Medicine in Britain, c1250 to the present · GCSE History

c1250–c1500: medieval medicine

Ideas about causes: God and the supernatural (illness as a punishment for sin), astrology (the positions of the planets), the Theory of the Four Humours (from Hippocrates and Galen) and miasma (bad air).
Prevention and treatment: prayer, purifying the air (carrying posies and burning herbs), bloodletting, purging and herbal remedies. Physicians trained at university and used urine charts and astrology; apothecaries mixed remedies; barber-surgeons did simple operations; most care was given at home, usually by women. Church hospitals cared for the sick, but few took in the infectious.
The Black Death (1348–49) was blamed on God, miasma or the planets. People prayed, joined flagellant processions, avoided bad air, and some towns tried quarantine.

The Four Humours were still widely accepted, but the Church's influence weakened. Thomas Sydenham, the 'English Hippocrates', stressed careful observation of symptoms. Vesalius (1543) corrected Galen's anatomy, and William Harvey (1628) discovered the circulation of the blood. The printing press and the Royal Society (1660) spread new ideas.
Treatments changed little, although some new remedies arrived, such as cinchona bark (quinine) from South America for fevers.
During the Great Plague (1665), the government ordered quarantine of infected houses, the killing of cats and dogs, and the burning of tar, but its ideas were still based on miasma.

Edward Jenner's smallpox vaccination (1796) was made compulsory in 1853.
Germ theory: Louis Pasteur (1861) proved that microbes cause decay, and Robert Koch identified the microbes behind particular diseases, such as tuberculosis (1882). Ideas changed faster than treatments.
Florence Nightingale improved nursing and hospital design after the Crimean War (1854–56). James Simpson used chloroform as an anaesthetic (1847), and Joseph Lister used carbolic acid as an antiseptic (1867).
Public health: John Snow linked cholera to a water pump (1854), and the Public Health Act (1875) made councils provide clean water and sewers.

Diagnosis improved with X-rays (discovered in 1895), blood tests, and later CT and MRI scanners. The structure of DNA was discovered in 1953.
Treatments: magic bullets such as Salvarsan 606 (1909) and Prontosil (1932); penicillin (discovered by Fleming in 1928, and developed by Florey and Chain in the 1940s); the NHS (1948); and modern surgery, such as transplants and keyhole surgery.
Case study, lung cancer: Doll and Hill linked it to smoking in 1950. Treatments include surgery, chemotherapy, radiotherapy and transplants. Prevention includes health warnings, advertising bans and the ban on smoking in enclosed public places in England (2007).

Conditions: trenches, mud, rats and lice, trench foot and trench fever. Injuries came from bullets, shrapnel and gas (chlorine, phosgene and mustard gas). Wounds easily became infected, because the farmland soil was full of bacteria.
The chain of evacuation: stretcher-bearers, the Regimental Aid Post, the Dressing Stations, the Casualty Clearing Station, then Base Hospitals and hospitals in Britain. The Royal Army Medical Corps and nurses, including the First Aid Nursing Yeomanry (FANY), did this work.
Developments: the Thomas splint (from 1915) kept broken thigh bones still, cutting deaths from about 80% to about 20%; mobile X-ray units (although the tubes overheated and had to be rested); blood transfusions, with a blood bank used at Cambrai in 1917; brain surgery; and plastic surgery pioneered by Harold Gillies.
The tunnels at Arras (1917) contained an underground hospital with 700 beds.

Four Humours: The theory that illness came from an imbalance of four body fluids.
Miasma: Bad air, once believed to cause disease.
Physician: A university-trained doctor.
Apothecary: A person who mixed and sold medicines.
Barber-surgeon: A barber who also did simple operations, such as pulling teeth.
Germ theory: The theory that microbes cause disease.
Chain of evacuation: The route wounded soldiers took from the front line to hospitals.
Casualty Clearing Station: A large medical unit behind the front line where the wounded were treated.
Thomas splint: A splint that kept a broken leg still, saving many lives.
Magic bullet: A chemical cure that kills a specific microbe without harming the body.