Ed Gcse History Medicine WB Answers

WORKBOOK ANSWERS
Edexcel GCSE (9–1)

History Workbook
Medicine in Britain, c.1250–present
The British sector of the Western Front,
1914–18
This Answers document provides suggestions for some of the possible answers that students
could give for the questions asked in the Workbook. They are not exhaustive and other
answers may be acceptable, but they are intended as a guide to give teachers and students
feedback.
Medicine in Britain,
c.1250–present
Medicine in medieval England: c.1250–
c.1500
Ideas about the causes of disease and illness
1 The Theory of the Four Humours was an idea first put forward by an Ancient Greek doctor
called Hippocrates. The theory stated that the body was made up of four humours: blood,
phlegm and black and yellow bile. It was believed that the humours must be balanced for
a person to be healthy. It was also believed that the humours had their own
characteristics, for example phlegm was cold and wet. The humours were also linked to
the seasons, for example it was believed that the body produces too much phlegm in
winter.
2 a Leprosy is a painful contagious skin disease that leads to paralysis.
b People suffering with leprosy were banished from communities and had to wear a bell
to announce their presence. Leper houses were set up on the edges of towns and cities.
3 A lazar house was a place, usually a religious house, in which lepers were cared for.
4 Barber surgeons performed small surgeries such as pulling teeth and bloodletting.
5 Galen’s ideas did not challenge the Bible. He believed in the idea of the soul.
6 During a dissection the physician would sit away from the body and read from the works of
Galen. Somebody else would dissect the body.
7 Miasma Theory stated that bad air was filled with poisonous fumes, which caused disease
and illness.
8 Urine was carefully examined before diagnosis of a patient. The physician would check the
urine’s colour, thickness, smell and taste.
Theory Explanation
The impact of the planets During the Middle Ages it was believed
that a movement in the planets would
result in a disease spreading
throughout England.
God’s punishment During the Middle Ages it was believed
that God sent illness as a punishment
for sins.
Theory of the Four Humours Medieval people continued to believe
that illness was caused by an
imbalance of the four humours.
Miasma Theory Medieval people believed that bad air,
filled with poisonous fumes, was the
cause of disease and illness.
10
The Church Individuals Attitudes and beliefs
Religion was so Galen’s ideas continued Religion was highly

influential during the to dominate medicine influential in medieval
Middle Ages that it during the Middle Ages. England, and this led to
led to most people The Church supported religious ideas about the
believing illness was his ideas and they were cause, prevention and
sent by God as a taught in all medical treatment of illness and
punishment for their schools. disease. For example,
sins. most people went on
pilgrimages and prayed
Edexcel GCSE (9–1) History Workbook: Medicine in Britain/The British sector of the Western Front 2
© Sam Slater 2018 Hodder Education

daily.
11 In this answer, you are looking for a clear focus on the explanation of ‘why’ throughout the
answer.
 You may wish to use bullet points to argue that Galen’s ideas dominated
medical training. The Theory of the Four Humours was widely believed in medieval
England and so Galen’s Theory of Opposites was used to treat illness.
 Stronger candidates will employ knowledge in addition to bullet points, for

example the influence of the Church in medical ideas in medieval England and its
support of the work of Galen.
 No introduction or judgement is needed when answering this question.
Approaches to prevention and treatment

12
Key term Definition
Bloodletting The opening of a vein to draw blood from a patient

Fasting Going without food
Stewes Public baths
Regimen A set of instructions provided by a physician to help
Sanitatis keep a patient healthy
Pilgrimage A journey to an important religious monument,
shrine or place
Monks and nuns The staff of a medieval hospital
Posy A bunch of flowers
Physician Medieval doctor
The king’s When the king’s hands were rubbed with holy oil
touch before he touched those suffering with scrofula
Apothecary Those who mixed herbal remedies
13

Belief about cause Treatments Preventions
God’s punishment Prayer Penance

Fasting Prayer
Pilgrimage Fasting
King’s touch Pilgrimage
Theory of the Four Bloodletting Bloodletting
Humours
Regimen Sanitatis
Stewes
Miasma Theory Stewes Posy
14
Statement True/ Corrected statement

False?
Most people in medieval False Most people in medieval

England were treated at home England were treated at
by a male family member. home by a female family
member.
Medieval physicians had a True
medical degree.
The main role of a physician False The main role of a physician
was to treat a patient after was to diagnose illness and
diagnosis. recommend treatment.
A physician’s medical care was False A physician was very
provided to everyone free of expensive and only the rich
charge. could afford to see him.
Apothecaries’ knowledge was True
passed down from family
member to family member.
A medieval hospital was a True
place where the sick were
cared for, not cured.
A nun’s duties included False A nun’s duties included doing
sampling patients’ urine and the washing and making sure

bleeding patients. everything was clean.
15 In this answer, you are looking for:
 a focus on similarity
 support from both time periods, for example, in both the thirteenth and
seventeenth centuries people turned to the Church to explain disease and illness.
During the Black Death and the Great Plague, it was believed that God had sent the
epidemic as a punishment for sin.
 a focus on difference
 support from both time periods, for example, in the thirteenth century monks
and nuns looked after patients who attended hospital, and they adopted a ‘care not
cure’ approach. However, by the seventeenth century patients attended hospitals with
wounds and curable skin conditions for treatment.
Dealing with the Black Death, 1348–49

17
Treatment Prevention
b Bleeding a Pilgrimage
d Prayer c Authorities stopped
cleaning the streets
f Strong-smelling herbs
d Prayer
e Leaving the village
f Strong-smelling herbs
g Quarantine
h Self-flagellation (whipping
oneself)
18
The Church The government Attitudes and beliefs
Many believed that the In order to prevent the Like physicians, people
Black Death was sent Black Death spreading, did not know how to
by God as a punishment local authorities treat or prevent the
for sins. As a result, introduced quarantine disease. They still

they used prayer, laws to stop people believed that miasma

pilgrimage and self- moving about too was the cause, and they
flagellation to much. People new to an thought that strong-
treat/prevent it. area were isolated for smelling herbs and
40 days. bleeding were potential
treatments.
19 In this answer, you are looking for a balanced answer that both agrees and disagrees with
the statement before reaching a sustained judgement.
Arguments that agree with the statement could include the following:
 Religious ideas that disease and illness were sent as a punishment from God
dominated medical practice and led to treatments and preventions such as prayer,
pilgrimage and penance.
 Religious teachings led to care of the sick taking place in religious institutions
and being carried out by monks and nuns.
 The Church supported the ideas of Galen, as they did not challenge the Bible
and so were taught in medical schools across Europe.
Arguments that disagree with the statement could include the following:
 There was a strong belief that disease and illness were caused by an
imbalance of the four humours. This led to treatments and preventions such as
bloodletting that were intended to balance out the humours.
 More rational ideas began to develop, including the belief that bad air caused
disease and illness (Miasma Theory). This led to people carrying and burning sweet-
smelling herbs and flowers during the Black Death.
A sustained judgement might include the following:
 Many people relied on religious ideas during the period c.1250–c.1500. However,
rational ideas were becoming more prominent and people turned to these ideas during
dangerous epidemics when they were desperate.
The Medical Renaissance in England:

c.1500–c.1700
20

Change Continuity
b Physicians carried out a Miasma Theory

observations of their patients
c God sent the plague as a form
e Illness was a result of the of punishment
weather
d An imbalance of the four
humours
21
Statement True/False? Corrected statement
Thomas Sydenham was True

nicknamed ‘the English
Hippocrates’.
Sydenham’s work was True
important in moving
medicine away from the
ideas of Galen and
Hippocrates.
Sydenham relied on the False Sydenham refused to rely on
works of Galen when medical books when diagnosing
diagnosing a patient’s a patient.
illness.
One of Sydenham’s ideas True
was that diseases were like
plants and animals, and
could be organised into
different groups.
Sydenham’s book The Fabric False Sydenham’s book Observationes
of the Human Body was Medicae was published in 1676.
published in 1676.
Sydenham encouraged his True
students to observe their
patients and note down their
symptoms.
Sydenham identified that True
measles and scarlet fever
were separate diseases.
Sydenham used ‘sweating’ False Sydenham prescribed airy
to cure his patients of bedrooms, light blankets and
smallpox. cold drinks to cure his patients

of smallpox.
22 a Animalcules were ‘little animals’ in plaque scraped from between the teeth. They were
the first recorded observation of bacteria.
b Microscopes allowed observation of animalcules to take place. Bacteria were

observed.
23 The rise of humanism led to more experimentation and questioning. New ideas began to
gain more support.
24 The new printing press enabled medical ideas to spread more widely and much more
quickly.
25 a The Royal Society’s aim was to promote and carry out experiments to further the
understanding of science. It shared scientific knowledge and encouraged debate.
b The Royal Society encouraged the new medical ideas that developed during the
Renaissance, for example animalcules. The Society made it possible for physicians and
scientists to access and study each other’s work.
26
The Church Science and Attitudes and beliefs

technology
Declined in power and New microscopes Development of

allowed new ideas to humanism,
Printing press
be questioned and questioning,
developed experimentation, all
leading to a more
Humanism and
scientific
experimentation
understanding of the
became more
cause of illness, e.g.
commonplace as the
animalcules
Church lost power
answer.
 You may wish to use bullet points and argue that people continued to believe
in the Theory of the Four Humours and Miasma Theory as the causes of disease and
illness.
 Stronger candidates will use knowledge in addition to the bullet points. For
example, although new ideas began to be developed during this period, including
animalcules, without widespread technology leading to a change in ideas people

turned to the old ideas of the Theory of the Four Humours and Miasma during
epidemics such as the Great Plague in 1665.

28
Key term Definition
Iatrochemistry Chemical cures for diseases

Sweating Making the patient sweat in order to
cool the body down
Transference Transferring an illness or disease to
something else
29 For example:
 Onion fixed to a wart
 Patients with a fever slept in a room with a sheep
30 a Your answers could include sarsaparilla, ipecacuanha (ipecac) and cinchona bark.
b New herbal remedies started to appear due to the discovery of new lands.
31 Paracelsus inspired the use of iatrochemistry.
32 For example:
 Removal of bad smells
 Regimen Sanitatis
 Prayer
 Cleanliness
33 For example:
 Practising moderation
 Monitoring the weather
 Removal of rubbish from the streets
34

Apothecary Surgeon Physician
a Mixed remedies c Carried out simple b Trained at

operations university
d New entrants to
this profession carried e Had to possess a f Learned from books,
out an apprenticeship licence to practise rather than practical
and learned from a their trade experience
master
g Used by those who h Rarely carried out
e Had to possess a could not afford a dissection due to a
licence to practise physician lack of corpses
their trade
g Used by those who
could not afford a
physician
35 Vesalius had a deep interest in the human body. In 1543, he published On the Fabric of
the Human Body, which was a book of anatomical drawings. To do this, he dissected
human corpses. He proved that there were errors in the work of Hippocrates. He also
proved that the human jawbone was in one part, that men did not have one fewer pair of
ribs than women and that the human breastbone was in three parts. Vesalius encouraged
other doctors to base their work on dissection.
 The printing press led to an improvement in the communication of new

medical discoveries during the Renaissance, for example Vesalius’ book On the
Fabric of the Human Body. This enabled his discoveries, which proved Galen wrong,
to spread and encouraged medical students to dissect and study the human body,
rather than rely on old texts.
 A change in attitudes and beliefs during the period encouraged a more

scientific approach to learning, for example the Royal Society encouraged doctors and
scientists to discuss and debate medicine, while humanism led to doctors and
scientists questioning old ideas and making new discoveries.
 Individuals such as Sydenham, Vesalius and Harvey became important as

they developed the confidence to challenge old ideas and encourage medical
professionals to study the human body in detail rather than rely on the ideas in old
medical texts.

 During the Renaissance an improvement in technology provided individuals

with the opportunity to share their ideas more widely and encouraged a more scientific
approach to medical learning.
Key individual: William Harvey and the discovery of the circulation

of the blood
37 a
Harvey proved that Harvey disproved the Harvey dissected

blood flowed in one ideas of Galen. cold-blooded
direction. animals.
Harvey had to steal Harvey discovered Harvey was not
bodies from graves for capillaries but was allowed to go to
dissection. unable to prove their medical school.
existence.
Factor Contribution to medical understanding Positive/

Negative
?
Individuals Harvey’s own abilities — reputation as Positive

Charles I’s physician, patience and
determination to dissect and experiment
Governme Support from Charles I Positive
nt
Science Dissection became more commonplace and Positive
encouraged Harvey
Technolog Harvey’s idea was developed from the Positive
y mechanical firefighter pumps
Attitudes Medical Renaissance — questioning and Positive
in society experimentation and
negative
c Harvey’s theory encouraged other scientists to experiment on actual bodies.
d Harvey’s discovery had little impact on medical treatment. Doctors of the time ignored
and openly criticised Harvey. Old ideas about treatment prevailed.
e Renaissance doctors ignored and openly criticised Harvey’s theory.

Arguments that agree with the statement could include:
 Despite Harvey’s discovery, medical ideas about the causes of disease and
illness, and therefore methods of prevention and treatment, stayed the same. This can
be seen during the Great Plague of 1665, during which people still used prayer
because they believed the epidemic was sent by God as a punishment and burned
fires in the street because they believed that bad air caused the disease to spread.
 Harvey published his book An Anatomical Account of the Motion of the Heart
and Blood in Animals in 1628. However, medical textbooks continued to give Galen’s
account until 1651 and Harvey’s ideas only began to appear in universities from 1673.
Arguments that disagree with the statement could include:
 Harvey’s discovery did encourage other scientists to experiment on actual

bodies and carry out dissections.
 Harvey’s discovery made little difference to medical understanding of the

causes of disease and illness, and therefore the methods of prevention and treatment.
However, it did encourage scientists to question and challenge old ideas, leading to
new scientific discoveries in the long term.
Dealing with the Great Plague in London, 1665

39
Key term Definition
Quarantine Isolation inside the home for 28 days

Pomander A ball containing perfumed substances
Quack Somebody who did not have any medical qualifications,
doctor but who sold their services as a doctor or apothecary
Plague A doctor employed to treat plague victims, who wore a
doctor special costume of a birdlike mask and a long coat to
avoid catching the plague
Searchers People employed to find, and remove, the corpses of
plague victims
40 a

Ideas about Preventions Treatments

cause
Miasma Theory Burning barrels of tar Sweating

Alignment of Fire Transference —
the planets strapping a live
Pomander
chicken to buboes
Punishment
Public meetings, fairs banned (swellings of the
from God
Theatres closed lymph nodes)
Contagion,
Cats and dogs killed Herbal remedies
person to
person Prayer and repentance
Red cross on doors, ‘Lord have
mercy upon us’
b This answer relies on your own answers to Question 40a.
41 a There is no right or wrong answer to this question, but you should be able to support
your decision.
b A possible answer to this activity could argue the following, but others are also
acceptable:
There was very little change in the ideas of the cause of disease between the Black Death
and Great Plague. People still believed that the disease was sent by God as a punishment
for sin and that it was spread by bad air (miasma). However, people began to use new
methods of prevention linked to these ideas during the Great Plague, including plague
water and the smoking of tobacco.
 support from both time periods, for example during both the Black Death and
the Great Plague bad air (miasma) was believed to have caused the epidemic. As a
result, people would smell herbs, carry sweet-smelling flowers and burn fires to drive
away the bad air.
 support from both time periods, for example during the Black Death people
would flog themselves to avoid catching the disease. However, by the time of the
Great Plague in 1665, the government took more action to prevent the spread of the
disease by banning public meetings and closing theatres.

Medicine in eighteenth- and nineteenth-

century Britain: c.1700–c.1900
44
Key term/Date Definition/Event
Germ theory The belief that microbes in the air caused

decay
Theory of The belief that microbes were the product of
Spontaneous decay, rather than the cause of it
Generation
1861 The year in which Pasteur published his germ
theory
Microbe A living organism too small to see without a
microscope (also known as germs)
Enlightenment A movement in Europe that promoted the
idea that people could think for themselves
1876 The year in which Koch discovered the
bacterium that caused anthrax
Robert Koch German doctor
Anthrax An infectious disease mostly affecting
animals but occasionally people
Tuberculosis A threatening disease in the nineteenth
century
Louis Pasteur French chemist
45
46 Louis Pasteur discovered germs. He published the ‘germ theory’ and developed vaccines
for chicken cholera and rabies.
47 Robert Koch used a petri dish and chemical dye to identify microbes using a microscope.
He discovered the microbes for tuberculosis, cholera and anthrax.

48 a Your answer could include any two of the following:
o Microscope
o Swan neck flask
o Petri dish
o Chemical dye
b Your answer could include any two of the following:
o Miasma Theory
o Spontaneous Generation
o Some doctors did not believe that germs existed and so continued to believe
the old ideas.
c Germ theory.
49
Factor Contribution to medical understanding Positive/

Negative
?
Individuals The scientific skill and determination of Positive

Pasteur and Koch.
Governme No government funding for medical Negative
nt experiments just yet.
Science Scientists and doctors were working together Positive
to carry out experiments and make progress
in the understanding of the causes of disease
and illness.
Technolog Vital to scientific experiments: microscope, Positive
y swan neck flask, petri dish and chemical
dyes.
Attitudes Scientific understanding (a part of the Positive
in society Enlightenment) was starting to dominate by
1900.
answer.

 You may wish to use bullet points to argue that the technology available,
such as the microscope, was important, alongside the new scientific thinking during
the Enlightenment, which encouraged questioning and experimentation.
 Stronger candidates will use knowledge in addition to the bullet points, for
example the importance of the individual, Louis Pasteur, and his ability to scientifically
question and experiment to discover that germs were the cause of disease and illness.

51
Event Chronologic Do I know

al order (1– the year?
9)
Florence Nightingale makes changes to 3 1854

hospitals in the Crimean War
Second Public Health Act 7 1875
Antiseptic surgery with carbolic spray is 5 1865
first used
Anaesthetic in surgery (chloroform) is 1 1847
discovered
The Nightingale School for Nurses opens 4 1860
The anthrax vaccine is first created 8 1881
Sewers are completed in London 6 1865
First Public Health Act 2 1848
The rabies vaccine is first used on a human 9 1885
52
Individual How did their actions lead to developments in the

prevention and treatment of disease and illness?
Florence Her books, Notes on Nursing and Notes on

Nightingale Hospitals, and a training school for nurses led to
improved hygiene in hospitals. They helped to
prevent the spread of disease and revolutionise

the care of patients during recovery from illness.

James Simpson Simpson discovered that chloroform is an
effective anaesthetic for removing pain in
surgery.
Joseph Lister Lister developed the carbolic spray leading to
antiseptic surgery and the beginning of the
removal of germs from an operating theatre.
Edwin Chadwick Chadwick conducted a report into the living
conditions of the poor. He came to the conclusion
that the government should clean up the slums to
improve the health, and economic output, of the
workforce.
Joseph Bazalgette Bazalgette developed the sewer system in
London after the Great Stink.
53

False?
Robert Koch developed a False Louis Pasteur developed a vaccine

vaccine for rabies. for rabies.
Florence Nightingale’s True
book Notes on Nursing
was published in 1859.
Nightingale believed in True
the Miasma Theory of the
cause of disease and
illness.
It was dangerous to use True
ether as an anaesthetic
because it was so
flammable.
Queen Elizabeth used False Queen Victoria used chloroform
chloroform during during childbirth.
childbirth.
Joseph Lister faced no False Lister faced lots of opposition,
opposition and the death mainly because doctors did not
rate in operations accept that germs caused
continued to fall. infection.
The Church supported the False The Church disagreed with the use

use of anaesthetics in of anaesthetics and believed that

surgery. pain in childbirth was intended by
God.
Antiseptic surgery False Aseptic surgery included the use
included the use of steam of steam sterilisation, rubber
sterilisation, rubber gloves and surgical gowns.
gloves and surgical
gowns.
The First Public Health True
Act made little difference
because it was voluntary.
The Second Public Health False The Second Public Health Act
Act showed the showed the importance of the
importance of the Church government in developing public
in developing public health.
health.
54 a In this answer, you are looking for:
o a focus on similarity
o support from both time periods, for example, in both the seventeenth and
early nineteenth centuries it was believed that disease was spread by bad air
(miasma) and so governments took steps during the Great Plague and early
cholera epidemics to clean the streets.
b In this answer, you are looking for:
o a focus on difference
o support from both time periods, for example during the Great Plague of 1665
the government banned public meetings and closed theatres. However, by the
late nineteenth century the government knew that dirty water spread cholera and
so it funded the building of sewers in London.
Key individual: Jenner and the development of vaccination

55 a
Event Chronologic Do I know

al order (1– the year?
6)
Edward Jenner carries out his experiment on 3 1796

James Phipps
The government makes the smallpox 6 1852

vaccination compulsory
Nationwide epidemics of smallpox (note: 1 1722,
multiple years) 1723,
1740–42,
1796
Jenner publishes his findings 5 1798
People are inoculated to prevent the spread 2 From
of smallpox early
1700s
The Royal Society refuses to publish Jenner’s 4 1797
findings, demanding more proof
Statement Short- Long-

term term
impact impac
t
Without knowledge of germs, Jenner was unable to 

explain why his smallpox vaccine worked.
Jenner showed the importance of scientific methods and 
encouraged other scientists to use experiments and
enquiry in order to improve medicine.
Jenner faced lots of opposition from inoculators, who 
refused to change their methods of preventing smallpox.
Jenner set up his own vaccination clinic and distributed 
the smallpox vaccine for free.
Smallpox deaths fell even more rapidly after 1872 when 
the compulsory vaccination was enforced.
By 1980, smallpox had been wiped out worldwide. 
c Jenner’s discovery of the smallpox vaccine had little impact in the short term because
he was unable to explain why it worked without knowledge of germs. As a result, there
was opposition and inoculation was still used. However, once the government made the
smallpox vaccine compulsory in 1852 and enforced its use as a prevention from 1872, the
death rate fell dramatically.
answer.

 You may wish to use bullet points and argue that opposition came from the
Royal Society because Jenner could not explain why the smallpox vaccine worked
before Pasteur’s ‘germ theory’. Additionally, many doctors made a lot of money from
inoculation and so opposed the new method of vaccination.
 Stronger candidates will use knowledge in addition to bullet points, for

example that opposition also came from the Church, as it did not think that it was
acceptable to use a disease from a cow to prevent disease in a human.
Fighting cholera in London, 1854

57 a Cholera first arrived in Britain in 1831. It spread rapidly in the slums, and so mainly
affected poor people. Victims of cholera suffered from diarrhoea, sickness and
dehydration before dying. Doctors found it impossible to treat because they did not know
its cause.
John Snow was a surgeon who lived in Soho. Snow investigated the cholera epidemic of
1854. Snow created a spot map to show where the deaths had occurred around Broad
Street. He was able to connect the deaths to the water pump in Broad Street. He removed
the handle from the water pump so that people could no longer use it.
There were no more deaths from cholera. It was then noticed that the well providing water
to the pump was close to a cesspit with a cracked lining. Waste from the cesspit was
leaking into the well and spreading cholera.
b Cholera was fatal. Sufferers would die between two and six days after falling sick.
The disease spread quickly and killed thousands.
c Observation, spot map, pattern noticed, removed handle to prove hypothesis.
d There were no deaths.
e Deaths were linked to a water pump on Broad Street. When the handle of the pump
was removed and people could not access this water, the deaths stopped. There were no
deaths among people who did not use the Broad Street pump, including at the workhouse
and brewery. Upon investigation, Snow found that the waste from a cesspit was leaking
into the water supply.
f There was no immediate action, but the government did agree to invest in a sewer
system from 1860.
g The ‘Great Stink’ was a bad smell from the River Thames in the summer of 1858.
h The government funded the building of London’s sewer system by Bazalgette from
1860.

Individuals Science and Attitudes and beliefs

technology
The commitment Scientific enquiry into The development of

and scientific the deaths on Broad scientific thinking
thinking of Dr Street from cholera during the nineteenth
John Snow. He (spot map, century led to much
observed the high investigation, removal questioning of medical
number of deaths of the water pump ideas.
and then carried handle, location of the
out his famous cesspit).
investigation.
 Dr John Snow discovered that dirty water caused cholera and he eventually
encouraged the British government to take responsibility for providing its citizens with
clean water. Sewers were built in London from 1860.
 John Snow’s discovery was limited because he was unable to explain the
spread of cholera without knowledge of germs and so the British government did not
take immediate action.
 Louis Pasteur’s discovery of germs was more of a turning point because it

explained the spread of disease and illness, leading to an increase in government
action, especially with the introduction of the 1875 Public Health Act. The ‘germ theory’
also led to the identification of microbes, such as tuberculosis by Robert Koch. The
identification of microbes enabled vaccines to be developed in order to prevent
illnesses such as anthrax and rabies.
 John Snow’s discovery was important in identifying the cause of cholera, but
the turning point only came once Louis Pasteur had discovered germs. The ‘germ
theory’ led to disease and illness being accurately understood and explained, which
forced the government to take responsibility and intervene to prevent its spread.
c.1900–present: medicine in modern Britain

59

Key term/Date Definition/Event
Hereditary Disease caused by genetic factors

disease
ECG Electrocardiogram, used to track heart
activity
DNA Carries genetic information from one living
thing to another
Endoscope A camera on the end of a thin, flexible
tube, used to see inside the human body
MRI scan Magnets and radio waves used to create
an internal image of the body
1953 The year in which DNA was discovered
CT scan A more advanced form of X-ray, used to
diagnose tumours and other growths
Ultrasound scan The use of sound waves to diagnose gall
stones and kidney stones
60
61
Technology Illness/Disease
Blood sugar monitor Diabetes

X-ray Broken bones
MRI scan Ligament damage
CT scan Tumours
Ultrasound scan Kidney stones
ECG (electrocardiogram) Heart defects
Endoscope Digestive concerns
Blood pressure monitor High and low blood pressure

62
 The discovery of DNA by Crick and Watson and the Human Genome Project
led to greater understanding of genetic illnesses, such as cystic fibrosis.
 The twentieth century also saw a change in the understanding of disease and
illness as related to lifestyle factors, for example stress, smoking and a poor diet.
 The discovery of DNA was important in understanding genetic illness.

However, the most common killer diseases in the late twentieth century, such as lung
cancer, are caused by lifestyle choices.
Approaches to prevention and treatment: NHS, science and

technology
64

Event Chronologic Do I
al order (1– know the
9) year?
The NHS is introduced 7 1948

First magic bullet: Salvarsan 1 1909
606
Second magic bullet: 4 1932
Prontosil
Clean Air Acts 8 1956 and
1958
Penicillin is discovered 3 1928
Penicillin is mass-produced 6 1942
Smoking is banned in 9 2007
enclosed workspaces
Diphtheria vaccination 5 1942
National Insurance Act 2 1911
65 A magic bullet is a chemical cure for a disease.
66 The 1911 National Insurance Act provided medical care to workers following government,
employer and employee financial contributions.
67 The NHS provided free medical care for all.
68 Not much changed due to a lack of money. Hospitals desperately needed updating.
69 Your answer could include the following:
 Microsurgery
 Laparoscopic (keyhole) surgery
 Robotic surgery
70 Medical treatment has improved greatly since 1900. For example, X-rays are used to
target and shrink tumours (radiotherapy), chemotherapy can treat cancer, dialysis is used
to ‘wash’ patients’ blood to help combat kidney failure, heart bypasses are widely
available, better prosthetic limbs are now produced.
71 a Your answer could include the following:
o Compulsory vaccinations
o Laws to provide a healthy environment


o Communicating health risks
b Examples could include any of the following:
o Diphtheria
o Polio
o Whooping cough
o Tetanus
o Measles
o Rubella
o HPV
c Your answer could include the following:
o Clean Air Acts (1956 and 1968)
o Smoking legislation, such as banning smoking in all workplaces (2007) and

banning smoking in cars (2015).
 support from both time periods, for example in both the nineteenth and
twentieth centuries vaccines were used to prevent disease and illness. In the
nineteenth century the government made the smallpox vaccine compulsory and during
the twentieth century more vaccines were used, including the HPV vaccine.
 support from both time periods, for example during the seventeenth century it
was believed that disease and illness could be transferred from a person to an object
and so people would place an onion next to a wart. However, by the twentieth century
bacteria were understood and magic bullets, including Salvarsan 606 and Prontosil,
were developed in order to treat disease and illness.
Key individuals: Fleming, Florey and Chain’s development of

penicillin
74 a/b

c An antibiotic is a drug that destroys or slows down the growth of bacteria.
d Amoxicillin, Doxycycline, Cephalexin, Ciprofloxacin, Clindamycin, Metronidazole,

Azithromycin, Tetracycline
e Fleming. He found the bacteria mould growing in his laboratory.
f Florey and Chain. They made enough penicillin to carry out experiments on mice and
a human.
g Fleming was unable to develop penicillin further due to a lack of funding.
75 A possible answer could conclude:

For example:
 Individuals: the genius of Fleming in recognising that the penicillin mould had
killed the staphylococcus bacteria it had landed on. The determination of Florey and
Chain to carry out tests on mice and humans when making enough penicillin to do this
was a challenge.
 Government: the funding of the mass-production of penicillin during the

Second World War so that there was enough to treat the casualties on D-Day.
 Science and technology: the building of a homemade penicillin factory out of

milk bottles and saucepans to enable Florey and Chain to perform the experiments on
mice and a human.
 Attitudes in society: the scientific approach to the development of penicillin by

Florey and Chain.
answer.
 You may wish to use bullet points and argue that penicillin was mass-
produced after Florey and Chain developed its production so that they had enough to
test the drug on mice, and then a human, to prove it successfully treated bacterial
infections. You may also argue that the mass-production of penicillin was funded
during the Second World War because both the US and British governments needed it
for mass use. This led to its use on D-Day to treat thousands of injured soldiers.
 Stronger candidates will use knowledge in addition to bullet points, for

example the initial discovery of penicillin by Fleming, who recorded his findings for
Florey and Chain to develop later.
The fight against lung cancer in the twenty-first century

77 a


False?
Lung cancer is the most False Lung cancer is the second

common cancer in the UK. most common cancer in the
UK.
Approximately 85% of lung True
cancer cases are people
who smoke, or have smoked.
British people are screened False Regular screening does not
annually for signs of lung take place.
cancer.
Medical professionals use a True
CT scan to determine
whether or not cancer is
present in the lungs.
If lung cancer is detected True
and is not advanced,
radioactive material is
injected into the patient’s
body.
Radiotherapy is used as a True
treatment for lung cancer.
It is possible to use genetics False It is not yet possible to use
to treat lung cancer. genetics to treat lung
cancer.
In 2007, the UK government False In 2007, the UK government
raised the legal age for raised the legal age for
buying tobacco from 14 to buying tobacco from 16 to
16. 18.
The government has True
increased tobacco taxes in
order to encourage people to
stop smoking.
All cigarette products are False Cigarette products are no
clearly on display in shops. longer on display in shops.

Advances
CT scan, PET-CT scan, bronchoscopy
Diagnosis
The government has passed laws to change people’s

behaviour, including banning smoking in all
Prevention workplaces (2007), banning smoking in cars (2015),
raising the legal age of buying tobacco to 18 (2007)
and increasing taxation on tobacco products.
Lung transplants, radiotherapy, chemotherapy
Medical
treatment
Science and technology Government
The use of technology in the Government intervention in the

diagnosis and treatment of lung form of legislation to change
cancer, including CT-scans, behaviour and prevent lung
bronchoscopy, radiotherapy and cancer, including banning
chemotherapy. smoking in all workplaces (2007),
banning smoking in cars (2015),
raising the legal age of buying
tobacco to 18 (2007) and
increasing taxation on tobacco
products.

 The NHS led to a change in the accessibility of medical care and treatment in
the UK, as medical care was available to all free of charge. This included hospital
treatment, surgery, and GP and dentist visits.
 Even though medical care and treatment was accessible to all, the
government did not have a lot of money to spend on medical care and so hospitals still
needed updating after 1948 and more hospitals needed to be built across the country.
A study in the 1950s argued that up to a quarter of GPs were not satisfactory.
 The development of magic bullets, such as Salvarsan 606, were more

important in the treatment of disease. They enabled a disease to be targeted and
cured.
 The development of radiotherapy and chemotherapy led to the treatment of

lung cancer, the second most common cancer in the UK, in the latter half of the
twentieth century.
 The NHS was a turning point in medical treatment because it enabled all
people — both rich and poor — to have access to hospitals and GPs. Scientific
developments, such as magic bullets, radiotherapy and chemotherapy, enabled the
treatment, but it was the NHS that made these treatments available to all.

The British sector of the Western Front, 1914–18
The British sector of the

Western Front, 1914–18
The theatre of war in Flanders and northern
France
Problems in providing medical treatment
1 a Front-line trench:
 Where attacks were made from
 Soldiers left the front-line trench via the fire step
b Support trench:
 About 80 m behind the front line
 Troops would retreat here if the front-line trench was under attack from the
enemy
c Reserve trench
 At least 100 m behind the support trench
 Reserve troops were mobilised here for a counter-attack if the enemy was
advancing
d Communications trench:
 Ran between other trenches
 Allowed communication to take place between soldiers in different parts of the

trenches
e Dugout
 Holes dug into the side of the trenches, providing protective cover
 Sometimes used as a regimental aid post (RAP)
f No man’s land
 The area between the two opposing lines of trenches
 Barbed wire was placed here

Nature of terrain Battles
Ypres Somm Cambrai Arras

e
  
Mud, sometimes knee-deep
Low-lying ground, waterlogged
Mass casualties
Tunnels
Chalky ground
Existing tunnels and quarries (before

the First World War)
3 In this answer, you are looking for two features, with a supporting sentence.
Features could include:
 Enormous casualties. On the first day, British casualties numbered over

57,000, while total deaths were around 20,000 men.
 New strategies. Tanks were used for the first time, but were not very
successful.
4 a In this answer, you should focus on how the sources are useful by considering their
content and provenance, and support with additional historical knowledge.
 Source A is useful for showing the problems that large amounts of mud
caused for stretcher-bearers as they collected casualties from no man’s land during
the Third Battle of Ypres. There were approximately 250,000 British casualties during
this battle. The source is useful because an official army photographer, who
experienced the battle and witnessed these conditions, took the photo. Therefore, this
photograph is a snapshot in time. However, we do not know whether or not mud also
prevented the stretcher-bearers from working effectively after other battles, for
example at the Somme or Arras.
 Source B is useful because it tells of the mass casualties stranded in no

man’s land and the trenches who waited for the stretcher-bearers to come to their aid
after battles. Sometimes these casualties were waiting ‘a day and half’ to be collected
for care and treatment. Stretcher-bearers were often exposed to shellfire and gunfire
while collecting the wounded, which would have slowed them down. The source is
useful because it is a contemporary account written by a Royal Engineer who
experienced these conditions. However, we do not know if these conditions were
typical of all trenches along the Western Front throughout the war.
i Detail in Source B that I would follow up: ‘Some had been waiting a day and a
half to be brought in’.
ii Question I would ask: How long after a battle were injured soldiers being
transported from the battlefield?
iii What type of source I could use: Admission records from a dressing station at the
Somme, 1916.
iv How this might help answer my question: Admission records would tell me the
dates and times that casualties were admitted, and I could then match this
information against the dates and times of the battles.

Conditions requiring medical treatment on the Western Front:

shrapnel and infection
5
Medical problem Symptoms
Trench foot Painful swelling of the feet

Trench fever Similar to flu, with headache and aching
muscles
Shell shock Mental breakdown
Dysentery An infection causing diarrhoea
Frostbite Freezing of the skin and underlying
tissues
Gangrene Death of body tissue, caused by lack of
blood supply to that part of the body
Gas gangrene An infection that produces gas in
wounds
Medical British Army solution

problem
Trench fever Delousing stations set up to remove contact with lice

Trench foot Rubbing feet with whale oil, keeping feet dry, regularly
changing socks, amputation used as a last resort
Shell shock Not understood at the time — men suffering with shell
shock were sent back to Britain for treatment
7 Soldiers typically suffered bullet, shell and shrapnel wounds.
8 The British Army reduced the risk of tetanus on the Western Front through anti-tetanus
injections.
9 The British Army reduced the number of head wounds by the end of 1915 by introducing
the Brodie helmet.

10 a Gases used in gas attacks on the Western Front were chlorine, mustard and
phosgene.
b Gas affected the soldiers on the Western Front by causing death by suffocation,
internal and external blisters, and burning of the skin.
c The British Army prepared British troops on the Western Front for gas attacks by
issuing them with gas masks from July 1915.
 Source C is useful for telling a historian about the ‘coughing and choking’ that
chlorine gas caused. The Germans first used chlorine gas in 1915 and it could lead to
death by suffocation. The source tells that the British Army carried out different
experiments to find a treatment for this new battlefield weapon, including using
different masks and ammonia to enable a soldier to breathe more clearly. Source C
also tells us that these experiments were carried out not only to treat injuries from gas,
but also to find a way of safely reaching the injured soldiers in order to help them. The
source is useful because a Queen Alexandra nurse wrote the account, and she was
on hand to witness the effects of the gas and the experiments carried out during the
months in which the Germans first deployed gas on the battlefield.
 Source D is useful because it tells us about the mental and emotional effects
of the Western Front in the form of shell shock — ‘men shaking with ague, mouthing
like madman, figures of dreadful terror, speechless and uncontrollable’. It has been
estimated that about 80,000 British troops experienced shell shock. The source is
useful because it is a contemporary account written by a journalist who experienced
the conditions on the Western Front and saw the effects that the war, and shell shock,
had on soldiers.
i Detail in Source D that I would follow up: ‘The shell-shock cases were the worst
to see and the worst to cure’.
ii Question I would ask: How was shell shock treated during the First World War?
iii What type of source I could use: A medical journal article that focuses on the
effects and treatment of shell shock.
iv How this might help answer my question: A medical journal would detail the
treatments used for this new mental and emotional illness suffered by soldiers
during the First World War.
The work of the RAMC: transport and treatment areas

12

13

False?
Wounded men would False Wounded men were taken by

travel in an ambulance stretcher-bearers to the RAP.
wagon to the RAP.
After 1915, nurses could True
be found at the dressing
stations.
A unit of the Royal Army True
Medical Corps (RAMC)
was known as the Field
Ambulance.
Dressing stations were False Dressing stations only had
able to accommodate facilities to accommodate
wounded soldiers for over wounded soldiers for less than a
a week. week.
Wounded soldiers were True
transported to a casualty
clearing station (CCS) by
ambulance wagon.
A system of triage was True
used at the CCSs.
There were 20 CCSs on False There were 24 CCSs on the Ypres
the Ypres Salient. Salient.
An underground hospital False An underground hospital was built
was built at Cambrai. at Arras.
 Source E is useful for showing the location of a dressing station on the

Western Front. It shows an old building being used. Dugouts and bunkers were also
used as dressing station locations. The source is useful because it is a photograph

taken on the Western Front during the First World War, meaning that you can see
exactly what the conditions were like. However, it only shows us the conditions of one
dressing station and further research would be needed to see how typical these
conditions were of all dressing stations.
 Source F is useful because it tells us about the first aid work carried out at a
regimental aid post (RAP), including the dressing of wounds and provision of pain
relief. The RAP was often located within 200 m of the front line because its role was to
give immediate first aid and get as many men as possible back to the battlefield. The
source is useful because it is an account from a member of the RAMC who
experienced the conditions in a RAP on the Western Front and saw the effects that the
war had on soldiers. However, we do not know if these conditions were typical of all
RAPs in all battle locations throughout the war.
i Detail in Source F that I would follow up: ‘But it was all first aid work’.
ii Question I would ask: What first aid supplies were available in the dugouts on the
front line?
iii What type of source I could use: RAP records from a dugout on the front line at
the Somme.
iv How this might help answer my question: Records would provide details of what
supplies were used and delivered to a RAP on the front line.
FANY’s voluntary work in Belgium and France

15 a FANY stands for First Aid Nursing Yeomanry.
b The FANY arrived in France on 27 October 1914.
c In 1914, the British Army only allowed the Queen Alexandra nurses to care for the
wounded in the British sector of the Western Front. Volunteer nurses were turned away,
and instead found work with the French and Belgian armies. As the number of casualties
increased, this attitude changed and thousands of volunteer nurses began helping the
British Army. In January 1916, FANYs were allowed to drive ambulances, replacing male
British Red Cross drivers. There were never more than 450 FANYs in France, but they did
encourage other women to join organisations such as the Voluntary Aid Detachments
(VADs) and contribute to helping soldiers on the front line.
Type of work Yes No
Provided baths to the soldiers 
Set up cinemas for the soldiers 
Cooked meals 

Collected the wounded from no man’s land 
Drove food and supplies to the front line 
Cleaned the dugouts 
Washed clothes 
Supported surgeons in the operating theatres 
Sources How?
National army records for Would include the individual experiences

individual soldiers of a soldier in battle and the nursing
care they received at a variety of places
along the evacuation route.
National newspaper reports Would include details of the work carried
out by the FANY and maybe an
advertisement for recruitment.
Government reports on the A government report on the evacuation
war route might detail the work of the FANY.
Medical articles from Medical articles might provide details of
doctors and nurses who the role of FANY nurses and the care
took part in the war they administered.
Personal accounts from The diary of a FANY nurse might
soldiers, doctors, nurses or describe the work she carried out on the
others who were involved Western Front. A soldier’s diary might
describe the care he received from a
FANY nurse. A doctor’s diary might
describe the support he received.
Photographs Images of the FANY could illustrate their
work and uniforms.
Hospital records Hospital records would detail personal
details of FANY nurses and the care they
gave to specific patients.
Army statistics These could include, for example,
statistics of soldiers who returned to the
front line after FANY nurses cared for
them in a dressing station.

The significance of the Western Front for experiments in surgery

and medicine
16
Medical development Usage
Carrel-Dakin method A system of tubes that maintained the flow

of a chemical solution through a wound in
order to fight infection and stop the spread
of gas gangrene
Debridement Cutting away of dead, damaged and
infected skin tissue
Thomas Splint System Used to help fractured bones heal and
prevent blood loss
Sodium citrate Used to prevent blood from clotting
Citrate glucose solution Used to defrost blood after frozen storage
Blood bank The storage of blood for blood transfusions
Skin graft Taking skin from one part of the body and
using it to cover a wound
17 You could include the following:
 High numbers of casualties
 Urgent need for improvements in medical care
 Government support
18 The problems surgeons faced on the Western Front included infection. There were no
sterile conditions (aseptic surgery) present in hospitals before the war.
19 The Thomas Splint reduced the death rate of soldiers dying from a broken thighbone from
80% to 20%.
20 Mobile X-ray units were used to identify and locate shell fragments and bullets embedded
within a patient’s body.
21 Soldiers were treated with a mobile x-ray machine in casualty clearing stations.
22 The first blood bank was used during the Battle of Cambrai.
23

Source How?
National army records Would include individual accounts of the

for individual soldiers treatment soldiers experienced on the front
line.
National newspaper Might include newspaper reports on the
reports advances in medical treatment during the
First World War.
Government reports Government reports would include medical
on the war advances, for example the use of the
Thomas Splint or the introduction of the
mobile X-ray unit.
Medical articles from Articles were written that describe the
doctors and nurses medical advances during the First World
who took part in the War, such as the use of sodium citrate in
war blood banks.
Personal accounts Personal accounts could include those from
from soldiers, doctors, soldiers who benefited from the medical
nurses or others who advances.
were involved
Personal accounts from doctors and/or
nurses would describe use of new
treatments and methods, for example
plastic surgery.
Photographs Photographs of doctors and nurses using
new equipment, such as mobile X-ray units,
would provide important visual information.
Hospital records Hospital records would provide information
about where new equipment was located,
for example we’d know how many mobile X-
ray units were available and where these
were used following key battles.
Army statistics Statistics could tell us the number of
soldiers who received certain treatments,
such as the Thomas Splint.
 Source G is useful for illustrating the Thomas Splint, which was first used on
the Western Front. The Thomas Splint was used to improve the survival rate of men
suffering from a gunshot or shrapnel wound to the leg from 1916. It increased the
survival rate from injuries of this type from 20% to 80%. The source is useful because

it is a diagram that shows exactly how the device was used to fix the injured leg in
order to prevent movement and further injury.
 Source H is useful because it tells us about portable blood transfusions used

on the Western Front after 1915. It describes the use of sodium citrate to transfuse the
blood successfully and reduce the number of soldiers who would have died from
‘shock and loss of blood’. The use of stored blood was successfully demonstrated in
1917 at the Battle of Cambrai. The source is useful because it is an account from
Keynes, who carried out experiments that led to a portable blood transfusion kit for
use on the Western Front. However, this source tells us of Keynes’ successful
experiments and doesn’t tell us how typical the unit’s use was throughout the Western
Front after 1915.
i Detail in Source H that I would follow up: ‘It saved countless lives of men who
would otherwise have died from shock and loss of blood’.
ii Question I would ask: How many men were given a blood transfusion following
the Battle of the Somme?
iii What type of source I could use: Casualty clearing station records from the
Somme.
iv How this might help answer my question: All blood transfusions would be
recorded following the Battle of the Somme.

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WORKBOOK ANSWERS

Edexcel GCSE (9–1)

2 a Leprosy is a painful contagious skin disease that leads to paralysis.

The Church Individuals Attitudes and beliefs

Religion was so Galen’s ideas continued Religion was highly

© Sam Slater 2018 Hodder Education

 Stronger candidates will employ knowledge in addition to bullet points, for

 No introduction or judgement is needed when answering this question.

Approaches to prevention and treatment

Key term Definition

Bloodletting The opening of a vein to draw blood from a patient

© Sam Slater 2018 Hodder Education

Belief about cause Treatments Preventions

God’s punishment Prayer Penance

Statement True/ Corrected statement

Most people in medieval False Most people in medieval

© Sam Slater 2018 Hodder Education

bleeding patients. everything was clean.

15 In this answer, you are looking for:

16 In this answer, you are looking for:

Dealing with the Black Death, 1348–49

The Church The government Attitudes and beliefs

© Sam Slater 2018 Hodder Education

they used prayer, laws to stop people believed that miasma

A sustained judgement might include the following:

The Medical Renaissance in England:

© Sam Slater 2018 Hodder Education

b Physicians carried out a Miasma Theory

Statement True/False? Corrected statement

Thomas Sydenham was True

© Sam Slater 2018 Hodder Education

b Microscopes allowed observation of animalcules to take place. Bacteria were

The Church Science and Attitudes and beliefs

Declined in power and New microscopes Development of

© Sam Slater 2018 Hodder Education

 No introduction or judgement is needed when answering this question.

Approaches to prevention and treatment

Key term Definition

Iatrochemistry Chemical cures for diseases

 Onion fixed to a wart

 Patients with a fever slept in a room with a sheep

31 Paracelsus inspired the use of iatrochemistry.

 Removal of bad smells

 Monitoring the weather

 Removal of rubbish from the streets

© Sam Slater 2018 Hodder Education

Apothecary Surgeon Physician

a Mixed remedies c Carried out simple b Trained at

 The printing press led to an improvement in the communication of new

 A change in attitudes and beliefs during the period encouraged a more

 Individuals such as Sydenham, Vesalius and Harvey became important as

A sustained judgement might include the following:

© Sam Slater 2018 Hodder Education

 During the Renaissance an improvement in technology provided individuals

Key individual: William Harvey and the discovery of the circulation

Harvey proved that Harvey disproved the Harvey dissected

Factor Contribution to medical understanding Positive/

Individuals Harvey’s own abilities — reputation as Positive

c Harvey’s theory encouraged other scientists to experiment on actual bodies.