History (OCR) - Medicine Through Time

Prehistoric Health:

Prehistoric people suffered from these health problems: 

• Osteoarthritis (Painful joints)
• Infection (Especially during childbirth)
• Poor diet
• Short life expectancy

Prehistoric beliefs about disease:

• Prehistoric people believed that if evil spirits entered your body then you would become ill

Prehistoric Healers:

• Women (For less serious/everyday illness)
• Medicine Man (Wise men who treated more serious illness with supernatural cures)

Prehistoric Treatments:

Natural Treatments:

• Massaging sore joints
• Herbal Rememdies for fevers
• Ointments made from animal fats for cuts

Supernatural Treatments:

• Magic spells to scare spirits out of the body
• Crystals to catch evil spirits in

Prehistoric Surgery:

• Trephining - a hole was drilled in the head to let evil spirits out causing illness out. (THIS WAS VERY PAINFUL)

Ancient Egyptian Life:

• The River Nile (This made Egyptian farmland good for growing crops)
• Wealth (Egyptians sold their crops and became wealthy)
• Trade (Egyptians built ships and used them to buy and sell to other countries)
• Religion (Egyptians believed in many Gods and in life after death)
• Writing (Egyptians wrote in hieroglyphics on papyrus)

Egyptian Surgery:

• Egyptians were able to do simple surgery such as mending broken noses by inserting greased plugs and bandaging
• Egyptians had bronze tools which were sharper and more accurate than prehistoric tools
• Egyptians were unable to stop pain or infection during surgery

Egyptian medical improvements:

• Specialist doctors (Could afford to pay for specialist doctors who were experts in treating a particular part of the body)
• Bronze tools (Could afford to pay craftsmen who were able to make stronger and sharper medical tools)
• Herbal Remedies (Egyptians bought herbs from other countries and built a large collection to use in making better remedies)
• Written records (Egyptians began to write down patients symptoms and the cures they used - useful for treating future patients)
• Knowledge of the body (Egyptians knew where the different organs were in the body because they embalmed the body)
• Channels theory (This was a natural idea of what caused illness which was based on the river nile)

Embalming:

The Egyptians embalmed the body to prepare for the after life and it helped improve their anatomical knowledge. However, because they left the heart in the body they never worked out that it was the brain that controlled the body

Ancient Egyptians beliefs about disease:

• Gods - They believed the Goddess Sekhmet could bring disease
• The Channels Theory - A natural theory based on the River Nile where they believed that just like the River Nile, if the channels in your body became blocked, you would become ill.

Egyptian Treatments:

Natural Treatments:

• Honey and Garlic
• Herbal Remedies

Supernatural Treatments:

• Prayers
• Magic Charms
• Spells

Ancient Greek Life:

• Religion (The Greeks believed in many Gods including Asclepius. For religious reasons, dissection was banned in most of Greece)
• Trade (Greeks became rich by trading and using slaves)
• Writing (Greeks wrote using an alphabet)
• Philosophy (The Greeks loved asking questions about the world around them and this led them to come up with new ideas and theories)
• War (Greek cities were often at war with eachother)
• Alexandria (Greeks built a centre of excellence with a library and university where doctors could share their knowledge and dissect bodies)

Greek ideas about disease:

• Gods -The believed Gods could cause and cure disease
• The Four Humours Theory - The Greeks believed that each person had 4 humours (liquids) in their bodies(blood, phlegm, yellow bile and black bile) and they believed that if any one of these humours became unbalanced, then a person would become ill.

An Asceleion:

The Asclepia were built for religious reasons however they did actually help patients to recover through sleeping/rest in the abaton, exercising in the stadium and stay cleaning by using the baths.

The also used the temple of Aslcepius to pray and leave gifts so that the God would cure them.

Hippocrates:

• Observation&Recording - Hippocrates stressed the importance of checking a patients' symptoms carefully and recording for future references
• Four Humours Theory - Hippocrates created a natural theory as to the cause of disease
• Natural Treatments - Hippocrates encouraged doctors to use natural cures
• Hippocratic Oath - Hippocrates asked doctors to swear to an oath to keep patients' details confidential - made patients trust their doctors
• Hippocratic Collection - Hippocrates created a book collection and shared his knowledge with doctors

Greek Treatments:

Natural Treatments:

• Purging
• Herbal Remedies
• Bleeding

Supernatural Treatments

• Asclepia

Greek Surgery:

• Greek cities often fought wars so surgeons got lots of practice treating wounds
• Washed wounds in wine and wrapped them in linen
• Greeks has steel and iron tool so they were stronger, sharper and more accurate than Egyptian tools

Ancient Roman Life:

• War (The Romans fought many wars so they often had to deal with wounded soldiers
• Communication (the Romans build roads and their medical ideas spread fast
• Big cities (Roman cities were crowded and dirt and dsease built up quickly
• Religion (Romans adopted the Greek God Asclepius
• Alexandria (Romans captured the city ofAlexandria where Greeks had stred their medical collections so they took some of the Greek's ideas)
• Wealth (The Roman empire was right so the government has movey to spend on health improvements)

Roman ideas about disease:

• Gods - The Romans believed God's could cure/cause illness
• Four Humours Theory - They believed the Greeks theory about unbalanced humours
• Dirty Water - The Romans knew that dirty water could cause disease however they did not know why

Roman Public Health:

The Roman governement built a public health system because they knew dirty water caused disease and that their cities were overcrowded and large.

• Aqueducts (To bring fresh water into the city)
• Latrines (Public toilets flushed with water)
• Public Baths
• Sewers (To take waste away from the city)
• Fountains (To provide fresh water)

Because the Romans needed their soldiers fit for war, the built water systems for the army too.

Roman Surgery:

• Army Hospitals - Where surgeons treated the soldiers
• Opium - Helped to numb pain during surgery - little effect on severe pain
• Better Tools - Scalpels and saws for amptuating

Galen:

Galen used many of Hippocrates ideas such as The four humours theory, observing and recording and natural treatments.

Galen also came up with new ideas which improved medicine:

• Dissection - Galen stressed the importance of dissection in order to learn more about the internal body. However he often had to dissect animals
• Treatment of opposites - A theory that if a patient had too much of one humour, the treatment given should have opposite qualities to the illness. (e.g. If a patient was ill winter cold&wet, they should be given a treatment of chillis hot&dry)
• Galen's Book - Galen recorded his methods in a book and was used by many students until it was challenged in the Renaissance

However, Galen did make some mistakes in his work about the body because he usually dissected animals.(E.g. He said that blood passes though the septum in the heart)

Medieval Life:

• War (The Roman empire was replaced by different kingdoms, often at war.
• Religion (The Christian Church became very powerful)
• Poor communication (The Roman roads were destroyed, making it harder for medical ideas to spread)
• Less trade & wealth (Trade was disrupted by war.  People and kingdoms had less money to spend on improving medicine)

Medieval Ideas About Disease:

• God & the Devil – Disease was a punishment from God for sin.
• Movement of planets – position of the moon and planets could cause sickness.
• Bad smells caused by dirt - They thought there was a link between dirty 
• conditions and disease
• Invisible poisons –could be spread through the air by looking at someone else.
• Four Humours Theory

The Black Death (1348):

• Bubonic Plague was spread by fleas living on rats.  It caused rashes, fever, swellings (buboes) and death. 
• Pneumonic Plague was spread in the air.  It caused coughing, fever and death

Medieval Public Health:

At the start of the Middle Ages, public health became worse because:

• The Roman public health systems were destroyed in war
• Medieval rulers spent their money on weapons instead of medical 
• improvements.

Medieval towns were dirty. The main problems were:

• Open sewers to take waste away
• Cesspits (pits in the ground to collect waste)
• Human and animal waste dumped into the streets  and rivers

Role Of The Church:

The Christian Church helped medicine because:

• It spread Galen & Hippocrates’s work including their ideas about natural 
• treatments, observation & recording and four humours theory.
• It set up monasteries with fresh water systems, though these were only for use 
• by monks, not everybody.
• It set up hospitals(infirmaries) where the elderly and tired could rest.
• It set up medical schoolsto train doctors.

However the Christian Church held medicine back because:

• It stopped criticism of Galen’s work so his mistakes were not uncovered.
• All books were handwritten by monks, who repeated the Church’s teaching.
• It taught people that diseases were a punishment from God. Stopped people looking for the true cause of disease. 
• It taught people to use religious cures.
• It stopped dissection. Dissection now happened rarely and was only used to show that Galen’s work was correct, not to challenge it.

Medieval Treatments:

**Medieval doctors were trained by the Church**  

Medieval doctors had to be men and used:

Natural Treatments:

• Purging & bleeding
• Herbal remedies (e.g. Poppy and hemlock)
• Natural remedies (e.g. Onion, garlic and wine)
• Leeches (To remove blood)

Supernatural Treatments:

• Prayers 
• Whipping Themselves (Flagellants)

Medieval Sugery:

• Surgeons required no qualifications.  Even women could be surgeons.
• Although some barber surgeons had experience and skill, most had a poor reputation.
• Many patients died of infection, pain and blood loss.
• Most surgery was basic e.g. amputation and tooth pulling.

Cauterization – Instead of cleaning wounds like the Greeks & Romans, medieval surgeons used hot oil or a hot iron to seal wounds and stop infection.  This was painful and made infection worse. But medieval surgeons thought the pus which it produced was a sign of healing.

Renaissance Life:

• Less religious (The Christian Church became less powerful)
• Scientific experiment (People began to test and experiment to discover things)
• Communication (The printing press made it easier & quicker to make books.The Church could no longer control what was being printed)
• War (gunpowder and explosives created new types of wounds)
• Ancient Learning (People began to study and criticize the old Greek and Roman medical writings e.g. Galen’s books.)
• Wealth (Trade improved so people and kingdoms became richer)
• Education (Wealthy people could afford to attend university)
• Dissection (Became more acceptable and common)
• Art  (Artists became much better at drawing the body realistically)

Vesalius:

• He wrote Fabric of the Human Body.  This was a detailed map of the human body.
• He uncovered Galen’s mistakes about the heart & septum and the jaw bone. This opened the way for others like Harvey to challenge Galen’s ideas too.
• He showed people that dissection was important to learn about the body. This encouraged others like Harvey to dissect the body for scientific reasons.

Factors which helped  him:

• Art - artists drew the pictures of his body for his book
• Ancient Learning - Vesalius was inspired at first by studying Galen’s books.
• Wealth & Education - Vesalius studied at University in France and Italy.
• Printing - Vesalius’ book was printed and spread across Europe.

Factors which held him back:

• The Church - It was difficult for Vesalius to challenge Galen’s ideas because the Church and many doctors supported Galen’s work, so they criticised Vesalius’ book.
• Lack of Bodies - He had to steal bodies in order to dissect because dissection was 'wrong'.

Pare & Surgery:

• He showed that herbal ointments were better for cleaning wounds than cauterization. 
• His ointment soothed wounds. This saved the lives of the soldiers he treated.
• He used ligatures – silk threads to tie veins to stop blood loss.

Factors which helped him:

• War – Pare was an army surgeon. He got lots of practice dealing with gunshot and cannon wounds.
• Ancient Learning - Pare’s herbal ointment was inspired by an old Roman recipe
• Printing - He wrote his book in French and it was printed and spread.

Problems with his work: 

• At first, surgeons continued to cauterize. They still believed in the old medieval methods.
• His ligatures caused infection because they were dirty. 

Harvey:

• He proved that the heart was a pump
• He showed blood moved around the body in a one way system (circulation)

Factors which helped him:

• Scientific experiment and dissection – he used this to measure & calculate the amount of  blood in the body
• Vesalius’ work – Vesalius had challenged Galen, which made it easier for Harvey to challenge Galen’s ideas about the heart too.
• Wealth & education – Harvey studied at university in Italy.

The Plague:

• Public health measures to stop large crowds e.g. closing pubs, sealing plague victims in their houses. These were based on the idea that humans could spread disease to each other.
• Airing bedding with perfume – (they thought bad smells cause disease)
• No flagellants – people were less likely to blame the disease on God.

Early 19th Century Explanations of Disease:

• Most people in 1800 believed in the miasma theory – the idea that bad air causes disease.  
• By 1900, the true cause of disease had been found – germs.

Jenner's Work:

• Before Jenner’s work: Doctors protected people from smallpox by inoculation.This means making people immune to smallpox by infecting them with a mild dose of smallpox on the surface of their skin.This was considered as dangerous because it could kill you.
• Jenner’s discovery 1798: He found out you could vaccinate someone against smallpox by giving them a dose of the milder disease cowpox which was safer because you cannot die from cowpox.

Factors which helped him:

• Chance - Jenner offered a dairy maid inoculation against smallpox. She told him she did not need not need it because she’d already had cowpox. This inspired him to think of vaccination.
• Scientific research - Jenner tested his vaccination 23 times to prove it worked.
• Government - The British government gave Jenner £30,000 to open a vaccination clinic.The gov. made vaccination compulsory in 1852.

Jenner's Work cont. :

Reasons why people opposed vaccination:

• Scientific reasons - Jenner could not explain how vaccination worked. He did not know about germs.This stopped him from discovering other vaccinations.
• Financial reasons - Inoculators were worried about losing their customers now that vaccination had been developed.
• Religious reasons - Some people thought it was against God’s will to put an animal disease into a human body.

Nightingale's Work:

• Before Nightingale’s work: nurses had a poor reputation.  They were seen as untrained drunks.  Hospitals were dirty and patients often died from infection.
• Nightingale’s work in the Crimean War: Nightingale cut the death rate of British soldiers in military hospitals in Turkey by improving hygiene, sanitation and ventilation (fresh air) in the hospital wards.
• Nightingale’s work after Crimean War: she set up a training school for nurses.This changed the reputation of nursing. Now people saw it as a respectable profession.
• Nightingale also advised the government on how to improve the layout of hospitals in Britain so nurses could do their jobs better.

Factors which helped Nightingale:

• War - Nightingale was sent to Crimea because the British government wanted to cut the number of dying soldiers during the Crimean War.
• Communication - British newspapers printed heroic stories about her work in the Crimean war. This improved the reputation of nursing in Britain.
• Religion - Nightingale said that she was inspired to work as a nurse by her belief in God.

Nightingale's Work cont. :

Obstacles for Nightingale:

• Attitudes to women – Men in the British army did not like being told what to do by a woman. Wealthy Victorian women were expected to stay in the background.
• Attitudes to nursing – Nightingale’s parents tried to stop her nursing career, because nursing had such a poor reputation
• Beliefs about disease – Nightingale never understood what caused disease. She based her ideas about ventilation and cleanliness on the miasma theory, which was incorrect.

Pasteur's Work:

Pasteur made three major discoveries:

• 1861 Germ theory – discovered germs and proved they cause animal diseases
• 1879 Discovery of how vaccination works – While working on chicken cholera germs, Pasteur discovered how to make a new vaccination for chicken cholera. He realised that vaccines could be made by using a milder form of the disease. This is something that Jenner never knew when he made his smallpox vaccination.
• 1882 Vaccines for anthrax, rabies and cholera

Factors which helped him:

• War between Germany and France.  Pasteur wanted to give France the advantage in the race to beat germs.
• Government - The French government gave Pasteur a team of scientists to help him with his research.This allowed Pasteur to make his discoveries quicker.
• Science & Technology - Pasteur used better microscopes to study germs.

Pasteur's Work cont. :

Criticism of Pasteur’s work:

• Pasteur’s germ theory was based on animals. It was Koch who went on to show that germs cause human diseases.
• Pasteur was not the first to discover a vaccine – Jenner was.
• Pasteur used Koch’s work on identifying germs like cholera to help him create new vaccinations
• Pasteur’s discovery of a chicken cholera vaccine was partly chance.  His team accidentally left some chicken cholera germs out in the air and they were weakened.  Then they were injected into a chicken.  The chickens recovered and became immune to the germ.

Koch's Work:

• Staining bacteria with dye - This made it easier to study them
• Germs cause human disease - Koch showed that germs could cause people to get sick, not just animals
• A method to prove which germs caused specific diseases - He injected germs into mice and repeated the experiment to test his results.This led to the discovery of anthrax,tuberculosis & cholera germs.

Factors which helped him:

• War - Koch wanted to give Germany the advantage in the race to beat germs
• Government - The German gov. gave Koch a team of scientists to help him with his research
• Science & Technology - Koch used improved microscopes to study germs. He used new chemicals to dye bacteria.
• Individual brilliance - Koch repeated his experiments with mice twenty times to prove which bacteria caused anthrax.

Criticism of Koch’s work:

• Koch’s discoveries were all linked to Pasteur’s discovery of germs. 

Problems of early 19th Century Surgery:

• Pain - This makes surgery difficult and patients can die of shock. So surgeons operated fast and sometimes got their patients drunk first. Operating fast made it difficult to be accurate. It also made it impossible to operate deep inside the body.
• Infection - In 1800 surgeons did not know germs existed. They operated in dirty conditions and patients died of infection. Surgeons still did not know about germs or how infection spread. 
• Bleeding - Surgeons had to operate fast in order to avoid too much blood loss

Surgery before 1800:

• Ancient Egyptians – Could only do simple surgery e.g. broken noses 
• Ancient Greeks – Washed wounds with wine or vinegar to clean them
• Ancient Romans – Used opium to stop pain, but this was not much use for severe pain.
• Middle Ages – Used cauterization to stop bleeding and infection, but this was a painful treatment and often infected the wounds. Barber surgeons had to do basic surgery e.g. Tooth pulling and amputation
• Renaissance – Pare invented ligatures, but they were dirty and spread infection

Simpson & Chloroform - 19th Century:

Factors which helped him:

• Individual brilliance – Simpson experimented with many chemicals before finding chloroform worked best.  He wrote articles about his discovery which spread his idea to other surgeons.
• Science – In the 1800s, new chemicals were being discovered, it was common for scientists to experiment with new chemicals and gases. 
• Communication – Simpson’s discoveries were published in a medical journal.This helped them spread quickly to other surgeons.

Opposition to Simpson & chloroform:

• Religious opposition - people thought it was against God's will to stop pain
• Scientific opposition - people were frightened that chloroform might have side effects. It was difficult to calculate the right dose and sometimes patients died from the anaesthetic.
• Scientific opposition – using chloroform to send patients to sleep allowed surgeons to operate deeper in the body. But this made the risk of infection and blood loss even worse
• Moral opposition - in the British army, using anaesthetics was seen as cowardly. Soldiers were expected to cope with pain during surgery.

Lister & Antiseptics - 19th Century:

Lister read Pasteur’s work on germs and wanted to stop germs causing infection during surgery.  He sprayed carbolic acid across the operating theatre during surgery as an antiseptic to kill germs during surgery. 

Factors which helped Lister:

• Individual brilliance - Lister’s idea to spray carbolic acid during surgery was brilliant. He recorded his results carefully to check his methods worked.
• Science - Lister's  use of carbolic acid to kill germs was based on Pasteur's Germ Theory 1861.
• Science - in the 1800s many scientists were experimenting with new chemicals and gases. This is what Lister was doing when he discovered carbolic acid. 
• Communication - Lister first discovered carbolic acid when he read about it being used to clean sewage in Germany. He read this in a newspaper, which was the main form of spreading news in the 1800s.

Lister & Antiseptics cont. :

Opposition to Lister:

• Side effects - Carbolic acid irritated surgeons skin, eyes and throat.
• Speed - Carbolic acid made tools slippery and slowed operations down. This made the blood loss worse.
• Lister’s personality – Lister was shy and did not like to demonstrate his methods in public. This stopped his ideas spreading quickly.

Long-term importance of Lister’s work:

• Lister’s work was the first step towards aseptic surgery.  This means removing all possible germs from the operating theatre.  This was done by introducing:-
• Sterilisation of all surgical instruments (after 1887)
• Sterilised rubber gloves (after 1894) This allowed more serious operations e.g. on the heart

World War I and Surgery - 20th Century:

World War I led to improvements in surgery because:

• Wounded soldiers gave surgeons the opportunity to experiment with new methods
• Powerful guns used during the war created severe wounds which needed new treatments
• Head wounds were common because soldiers fought in trenches.  This led to developments in eye, ear, head, face and brain surgery.  Plastic surgery was developed.
• Bullets and shrapnel became stuck in soldiers’ bodies. New methods were needed to remove them.
• Blood loss needed to be solved, because soldiers were bleeding to death on the battlefields.

X-Rays - 20th Century:

Factors which led to the development of X-rays:

• Science - X-rays were discovered in 1895.  A German scientist called William Rontgen was experimenting with cathode rays when he discovered they could pass through human flesh, but not bone.
• World War I – many soldiers had bullets and shrapnel stuck in their bodies, causing infection.So the government paid for X-ray machines in army hospitals to treat soldiers more successfully

Blood Transfusions - 20th Century:

Factors which led to discovery of blood transfusions:

• Science - Blood groups were discovered in 1901.  Surgeons realised that blood transfusions only worked if they used compatible blood types. But there was still no way of storing blood, so transfusions had to be person-to-person.
• World War I - It was impossible to do person-to-person blood transfusions on the battlefield, so doctors found a way of storing blood. This was done by separating the blood plasma from the blood cells

Public Health After The Romans:

Reasons why there was not much improvement in public health after the Romans:

• War in the Middle Ages – War destroyed the Roman public health system. Kings spent their money on armies & weapons not public health improvements.
• Lack of understanding of disease – People in the Middle Ages and Renaissance did not know about germs or understand the cause of disease so they did not build public health systems

Public Health Problems - Early 19th Century:

The main public health problems in British towns were:

• Overcrowding – Whole families shared single rooms to wash, cook and sleep
• No sanitation – There were no sewer systems to remove waste
• Cesspits– Human waste was dumped into pits until they overflowed
• Privies – Toilets were holes in the ground which had to be emptied by hand.
• Rivers – Waste was dumped straight into rivers
• No fresh water – Often water supplies were contaminated from sewage from rivers&cesspits
• Diseases – Infectious diseases like smallpox and cholera spread quickly

Opposition To Public Health Improvements:

In the early 19th century people were against cleaning the towns because of:

• Laissez faire ideas – People believed the government should not interfere in people’s lives and try to keep them clean
• Money – Tax payers did not want to pay more tax to clean up cities for the poor.  
• Landlords who rented houses for a profit did not want to pay to connect the houses to the water supply.
• Science – Most people believed in the miasma theory, that dirty air spread disease.  They did not know about germs, so they did not see a reason to clean up

SEVEN factors changed these attitudes:

Factor 1 - Edwin Chadwick’s work:

Edwin Chadwick wrote the 1842 Sanitary Report on poor areas of London. He said:

• Dirty conditions – Poor people were living in overcrowded, dirty conditions.
• Sickness – Poor people were getting too sick to work
• Tax – It was costing taxpayers too much to look after sick, poor people 

Impact of Chadwick’s Report

• Chadwick’s report persuaded the Government to pass the 1848 Public Health Act.  This set up  a National Board of Health whose job was to encourage towns to clean up.  
• However this was voluntary and many towns and their tax payers did nothing to clean conditions.

Factor 2 - Cholera Epidemics:

• What happened?: Cholera  epidemics in Britain in 1832, 1847, 1854
• Impact: Killed thousands of people in towns.  Frightened people and made them more willing to pay to clean up 
• However:  many people still saw no reason to clean the water supply, as they still believed the miasma theory.

Factor 3 - John Snow's Work:

• What happened?: During a cholera outbreak in London In 1854 John Snow proved cholera spreads in dirty water using scientific research.  He recorded the cholera deaths in Soho on a map.  This proved that the deaths were linked to the water pump on Broad Street.
• Impact: Snow’s work was the first to prove that disease spread in dirty water.  Pasteur’s germ theory hadn’t even been published yet.
• However: Many scientists still believed in the miasma theory of disease even after Snow’s work.

Factor 4 - The Great Stink 1858:

• What happened?:  The summer was hot and the smell from the dirty River Thames became unbearable.
• Impact: The smell of the river by the Houses of Parliament was so bad, it persuaded the government to build a new sewer system for London.
• However: there was still no action taken to clean up other towns across the country.

Factor 5 - Pasteur's Germ Theory 1861:

• What happened?  Pasteur proved that disease was spread by microbes (germs).  
• Impact:  It finally proved that dirt causes disease.  This persuaded tax payers to cover the cost of public health reforms to clean the towns

Factor 6 - Political Changes:

• What happened?  In 1867 working class men in towns were given the right to vote.  In 1884 working class men in the country were given the right to vote.
• Impact:  Politicians had to start making promises which appealed to the working class men too, instead of just the rich.  So they had to promise to clean towns.

Factor 7 - Technology:

• Steam powered machinery – This made it possible to build the huge pipelines for sewer systems.
• Lavatories – Flushing toilets meant that privies no longer needed to be emptied by hand.  Waste was sent straight into the sewers.
• Soap – In 1853 the government took the tax off soap, so more people could afford to wash.
• Vaccination – Jenner discovered vaccination in 1798 which made it possible to protect the public from smallpox.

Public Health Improvements (19th Century):

• Bazalgette’s sewer system – Bazalgette designed and built London’s sewer system after the Great Stink of 1858
• The 1875 Public Health Act – Made it compulsory for councils to provide better sewers, fresh water supplies and inspectors to check public health facilities
• Other public health laws – Improved housing standards, food standards and compulsory health education for children.
• Compulsory vaccination – After 1872 vaccination against smallpox was made compulsory. This led to a huge drop in deaths from smallpox.

Impact: These changes made towns cleaner and infant deaths decreased.

Liberal Health Reforms (20th Century):

After 1906 the Liberal government introduced many public health improvements:

• Compulsory training for midwives helped reduce infant deaths
• Free school meals improved diet of the poorest children
• Old age pensionsstopped old people from living in poverty
• National Insurance Act 1911 set up a sickness fund which all workers, employers and the government paid into.  This provided health care to workers when they needed it.

World War II:

World War II changed people’s attitudes to health because:

• Evacuation – Middle class families in the countryside were shocked at the poor health of working class evacuees.
• The Blitz spirit – World War 2 created a sense of community and working together.  People began to believe that everyone should have good health care, not just the wealthy.

The NHS (20th Century):

The British government asked Sir William Beveridge to write a report on how to improve people’s lives.

• The Beveridge Report 1942 said that a National Health Service should be set up to provide free health care for all.
• The NHS was set up in 1945.  It provided free healthcare and medicines for all. Doctors and nurses were now employed by the government instead of charging fees.

Opposition To The NHS (20th Century):

• Doctors did not want to be told what to do by the government.  They wanted their freedom.
• Attitudes to the poor: Some people still believed the poor were lazy and should not be helped.  Giving them free healthcare might make them lazier.
• Councils did not want the government to take control of hospitals from them