MEDIEVAL: 1250-1500�Religion: God sent sickness to punish or test faith.
Witches/Evil/Devil brought sickness.
Rational: 4 Humors imbalance caused sickness
Miasma and bad smell caused sickness
Supernatural: Alignment of stars or planets caused sickness.
Church had ultimate power over everything
Prevention, Diagnosis, and Treatment:
Religion: Repent sins/pray/mass/candles/pilgrimage to prevent, treat or look for signs of what’s wrong from God.
Rational: Keep Four Humors balanced for treatment and prevention.
Avoid miasma, keep good smells
Examine urine for diagnosis
Herbal Remedies
Supernatural: Spells or incantations
Hospitals were mainly in monasteries, focused on rest and prayer. Focused on helping rather than treatment, and was mostly a place of rest. They did offer some herbal remedies however.
Monarchs didn’t see the public health of the people as their issue. They only helped in the black death by ordering the cleaning of the streets.
Care-givers: Physicians, Barber surgeons, Apothecaries, Wise Women, Lady of the Manor, Women of the family
Training: Physicians trained at university for 7 years, they focused on Galen and Hippocrates.
Barber surgeons and Apothecaries were trained as apprentices and were not educated in university.
Hippocrates – Four Humours, observation, Hippocratic Oath.�
Galen – Theory of Opposites, animal dissection, supported by Church.
RENAISSANCE: 1500-1700
Religion: God and supernatural became less important
Rational: 4 humors discredited by Vesalius and Harvey
However, miasma continued as a belief.
Invention of the Microscope, discovery of ‘Animalcules’ and theory of ‘spontaneous generation of matter’
Prevention: Key focus on miasma, avoiding bad smells and smelling herbs or flowers. In Great Plague, people are locked in to prevent spread from person to person.
Diagnosis: Religion and Supernatural or astrological falls away. Diagnosis became less about four humors, and no more urine charts. Mostly was Sydenham and developing Clinical Observation of patients.
Treatment: Despite new discoveries, no new treatments are developed even with 4 humors discredited. Main treatment is still bleeding and purging.
Most monasteries with hospitals close in the Reformation, and hospitals were lost. St Bartholomew's survived. Smaller cottage hospitals, such as Lazar Houses for leprosy. Hospitals now have their own apothecaries and Physicians
Medical training improves due to Vesalius and Harvey. Barber Surgeons and Apothecaries had to now be registered and follow proper apprenticeship, meaning higher standard of healthcare.
Vesalius’ work on dissection and printed books with anatomically correct drawings, along with Harveys understanding of the heart improved the understanding of anatomy and Physiology and improved medical training.
INDUSTRIAL: 1700-1900
Initially there was the belief of miasma and Spontaneous generation.
In 1861, began Louis Pasteur’s Germ Theory:
Microbes = infection, Robert Koch isolates and identifies infectious microbes, grows them in Agar Jelly and dyes them
First ever vaccine created by Edward Jenner. It was for smallpox, however it wasn't understood at the time. After germ theory and microbes, Pasteur developed new vaccines. He understood he was creating immunity.
Diagnosis by percussion develops after 1761 (tapping the body to look for abnormalities), the stethoscope was developed in 1816, and thermometer in 1871, doctors began to look at medical history of patients.
IMPROVEMENTS IN SURGERY:
1 - James simpson, 1846 chloroform as a reliable anesthetic.
2- Joseph Lister reads Germ Theory and develops antiseptic surgery using carbolic acid.
FLORENCE NIGHTINGALE:
Transforms hospital care, works in hospitals in the Crimean War and transforms survival rates. New schools for nursing; makes a clear link between dirt and disease. Develops new ‘Pavillion’ style of hospital which separates infectious patients. We now had trained nurses and doctors.
Doctors trained at university using dissection and improved quality and also knowledge of medicine.
1. Edward Jenner 1796 Developed the first vaccination (smallpox using cowpox).
Proved disease could be prevented; led to vaccination becoming widespread.
2. Louis Pasteur: 1861 Published Germ Theory; proved microorganisms cause disease.
Revolutionised medical thinking, ended belief in miasma.
3. Robert Koch 1876+: Identified specific bacteria (anthrax, TB, cholera); invented staining techniques. Made Germ Theory practical for identifying diseases.
4. Joseph Lister 1867
Used carbolic acid as antiseptic; introduced antiseptic surgery. Reduced surgical infections and death rates.
5. Florence Nightingale 1854 (Crimean War)Improved hospital hygiene and nursing standards; wrote Notes on Nursing. Made nursing a respected profession and saved lives through cleanliness.
6. John Snow 1854 Proved cholera spread through contaminated water (Broad Street pump). Early use of epidemiology; influenced public health reforms.
MODERN: 1900-PRESENT
Modern medicine (c1900–present) is defined by rapid scientific and technological advances. The discovery of penicillin by Fleming in 1928 (and its development by Florey & Chain in the 1940s) revolutionised treatment through antibiotics. The structure of DNA, discovered by Watson and Crick (with crucial work from Rosalind Franklin) in 1953, paved the way for genetic medicine and understanding inherited diseases. Government and public health expanded with the creation of the NHS in 1948, improving access to free healthcare. Overall, modern medicine focuses on prevention, early diagnosis, and highly targeted treatments using scientific research.
Landsteiner finds blood groups in 1901, crucial for battles in WW1. Plastic and brain surgery developed, Magic Bullets, antibiotics and modern surgery. New transplants, keyhole surgery and robotic surgery.
New NHS hospitals, trained and specialist nurses, community care and doctors, and a wide range of specialists such as radiologist.
Training in universities for 7 years, training in various aspects, and specialised areas.
WESTERN FRONT: 1914-1918
YPRES SALIENT:
Battles of Ypres:
1st: 1914
2nd: 1915
3rd: 1917
Germans had advantage of the high ground, Tunneling and mines used at Hill 60
SOMME:
Jul-Nov 1917
1st Day: 20k allied deaths, but total for entire battle over 400,000.
Put pressure on medical Services on the front.
ARRAS:
1917
Before battle they dug tunnels below which led to rooms and had an underground hospital 700 stretchers. It had electricity and running water.
CAMBRAI:
1917
Over 450 Tanks to advance on the German position, however this failed as it lacked enough infantry support.
CONDITIONS REQUIRING TREATMENT ON THE WESTERN FRONT
During WWI, soldiers faced numerous medical challenges in the trenches. Trench fever, spread by lice, caused flu-like symptoms and was treated with electric currents, while trench foot resulted from prolonged exposure to damp conditions and could require amputation; prevention included dry socks and whale oil. Shell shock, a mental condition from the stress of war, caused severe psychological symptoms and was poorly understood at the time, with some sufferers even executed. Weapons like rifles, machine guns, artillery, and shrapnel caused devastating injuries, while chemical weapons such as chlorine, phosgene, and mustard gas inflicted deadly and disfiguring effects; gas masks were introduced to reduce fatalities.
ROUTES OF TREATMENT:
Wounded soldiers on the Western Front were treated through a structured system. First, they were taken to the Regimental Aid Post (RAP) near the front line for immediate first aid. More serious cases were moved to Dressing Stations for further assessment and care. If injuries were severe, soldiers were then sent to Casualty Clearing Stations (CCS), often located near railways to allow transport. Finally, the most critical patients were transferred to Base Hospitals near the coast, where they could be stabilized and, if needed, evacuated back to Britain.
RAMC (Royal Army Medical Corps): Provided medical care on the Western Front; treated wounded soldiers, ran dressing stations and hospitals.�
FANY (First Aid Nursing Yeomanry): Voluntary women’s unit; drove ambulances, gave first aid, and supported soldiers behind the front lines.�
Field Ambulances: Mobile medical units (not vehicles); gave first treatment, organized stretcher-bearers, and moved injured to dressing stations.
DEVELOPMENTS IN TREATMENT
Thomas Splint: Stopped limb movement, boosted survival from 20% to 82%, reduced infection.�X-rays: Diagnosed injuries before surgery; fragile, overheated, missed some issues.�Mobile X-rays: Used near the front to locate shrapnel; quicker treatment.�Blood Transfusions: Solved blood loss; used at Base Hospitals, later at CCS (from 1917).�Blood Bank (Cambrai): Stored blood with sodium citrate; saved lives in battle.�Brain Surgery: Used magnets to remove metal; local anaesthetic.�Plastic Surgery: Harold Gillies developed skin grafts for facial injuries.�
Salvarsan 606 (1909): First magic bullet, treated syphilis (by Ehrlich).�Prontosil (1932): Treated blood poisoning; discovered by Domagk.�Both were the first chemical cures that targeted specific bacteria without harming the body.
New mass vaccination schemes by the government
EXAM FORMULA: ‘Features’- for each one, give one feature and explain for 2 marks
‘How Useful is Source?’ - Remember to give two reasons why the source is useful because of its provenance, purpose, and then give any limitations of the source.
‘Follow up the source’ - Focus on the enquiry, choose an issue that will tell you more about the enquiry, and use statistics from RAMC, e.g cases of trench foot or survival rates.
Key Individuals: Andreas Vesalius 1543 (published The Fabric of the Human Body)�Dissected humans, disproved 300+ of Galen’s errors; emphasized anatomy.�Kick-started anatomical understanding based on observation, not theory.�William Harvey 1628 (published On the Motion of the Heart)�Discovered circulation of blood, heart pumps blood around the body.�Overturned Galen’s ideas about blood being constantly made and used up.�Thomas Sydenham Active 1660s–1670s�Promoted careful observation and classifying diseases; rejected reliance on old texts.�Helped move medicine toward a more scientific approach.