Treatment and the
Prevention of Disease
1350-2000
How Far Did Approaches to Treatment and the
Prevention of Illness Change from 1350-1750?
The Ancients: 1. Hippocrates stressed the importance of focusing on the nature of diseases to
find out how to treat them.
 Taught the need to restore the balance of the humours- eg make
patients vomit, purge their bowels and bleed them.
 Patients could visit the Asclepion to ask the god Asclepius (of
healing) for help.
 Patients should live carefully and consider the seasons- in Spring
and Summer bleed people, in winter people should eat a lot and
drink a little.
 Natural treatments- diet, exercise, warmth…
 2. Galen
 Mainly the same as the Greeks- exercise, diet...
 Prescribed herbal remedies based on herbs and vegetables.
 Opium given as a mild anaesthetic.
 Used ‘opposites’ to treat the imbalance of the humours eg
too much phlegm means they are cold and need to take a
hot treatment like pepper.
 He suggested daily exercise to prevent illness.
Doctors and Healers by 1750:
Licensed
Healers
Training and Methods
Physician
Studied for 14 years at university- 7 studying medicine. All
men. Knew Galen and other ancients as well as more modern
doctors. Charged a lot.
Apothecary
Sold and made medicines prescribed by physicians. Not meant
to treat sick or prescribe but many did for the poor- charged
small fees.
Surgeon
Trained by watching and copying other surgeons during long
apprenticeships. Given licenses to treat by Bishops, could
charge fees.
Midwife
Also licensed by local bishops. If complications, handed
patient over to physician.
Unlicensed
Healers
Training and Methods
Family
Usually mother or wife treated sick person first.
Wise Women
Local women trusted because of their knowledge of herbs and
other treatments, passed down in family. If things went
wrong, they could be called witches.
Housewifephysicians
Girls were expected to learn to treat common illnesses and
injuries. Books were written to advise ladies and some read
medical texts. These ladies treated people from their
villages, families and their servants.
Travelling
Quacks
At fairs and markets, tooth-pullers and herb-sellers would
treat people. Some had built up knowledge and did good,
most took money and ran.
What were hospitals like in 1350?
 Wardens on the door would not let people in who looked
too poor or if they were clearly infectious or seriously
ill.
 There were servants, monks to pray for the sick and
nuns treated people.
 Beds were set up in large halls and shared.
 People were kept fed, warm and clean. They were given
herbal remedies if necessary.
 Hospitals were run and paid for by the Church.
What were hospitals like by 1750?
 After the Reformation of the 1500s, town councils and
charities began to take over.
 In the early 1700s many new hospitals were opened.
 By 1750 lots of people still had to pay doctors to treat
them at home rather than go to a hospital.
 Treatment was still looking after people and giving them
herbal remedies or bleeding them. Simple surgery could
be done but things like amputation were only done in
desperation. Treatments were still free in hospitals but
patients were meant to pay for their recovery.
How Far Did Approaches to Treatment and the
Prevention of Illness Change from 1750-1900?
Smallpox
Epidemics broke out every few years. Many died,
survivors often lived with terrible scarring. It left
families isolated as no-one would visit, houses and
belongings had to be disinfected, and many lost
their jobs. Many families tried to keep it secret.
Date
Total deaths in Maidstone
Deaths from Smallpox
1740-51
1594
260
1764-75
1798
76
1788-99
2308
31
Developments in orevention
Inoculation
Idea arrived in the 18th Century to avoid catching
Smallpox from china where used for centuries. Their
method of inoculation involved putting a small amount
of matter from a smallpox scab onto a cut to give
someone a mild form of the illness. They knew that this
often prevented them from catching the disease again.
Trade brought this idea to Europe and a woman called
Lady Mary Wortley Montague witnessed it in Turkey. She
had survived smallpox but feared for her children so
she had them inoculated.
Friends of hers were doctors and they saw the potential
to make money. Mass inoculations were carried out in
Maidstone during an epidemic in 1766.
Problems with inoculation:
 It saved lives without a doubt but also posed some risk.
Some people died from the mild dose they were given,
others became carriers of the disease and probably passed
it on to others. Some people refused the treatment
because of the risks.
 How does immunity work?
1. Germs enter the body.
2. The body creates antibodies.
3. The antibodies ‘lock on’ to the germs and kill them.
4. The antibodies stay in the body so that next time the
body meets similar germs, it can respond more quickly.
Edward Jenner and the development of Vaccination.
 A doctor in Gloucestershire who was surprised how few
people wanted to be inoculated. Local farmers
explained that they didn’t need to be inoculated as
cowpox protected them. Jenner looked into it and
found dairymaids rarely caught smallpox. He wondered
if cowpox could be used to protect people from
smallpox.
 What factors helped Jenner and the development of a
smallpox vaccine?
 Luck- he was working in the countryside with farmers.
Other factors:
 Scientific investigation-
 Government-
 Communications-
 Individuals-
The importance of Robert Koch
 He developed methods which could be used by other
scientists to study bacteria- a solid medium to grow
them in and a method for staining them.
 He therefore identified methods for identifying the
causes of disease eg TB 1882, cholera 1883 and plague
1894.
 He did not develop any new treatments or cures.
Louis Pasteur and Chicken Cholera
 Pasteur had thought a lot about the work of Jenner on his
smallpox vaccine.
 In 1879 Pasteur was researching chicken cholera for French
farmers. He was injecting chickens with cholera as part of his
testing when one day a chicken didn’t die. When Pasteur
asked his assistant which germs he had injected the chicken
with, they realised it was an old batch that had been exposed
to the air for a long time. They injected the chicken with
fresh germs and it didn’t get ill, they had discovered the
second vaccine as the old batch protected the chicken.
Pasteur called it a chicken cholera vaccination to show his
debt to Jenner.
 In 1882 Pasteur turned to rabies and developed a vaccine
within two years.
Discovering the cause of disease
Jenner
Pasteur
Koch
• Used cowpox to vaccinate against smallpox.
• Germ Theory linked germs to disease.
• Studied bacteria to show which caused which illnesses.
• Developed a vaccine for chicken cholera then chicken pox,
Pasteur cholera, anthrax and rabies. Other scientists followed suit.
What next?
How far did treatment of ordinary people change 1750-1900?
Change
Continuity
Healer/
practitioner
Start 20th Century ¾ people
practicing medicine
unqualified. 1858 Medical Act
set qualifications. General
Medical Council set up to
keep list of approved doctors
and what students needed to
know.
Physicians still only saw
rich. Apothecaries less
training but still helped
most. Many methods the
same for 1000s years eg
bleeding and purging.
Couldn’t help infectious
diseases like whooping
cough.
Domestic
medicine
Development of the
thermometer helped with
diagnosis.
Most people still treated at
home with comfort, food,
warmth. Used herbal
remedies, common sense
and knowledge passed
down.
Change
Patent and
improved
medicines
By 1800 more people visited
‘quacks’ and bought patent
medicines. People bought
‘cure alls’ because to be
honest, doctors had no better
remedies. Till the 1880s there
was no control over what
went into patents.
In the 1880s the first
effective painkillers such as
aspirin were developed and
by 1900 companies like Boots
and Wellcome were set up.
Continuity
The training of doctors 1750-1900.
 From the 1750s people could call for a local doctor or
general practitioner.
 Training- doctors were trained by apprenticeship, they
went to lectures and learned to use new devices like
the stethoscope from 1816 and thermometers.
 They were generally respected and had standard
charges though they usually let the very poor off. They
had a combination of private patients and had contracts
with local parishes.
 Doctors delivered babies, carried out vaccinations and
made up medicines.
Treatment in hospitals 1750-1900
 Hospitals were often cramped and stuffy, infections
spread quickly. There were few toilets and sewage
systems were often poor.
 Nurses were often dirty or drunk and were not trained.
 Only the poor went to hospitals as they couldn’t afford
a doctor to visit them at home. Hospitals were where
people went to die.
How far did the role of women in medicine
change 1750-1900? Florence Nightingale
 Born to a rich family. Believed God wanted her to be a nurse. 1851 she went
to Germany to work in a hospital for three months, she learned how they
were trained and kept patients healthy.
 1854 war broke out in the Crimea between Russia and Britain. The public
were horrified to hear half the wounded soldiers were dying in hospitals. A
government minister asked Florence Nightingale to lead a group of trained
nurses to the Crimea.
 Florence reorganised the army hospitals, new wards were built and scrubbed
regularly, they also gave the wounded good food. In 6 months the death rate
fell from 42 to 2%.
 When she returned to Britain, Florence raised £50,000 to improve hospitals
and the training of nurses. She published a book and used statistics to support
her arguments.
 1859 she published ‘Notes for Nursing’ stressing the importance of air, light,
warmth, quiet etc 1860 she set up the first training school for nurses.
What other factors helped the improvement of
hospitals?
 Communications- the invention of the Telegraph.
 Attitudes- people began to see nursing as an acceptable job.
They gained more respect and young women wanted to
become nurses.
 Money- was raised by the Florence Nightingale Fund.
 Science and technology- the development of antiseptics and
anaesthetics.
The impact of the Magic Bullets
Salversan 606- first chemical compound used to kill a
disease but didn’t hurt the patient.
Prontosil- cured blood poisoning.
The sulphonamides- drug companies raced to find other
drugs nased on coal tar and develop drugs to cure illness
eg scarlet fever, meningitis. Maternal mortality reduced
massively as infections could be controlled.
What factors aided the development of penicillin?
 Individuals- Fleming, Florey and Chain
 War-WWII and new weapons
 Government- US government
 Money- Funing from US gov and Pharmaceutical
companies
 Science and technology- freeze drying technology for
mass production
Drugs and treatments since 1945:
 Drug companies spend millions on research, there are
1000s of antibiotics and vaccines for many illnesses such
as polio and german measles.
 There are also drugs based on the body’s hormones such
as the pill.
 However, we cannot attack viruses and there have been
problems such as with Thalidomide which led to birth
defects in children whose pregnant mother took the
anti-sickness drug.
 Some bacteria are increasingly resistant to antibiotics.
 Genetic engineering means DNA can increasingly be
used to develop drugs and genes can be manipulated.
Medicial Practitioners:The role of
doctors:
 By 1930- some knowledge of causes of disease. Few
cures. Respected, paid by patients, does some charity
work. Little equipment- stethoscope, thermometer, Xray… Few were women. Visit patients at home.
 Today-
Medical Practitioners: The Role of Nurses:
 Before 1948- General nursing Council set standards.
Trained in hospitals. Respected. Pay fairly low. Cleaned,
looked after comfort of patients and followed doctors
directions. 1919 Nursing Act set standards.
 After 1948- Degree/Diploma needed, study for 3 yrs at
least. Must be registered. Train in a range of wards and
specific situations but then need further exams to
administer drugs or chemotherapy.
Hospitals
 Early 20th century: Few women, people only used if
necessary as expensive so they used patents and
chemists, did minor surgery at peoples homes.
 Charitable hospitals: offered basic care, some were
fever houses or asylums. Dependent on fundraising.
 Role of government: Increased after Boer War
embarrassment, Liberal gov 1905-11 increased access to
care. 1911 Health Insurance Act meant employers and
gov helped pay for sick cover.
 1919: Ministry of health set up to overview whole health
provision in Britain.
 1948 : Most hospitals taken over by NHS, but some still
private or charitable