Answers. Page 7: Eliminate irrelevance. Page 9: Identify the view

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1 Answers Page 7: Eliminate irrelevance In medieval England there were religious and supernatural explanations for the cause of illness. The Church was very powerful and controlled education throughout the period, which led to the continuity of ideas. The Church taught that God was responsible for illness and disease. The Church taught that God sent disease as a punishment for sin or to cleanse the soul. As a result of this, many people would also turn to the Church for treatments and preventions. Religious believers would attend church and pray, pay for a special mass to be said to remove their sin and also fast. Some believers would go on a pilgrimage and during the Black Death in 148 flagellants across Europe would whip themselves to show God how sorry they were for their sin and to show that they did not need to be punished with the disease. These beliefs continued throughout the period c.1250 c.1500 because the Church remained in control of education and continued to teach these ideas. Due to the power that the Church held in society, there was no challenge of the religious explanations, treatments and preventions for disease and illness. Page 9: Identify the view What view is offered by the statement about medicine in medieval England? That the Church and religious ideas dominated ideas about treatment and prevention of illness during medieval England. Knowledge which agrees with the statement Knowledge which disagrees with the statement Religious actions included healing prayers, fasting (going without food), lighting candles in church, flagellation and going on pilgrimages Star charts were used to prescribe treatments, including herb gathering, bloodletting, purging and operations To balance the humours bloodletting and purging were used Herbal remedies were also used to treat the sick To prevent illness, medieval people were encouraged to take care of their bodies by exercising, sleeping, keeping clean, breathing clean air and avoiding stress Medieval people also purified the air by spreading sweet herbs and carrying flowers (posy) The statement is partially correct: religious ideas did influence prevention and treatment of disease and illness in medieval England. Religious actions included healing prayers, fasting (going without food), lighting candles in church, flagellation and going on pilgrimages. The majority of people believed that God sent illness as a punishment for sin and this led them to believe he could also prevent and remove illness. However, the statement is also partially incorrect because more rational ideas about treatment and prevention also existed. These included balancing the humours by bloodletting and purging, taking herbal remedies, purifying the air by spreading sweet herbs and carrying flowers. The rational ideas of Hippocrates and Galen that illness was caused by an imbalance of the four humours had survived into the medieval period and influenced some physicians. The miasma theory that disease and illness was caused by bad air also encouraged some to believe a successful prevention was to ensure the air was clean. 1

2 Page 11: Organising knowledge Black death Religion Rational Supernatural Beliefs about cause Treatment Prevention God sent as a punishment for sins Prayer, confession, donations, holy charms Prayer, processions, pilgrimages, fasting, flagellation Imbalance of four humours Miasma theory Bleeding, purging Smelling strong herbs such as myrrh Lighting fires to remove bad air Lancing buboes Carrying posies of herbs and flowers Rakers cleared animal dung from the streets. Fines for dropping litter. Butchers used segregated area Keep air moving by ringing bells and birds Quarantine Unusual alignment of the planets Page 1: Organising knowledge Ideas about the cause of disease and illness during the medical Renaissance in England New ideas Animalcules Thomas Sydenham encouraged doctors to observe their patients carefully and question the older ideas Page 1: Making comparisons Old ideas Miasma theory: bad air caused disease and illness Religious ideas God sent disease and illness as a punishment for sin Evil spirits Answer 2 because it refers directly to both time periods in the question and supports with precise historical knowledge from each. Page 15: Organising knowledge Theory of the Four Humours still used to diagnose illness Similarities Ideas about the cause: Astrology alignment of planets Sent by God as a punishment from sin Imbalance of the four humours Miasma theory bad air Preventions and treatments: Prayers Quarantine Smelling herbs and flowers Fasting Cleaning streets Differences Ideas about the cause: Contagion touch Preventions and treatments: Plague doctors Smoking tobacco Authorities took action: l banning public meetings, funerals and fairs l closing theatres l burning barrels of tar and herbs l killing cats and dogs l appointing searchers to monitor the spread of the disease and clear victims bodies from towns 2

3 Page 15: You re the examiner Level Reason: This is a mainly descriptive answer rather than analytical. It does answer the why part of the question later in the paragraph. However, this is not consistent enough for a level 4. Now suggest what the student has to do to achieve a higher level. This candidate needs to clearly explain why there was a continuity in the prevention and treatment of disease and illness between 1250 and 1700 from the beginning of their paragraph. Try and rewrite this paragraph at a higher level. There was continuity in the methods of treatment and prevention of disease and illness during the period because people continued to believe in the miasma theory; that disease and illness was spread by bad air. People tried to prevent catching the Great Plague by placing those who had the disease in quarantine for 28 days, by carrying a pomander to drive away the miasma because they believed it was caused by the bad air and eating a diet heavy with garlic. Some healers advised to smoke tobacco to also ward off the miasma. Local government also took action by banning public meetings, fairs and closing theatres. Fires were lit and barrels of tar were burned. These actions took place because the local government wanted to prevent the spread of the disease by contagion and miasma. Although doctors were starting to question medical ideas, this did not change the methods of treatment and prevention of disease and illness before Here we can see a similarity with the Black Death during the Middle Ages as this epidemic was also believed to have been spread by bad air and contagion. Page 17: Support or challenge Statement Support Challenge More powerful microscopes were being developed and, in 168, one allowed for the observation of tiny animalcules The Royal Society first met in 1660 to share scientific knowledge and encourage new ideas The Theory of the Four Humours was starting to be rejected by physicians Doctors and anatomists were starting to observe the human body themselves rather than relying on old books Thomas Sydenham encouraged doctors to observe their patients and note down their symptoms The newly developed printing press allowed for medical information to be spread quickly and accurately Vesalius dissected human corpses and proved around 00 ideas of Galen incorrect Harvey discovered that blood circulated around the body and that the heart acted as a pump Without a microscope, Harvey was unable to prove that capillaries existed and so many physicians ignored his ideas

4 Page 19: Complete the paragraph There was complete change in the ideas about the cause of disease and illness in the period c.1700 c.1900 because science prevailed and microbes were identified and understood. In 1861, Louis Pasteur discovered and published his Germ Theory. Although Pasteur had only proven that microbes caused decay in liquids, he inspired other scientists to look for a similar cause to explain disease in the human body. Robert Koch followed Pasteur and identified the microbes that caused anthrax, tuberculosis and cholera. Pasteur s discovery disproved the idea of spontaneous generation and so led to a complete change in understanding of the cause of disease and illness from 1861 as scientists and doctors correctly understood medicine. Page 21: Understand the chronology Date Event 1796 D: Jenner developed the smallpox vaccine 1847 C: Simpson discovered chloroform was an anaesthetic 1848 H: Hannah Greener died from a chloroform overdose 1852 F: The British government made the smallpox vaccine compulsory 185 E: Queen Victoria used chloroform during childbirth 1854 K: Nightingale went to the Crimea to improve hospitals 1859 G: Nightingale wrote Notes on Nursing 1860 A: Nightingale set up the Nightingale School of Nurses 1861 L: Louis Pasteur published his Germ Theory 1865 J: Lister used the carbolic spray in the operating theatre 1876 B: Koch identified the microbe for anthrax 1882 I: Koch identified the microbes for tuberculosis and typhoid Page 2: RAG: Rate the timeline Amber: 1796 Edward Jenner discovered the smallpox vaccine Amber: 1842 Edwin Chadwick published his Report on the Sanitary Conditions of the Labouring Classes Red: 1847 Simpson discovered chloroform as an anaesthetic Green: 1848 First Public Health Act Green: 1852 Government made the smallpox vaccine compulsory Green: 1854 Cholera epidemic Amber: 1854 Dr John Snow proved that cholera was caused by dirty water Green: 1858 The Great Stink Red: 1859 Nightingale wrote Notes on Nursing Green: 1861 Louis Pasteur published his Germ Theory Green: 1875 Second Public Health Act Amber: 188 Koch discovered the microbe that caused cholera 4

5 Page 2: Spot the mistakes In 1848 the British government passed the first Public Health Act. This was because the deadly disease cholera returned to Britain. The government had listened to the advice from Edwin Chadwick and passed an act that could provide clean water to its citizens. Unfortunately, it had little impact because the measures were too expensive. When cholera returned in 1854, Dr John Snow was able to prove that it was spread by dirty water. But he was unable to explain how or why. In 1861, Louis Pasteur published his Germ Theory. He did this after experimenting with liquids. The new understanding of the cause of disease and illness led to the government passing the second Public Health Act in This Act was compulsory and shows the change in attitudes towards the government s role in public health. Page 25: Choosing a third cause Reason: New technology. Why I have chosen this reason: New technology has enabled doctors to identify irregularities inside the human body that cause disease and illness. Details to support this reason: CT and MRI scans create detailed images of internal organs to diagnose internal damage, tumours and other growths. Ultrasounds produce a medical image from sound and can diagnose kidney stones. ECGs (electrocardiograms) measure heart activity and identify irregular heart movement. Endoscopes are used to see inside of the body and investigate digestive problems. Blood pressure monitors measures blood pressure to diagnose high and low blood pressure. Page 25: Complete the paragraph Understanding of the cause of illness has changed in the twentieth century as scientists and doctors have increased their understanding of the link between lifestyle and disease and illness. It is now accepted that smoking, diet, alcohol and tanning are the causes of disease. It is now accepted that smoking causes a variety of diseases, such as high blood pressure, a wide range of cancers and heart disease. Diet has also been identified as a cause of disease and illness. What we eat has a huge impact on our health and we are advised to maintain a healthy diet. For example, too much sugar can lead to type 2 diabetes and too much fat can lead to heart disease. Doctors now understand that skin cancer can be caused by too much exposure to the sun without sunscreen. With this additional knowledge of how disease and illness can be caused by lifestyle there is more emphasis on the role of individual and education in medical understanding. Page 27: Organising knowledge Individuals Fleming: initial discovery that penicillin kills the staphylococcus germ in 1928 The Church The government Science and technology Attitudes in society Florey and Chain: development of penicillin as an antibiotic, both in Britain and the USA The British government funding Florey and Chain s initial research. However, the main contribution came from the US government when it funded the mass production of the drug during the Second World War Scientific experiment by Florey and Chain when they developed penicillin; initially on mice and then on humans. Technology the creation of the initial equipment needed to make enough penicillin to carry out these scientific experiments 5

6 Page 27: Identify the view What view is offered by the statement about the development of penicillin? That the development of penicillin took place because of the work of individuals; Howard Florey and Ernst Chain. Knowledge which agrees with the statement Knowledge which disagrees with the statement Florey and Chain read and developed the work of Fleming. They secured funding from the British government to create enough penicillin and to test it on mice and humans. During the Second World War, Florey and Chain secured the funding from the USA for the mass production of penicillin Other factors also played a role: Science and technology: scientific experiment by Florey and Chain when they developed penicillin; initially on mice and then on humans. Technology enabled the creation of the initial equipment needed to make enough penicillin to carry out these scientific experiments The government: the British government s funding of Florey and Chain s initial research. However, the main contribution came from the US government when it funded the mass production of the drug during the Second World War The statement is partially correct because the work of Florey and Chain was vital in the development of penicillin. Florey and Chain read and developed the work of Fleming, who initially discovered that penicillin killed the staphylococcus germ in They secured funding from the British government to create enough and test penicillin on mice and humans. During the Second World War, Florey and Chain secured the funding from the USA for the mass production of penicillin. Without the work of Florey and Chain, knowledge of penicillin and its ability to eliminate deadly infections would not have been recognised and understood. However, the statement is partially incorrect because other factors also played a role in the development of penicillin. Science and technology was important. Scientific experiments were carried by Florey and Chain when they developed penicillin; initially testing it on mice and then on humans. Technology enabled the creation of the initial equipment needed to make enough penicillin to carry out these scientific experiments. This shows that science and technology was vital in providing Florey and Chain with their knowledge and understanding of the powers of penicillin in medicine. Page 29: The comparison question Answer 1 because the argument about change across both time periods is supported by precise historical knowledge of both the nineteenth and the twenty-first centuries. Page 1: Eliminate irrelevance The trench system used in the First World War by the British began in 1914 and was improved from The trenches were dug quickly and so were very simple to start with. There was the front line trench, which was closest to the enemy and is where soldiers would fire and mount an attack from. Behind the front line trench was the command trench. The reserve line trench was the furthest away from the front line. It was here that soldiers would be mobilised from for a counterattack should the enemy make it into the front line trenches. Between the British and German trenches was an area of unoccupied land called No Man s Land. 6

7 Page : You re the examiner Chlorine gas was used in the Western Front by the Germans in Chlorine gas to led to death by suffocation after attacking a victim s lungs. Mark 2 Reason: Feature (chlorine gas) and supporting information. Now suggest what the student has to do to achieve more marks. This student needs to write about another feature and add supporting information. Write an answer that would achieve more marks. Chlorine gas was used in the Western Front by the Germans in Chlorine gas to led to death by suffocation after attacking a victim s lungs. Mustard gas was an odourless gas. Mustard gas caused blisters and could burn the skin through clothing. Page 5: The utility question Answer 2 is better because the student explains how the content of both sources is useful and supports their argument with their own historical knowledge. Page 7: Complete the answer The Thomas splint was used in surgery on the Western Front. After its introduction men with a gunshot or shrapnel wound had an 82 per cent chance of survival. Mobile X-ray units were also used on the Western Front. They were used to locate shrapnel and bullet wounds. Page 7: The utility question Answer 2 is the stronger answer because it is a developed argument about the usefulness of the provenance of Source A and supports this with precise historical knowledge. 7

8 Page 9, Organising knowledge Factor Before First World War During First World War War wounds Not applicable Wound incision Debridement: the cutting away of dead, damaged and infected tissue around wound Carrel Dakin method: sterilised salt solution in the wound through a tube Amputation: 240,000 men had lost limbs by 1918 Thomas splint used to stop two joints moving: increased survival rate to 82 per cent Infection Aseptic surgery Aseptic surgery not possible X-rays Blood transfusions Discovered in 1895 by Wilhelm Röntgen Radiology departments in hospitals from 1896 First blood transfusion in But, problems with early blood transfusions included blood clots, blood of donor rejected and danger of infection from unsterilised equipment Blood groups were discovered by Karl Landsteiner in 1901 Gas gangrene a problem Used to locate bullets and shrapnel Some problems: could not detect clothing, wounded soldier had to remain still for several minutes and X-ray tubes were fragile and overheated quickly Mobile X-ray units began to be used Blood transfusions used at Base Hospitals from 1915 and Casualty Clearing Stations from Portable blood transfusion kit used, designed by Geoffrey Keynes 1915: sodium citrate added to blood to allow blood to be stored and clotting prevented 1916: citrate glucose solution allowed blood to be stored for up to four weeks 1917: stored blood used at Battle of Cambrai Plastic surgery Not applicable 1915: Gillies sent to Western Front. Interested in facial reconstruction. Skin grafts developed 8

9 Page 9, Organising knowledge Types of sources Useful for Advantages National army records for individual soldiers Experience of soldier Service of soldier Date of birth Enlistment date Family The story of one soldier s experience on the Western Front National newspaper reports Government reports on aspects of the war Medical articles by doctors and nurses who took part in the war Personal accounts of medical treatments by soldiers, doctors, nurses or others who were involved Photographs Hospital records Army statistics Details of battles Progress of war Overall impact of war on the British army Progress of war Impact of battles on British army Detailed information about the new wounds experienced and how they were treated and prevented Details of new surgical procedures developed in war Descriptions of wounds, injuries, illness, disease and infection experienced by soldiers Visual image of terrain, injuries, medical equipment and advances Numbers of soldiers treated during an offensive Nature of wounds, illness, disease Surgical procedures Treatment given to soldiers Numbers of soldiers in each battle Numbers of soldiers injured or dead after each battle Insight into the information shared at home about the Western Front Not produced for propaganda reliable and accurate figures First-hand accounts of medical advances Shows medical progress because of battles on the Western Front Not produced for propaganda reliable and accurate figures A personal story truth Snapshot of a second in time. Not altered with or created from opinion Not produced for propaganda reliable and accurate figures Not produced for propaganda reliable and accurate figures Page 41: Complete the answer l Where the feature has been identified. l Where supporting information has been added. The wounded were first collected by a stretcher bearer. Each battalion had sixteen stretcher bearers and it took four men to carry a stretcher. Feature 2: There were also Casualty Clearing Stations on the Evacuation Route. These were located in tents or huts about 10 miles from the fighting. 9

10 Page 44: Develop the detail In the seventeenth century it was believed that miasma (bad air) was the cause of disease. This was believed during the Great Plague and people would burn tar in the street. However, by the nineteenth century scientists had discovered that germs were the cause of disease. Louis Pasteur published his theory in Page 45: Now have a go There were changes in medical knowledge during the period c.1500 c.1700 because of changes in the attitudes in society and an increase in scientific thinking. Scientists and doctors were encouraged to question the world around them rather than just believe what they read in books. Thomas Sydenham encouraged doctors to question and look closely at the symptoms of his patients, rather than to just believe the ideas of Galen. Questioning and debate was also encouraged by the Royal Society, which met for the first time in The Royal Society encouraged scientists and doctors to carry out experiments, share scientific knowledge and debate new ideas. This questioning led to new knowledge. Thomas Sydenham published his book Observationes Medicae, rejecting the Theory of the Four Humours. In a world of questioning and debate, other individuals were encouraged to develop new ideas that changed medical knowledge during this period. Andreas Vesalius challenged the anatomical ideas of Galen after dissecting human bodies. He proved that a human had only one jawbone and that blood did not pass through the septum. Vesalius new ideas about the anatomy of the human body were published in his book The Fabric of the Human Body and circulated widely due to the invention of the printing press. This allowed changes in medical knowledge to take place. With a decline in the power of the Church between 1500 and 1700 there was an increase in scientific experiments. New ideas about the causes and treatment of illness developed following observation and scientific experiments. These included animalcules and transference. Animalcules were seen through a microscope in 168. Some believed these tiny animals were created by illness. Transference was where people believed illness could be passed from a person to an object in order to treat them. This new medical knowledge spread throughout this period thanks to the printing press and the Royal Society where these ideas would have been discussed and debated. Page 46: Now have a go A disagree paragraph using the second bullet point. On the other hand, the discovery of John Snow that cholera was caused by dirty water was also an important factor in improving public health in towns during the nineteenth century. Snow carried out an investigation of the Broad Street water pump after observing the number of deaths in this area from cholera. He noticed that those dying were using the same water pump and so he removed the handle; taking the water pump out of use. When he did this, the number of deaths went down. Snow then investigated further and noticed that there was a cesspit next to the water pump with a cracked lining and waste from the cesspit was seeping into the water and spreading cholera. Snow had proved that dirty water was a cause of a major killer in the nineteenth century. Unfortunately, the government did not act immediately. It needed Pasteur s Germ Theory to explain Snow s findings. However, the government did eventually fund the building of a sewer network below London to remove waste and dirty water. This was designed by Bazalgette and begun in