. Modern-day cancer treatments are rooted in early-twentieth-century physics and the work on radiology pioneered by Marie Curie.
In the 1950s and 1960s transplant surgery was introduced. Science and technology contributed to developments here through not only the manufacture of precision tools, but also in life-support apparatuses that enabled the patient to be kept alive while vital organs such as the heart and lungs were removed. Powerful antiseptics and auto-immunosuppressants to prevent the rejection of foreign tissue have been developed by drug companies, and these have proved so effective that complex operations such as heart transplants (first done successfully by Christiaan Barnard in 1967) are now possible. Surgeons today prefer to operate without making large cuts in the body and wherever possible operate through tiny incisions. This keyhole surgery uses fibre optic cables containing cameras and lasers instead of knives or scalpels.
So which of these two factors, war or science and technology has contributed the most to the development of surgery? Science and technology has undoubtedly made significant contributions including those necessary for successful transplants, and while some of these have come about as a result of war, such as the mass production of penicillin, it is doubtful whether many of the advances made in wartime such as the discovery of X-rays or the improvements in prosthetic surgery could have been sustained without the support from science and technology.
Exam practice (page 40)
1a Choose one of the periods below:
The sixteenth and seventeenth centuries
The nineteenth century
What were the main developments in surgery and anatomy in your chosen period? (4 marks) In the sixteenth and seventh centuries there were important changes in the knowledge of anatomy and some improvements in surgery. Before Vesalius, who wrote his anatomical textbook The Fabric of the Human Body in 1543, doctors believed that the books of Galen and other ancient doctors were completely accurate and that there was no need to learn more about anatomy or to dissect human bodies. Vesalius was the first to prove that some of Galen’s ideas about anatomy were wrong – for example, he showed that the human jaw was made up of only one bone, not two as Galen had written. Galen’s ideas were based on dissecting animals but Vesalius said that it was vital that doctors did human dissection to find out about the structure of the human body. As a result, The Fabric of the Human Body was the most accurate map of human anatomy, partly because Vesalius used the very best artists so that doctors could learn from the very best illustrations.
William Harvey’s specialism was the circulation of the blood. Many doctors still believed in Galen’s idea that new blood was being constantly manufactured in the liver to replace blood that was burnt up in the body. This idea had been challenged by a number of doctors but no one had proved exactly how blood moved around the body until Harvey in 1628. He showed that blood circulated round the body and it was carried away from the heart by the arteries and returned to the heart by the veins with the heart acting as a pump.
Paré was a surgeon at a time in the sixteenth century when wounds were treated by pouring boiling oil onto them as a way of helping the healing process. Paré discovered that wounds heal more quickly if simple bandages were used rather than boiling oil. Pare was also the first to challenge cauterisation as a way of sealing wounds after amputation. Instead, he used ligatures to tie off the blood vessels. While this was less painful for the patient, the ligatures could cause infection, complications and death, so were not adopted as readily by other surgeons.
1b Which of these periods was more important in the development of surgery and anatomy? Explain your answer. (8 marks) Both the Renaissance (sixteenth and seventeenth centuries) and the nineteenth century were important times for developments in surgery and anatomy. The Renaissance period saw important advances in the understanding of human anatomy. In the nineteenth century doctors became capable of performing safer, more effective surgery.
Vesalius and Harvey were two very important people who helped increase knowledge about anatomy. Harvey and Vesalius both did dissections. The methods they used were almost as important as the discoveries they made. Vesalius used observation and hands-on dissection. He said doctors should be taught this way and new knowledge gained through dissection. He created the new science of anatomy. His work disproved Galen, who had been an authority for centuries using the method of animal dissection. Vesalius discovered that the human jaw was made up of only one bone and proved by human dissection that Galen, who said the human jaw had two bones based on his dissection of apes, was wrong. This was a massive achievement to overcome the traditional belief that Galen was always right. Harvey’s methods were also scientific. He measured the amount of blood passing a point in the body and calculated that for it to continue at that rate for over an hour it would result in a quantity of blood that was three times the weight of the person – an impossible event. Harvey put rods down veins to show how one-way valves prevented blood from flowing in both directions. He dissected human hearts and the bodies of cold-blooded animals to observe how the heart worked. He concluded that it worked like the mechanical pumps that were being developed at the time.
Paré’s treatment for wounds was a vast improvement because, before Paré, wounds were treated by pouring boiling oil onto them. Paré discovered that wounds heal more quickly if a mixture of turps, rose oil and egg yolk was used. Paré also rejected cauterisation as a way of sealing wounds after amputation. Instead, he used ligatures to tie off the blood vessels. While this was less painful for the patient, the ligatures could cause infection, complications and death, so were not adopted as readily by other surgeons. Even though there were some complications he was the first to challenge cauterisation.
All these developments in surgery and anatomy were widely available because of the invention of the printing press. Vesalius’ The Fabric of the Human Body (1543) was a ground-breaking book – the first modern anatomical textbook, which astonished readers with the accuracy and clarity of its 23 full-page illustrations. Harvey’s book on The Circulation of the Blood in Man and Animals (1628) took full advantage of the Renaissance technology of printing. Paré’s book, Works on Surgery (1575), was also a great success and was translated into many European languages.
However, Vesalius’ work encountered much opposition because, like Harvey, this was based on his criticism of Galen. Fortunately for Vesalius he had a powerful patron in Charles V, the Holy Roman Emperor, who made him a court physician. Similarly Harvey’s discovery about circulation was not taught to medical students at the University of Paris until 1673. Another important drawback was that the work of Vesalius and Harvey had no practical application in the treatment of patients. For example, the idea of blood transfusions had to wait until 1900, and the discovery of blood groups by Karl Landsteiner, before it became a reality.
In the nineteenth century there were three main problems during surgery – pain, infection and bleeding. Operations in 1800 were done very quickly and surgeons like Robert Liston prided themselves on the speed with which they could operate. Operations were done quickly because they had no effective pain relief. Unfortunately, no matter how quickly they operated, patients died because there was no knowledge of the reasons for infection. Germs, it was believed, were a product of disease. As a result many patients died of the dreaded hospital sickness.
The first problem of surgery to be overcome was that of pain during an operation. James Simpson used chloroform in 1847 to ease pain during childbirth. He preferred it to ether, which irritated the patient’s lungs and could be flammable. As a result chloroform replaced ether in most European operations. Some surgeons opposed Simpson’s use of chloroform because they were unsure about its effects and how much to give. Some people thought it was unnatural to stop pain in childbirth because they thought that pain was God given. In spite of this opposition, the case for chloroform slowly advanced and became unstoppable after Queen Victoria used it in childbirth.
Infection rates soared after the development of effective anaesthetics because, although surgeons could make the patient unconscious, they were now infecting them more thoroughly. Surgery changed again when Joseph Lister began experimenting with an antiseptic method after reading about Pasteur’s germ theory. Lister believed that germs were the cause, not the result, of infection. Lister found that a thin mist of carbolic acid sprayed over the wound during surgery limited infection. Bandages and instruments were soaked in carbolic acid. As a result his death rate during surgery fell from 45.7 per cent to 15 per cent.
These two periods contributed to the development of surgery and anatomy in different areas – the sixteenth and seventeenth centuries in anatomy and the nineteenth century in surgery. It must have been very exciting to be a doctor in the Renaissance period as centuries of ignorance were being overturned with new knowledge. However, little of that knowledge improved treatments. The application of a scientific approach at this time was also an important change to developing further knowledge. Vesalius was a general anatomist but his successors, Fallopia, Fabricius and Realdo Colombo, all specialised in different parts of the body. While it was doctors who perhaps benefited most from new knowledge during the Renaissance, in the early nineteenth century it was the patient who benefited most from the developments in surgery. In 1800 the patient dreaded the prospect of an operation as they faced pain and the prospect of death from infection. By the end of the century both the pain of the operation and the threat of infection had been largely removed. This had been achieved by the application of scientific discovery to the field of medicine. Chemistry played a part in supplying chemicals like chloroform and carbolic acid while physics provided X-rays for diagnosis. However, it is possible to argue that the discoveries that benefited patients in the nineteenth century were built on the greater knowledge of anatomy started by Vesalius and Harvey.
Theme 3: Public health
1.7 Public health in the pre-industrial world, pre-c.1750 Exam practice (page 45)
1a Study Source A. What does it suggest about public health in Ancient Rome? (4 marks) The source shows that the Romans had good technical skills in engineering and architecture because they could build places like this. They would not have spent so much time and money on providing these facilities for the public unless they valued cleanliness, either because they liked to feel clean or because they realised that being clean meant you were more likely to be healthy. They must have valued baths and bathing for all the people throughout their empire or else they wouldn’t have built baths in Britain, which was a distant part of the empire. It wasn’t just in Rome.
1b What different impression of public health is suggested by Source B? (6 marks) Public health must have been bad at the time of picture B because the number of dead bodies shows that epidemic diseases were devastating and that people had no answer to them. They approached the church for comfort and looked to religion or superstition for some hope that the disease could be defeated. This shows that in the Middle Ages they had no understanding of what caused disease or how it spread. The bodies are all piled up in the street so the people don’t know about public health and how to keep a public place clean whereas in Roman times they had public facilities like the baths shown in picture A, which enabled them to keep clean. This suggests that the Romans had a more practical approach to public health that involved building facilities to keep all their people healthy, wherever in the empire they lived.
1c Why was public health different at these times? (8 marks) Public health was different partly because government was different at these times. In Rome and the empire there was clear authority from the emperor down to make decisions and to see that laws were enforced. There were authorities in medieval towns but the enforcement was weak. Conditions in the towns were often impossible to keep clean as the roads were unpaved and people lived closely with their animals. Houses were packed together so paid officials found it hard to remove all the rubbish and filth even if they had the will to do so. By the Middle Ages the Roman empire had fallen apart so the effective systems of public health that they had built had fallen into disrepair. The Romans had the engineering skills necessary to plan, design and build aqueducts, latrines and sewers but at the beginning of the Middle Ages there was not the knowledge or will to repair them. Attitudes were also different. In the Roman Empire there was wealth to spend on making the towns and empire an attractive place. The Romans also realised that healthy slaves, workers, merchants, traders and, most importantly, soldiers were necessary to keep the empire strong. The medieval towns were wealthy but town leaders did not want to spend money keeping the town clean. They may have thought that they would be unpopular if they spent money cleaning up areas where the rich rate-payers did not live. Kings often thought they should concentrate on other things like war and conquest or defence rather than public health.
Section 2: The American West, 1840–95 2.1 The Great Plains and the Plains Indians Exam practice (page 59)
‘Without the buffalo the Indians would not have been able to live successfully on the Great Plains.’ How far do you agree with this interpretation of why the Indians were successful at living on the Plains? Explain your answer. (12 + 4 marks)
The buffalo was very important in allowing the Indians to live successfully on the Plains. Every part of the buffalo was used by the Indians and nothing was wasted. Its flesh was eaten by the Indians and could be dried as pemmican to be eaten on long journeys by the tribe. The raw hide could be used as everything from containers to travois lashings, or it could be tanned for items such as bedding, leggings, moccasins or tipi covers. Tendons were used as bow strings and sewing thread while buffalo dung was used as fuel.
However, there were other factors that allowed the Indians to live successfully on the Plains. The tipi was a cone-shaped tent made of buffalo hides. Its shape was sturdy in strong winds, which was practical because there were often very strong winds on the Plains that would have damaged weaker structures. Being made of buffalo hides was a good adaptation because it was a widely available material, making the tipi easy to build and repair. Tipis were also very easy to take down and light to transport, which was useful because the Plains Indians were a nomadic people and this portability allowed them to follow the herds of buffalo quickly and efficiently.
Horses were also an important part of Indian life on the Plains. They could be used to transport families and belongings by pulling a sledge-like structure called a travois, which was made of tipi lashings and poles. The horse allowed hunters to kill buffalo more easily and more safely, over longer distances and more often as the carcass could be carried back to the tribe more quickly and with less effort. This meant that the tribe would have more food and resources. Horses could also be used in warfare because they allowed the Indians to attack more distant and valuable targets and made it easier to escape from battles. This was important because it allowed more damage to be done to enemy tribes while ensuring more men survived to hunt and protect the band.
The Indians were also able to live successfully on the Plains because they lived in harmony with nature and their environment. The Plains Indians had a complex religion based on the belief that all living things had a spirit and that they should be respected in order to please the Great Spirit – the creator (Wakan Tanka). The Great Spirit could be asked for help through dances such as the Buffalo Dance or thanked for victory in battle with the Scalp Dance. Through these dances the whole tribe was brought together and given a sense of unity. The land itself was seen as a living thing that could not be owned, farmed or mined. This made sure that the Indians respected nature and so couldn’t overexploit resources, particularly the buffalo.
The fact that men and women had different roles in the tribe was also important to the success of the Indians on the Plains. The men hunted, made decisions and defended the camp while the women prepared food, made clothes, had children and looked after the tipi. Children were seen as the future of the tribe and were taught and cared for by older members of the tribe and the extended family. Boys, for example, were taught from an early age through play how to use a bow and arrow or how to hunt so that they could play their full part in the tribe when older. Old people were respected for their experience and wisdom and played a valuable role as storytellers, passing on the traditions and history of the tribe. In this way the tribe was given a sense of common purpose through a link to the past.
It is possible to interpret the success of the Indians as due to the buffalo alone but it was the combination of the horse and buffalo that was crucial to this success. For a long time the Indians lived difficult lives on the fringes of the Great Plains growing maize and beans, occasionally hunting buffalo on foot. Acquiring horses from white settlers changed their lives forever as the horse gave them power and freedom. This was why an Indian gauged his wealth by the number of horses he owned. They could now follow the herds of buffalo over the Plains and hunt them more efficiently to gain all the materials needed for their life on the Plains. The Indians themselves realised the importance of the buffalo to their success because although every part was used, the heart was always buried to bring new life to the herd. White settlers also realised the importance of the buffalo, hence their destruction of the herds as a way of defeating the Plains Indians.