1. Year 9 May Exam Revision booklet
Name:
Class teacher:
To be completed by:
Use the information in this booklet AND your class notes to complete the tasks and revise for your exam! The last page has information to help you structure your answers – make sure you learn this!
Content:
Revised:
Due in:
How dangerous was surgery in the Middle Ages?
How did surgery progress through the Renaissance?
Anaesthetics: How did they develop, What was their impact/
The role of the NHS in medicine and opposition to it.
16 marker exam question.
Top tips for exam questions card.
What questions will I be asked?
How useful is this source? (8 marks)
Explain the significance of… (8 marks)
Compare/in what ways are they similar or different? (8 marks)
Essay question on the role of factors (16 marks +4 SPGST)

2. Medieval Treatments and Surgery
Summary
Surgery was dangerous and painful
There were five main types of healers
The Islamic Empire increased its knowledge
The Church played a vital role in Western medicine.
Dissection was not allowed.
Background
When the Romans left Britain in 450ad they took all of the knowledge that they had with them. This led to medicine going backwards as WARS prevented people from discovering knew ideas. The CHURCH played a vital role in bringing back knew ideas from the Islamic Empire, which had kept much more of the Roman ideas.
The Christian Church
Treated people with non-infectious diseases at HOSPITALS as part of their Christian duties.
They used a mix of herbs and prayer to cure patients
They did not understand about the need for hygiene so people shared beds.
Only 10% of hospitals treated the sick. The rest looked after the poor and needy.
They did NOT treat, pregnant women, the insane, wounds or infectious diseases.
Supported the work of Galen above all others
Banned dissection so knowledge of the anatomy was limited.
Healers
Healer
What they did and who they worked for
Physician/Doctor
University trained
Used Galen’s and Hippocrates’ ideas
Used mainly herbs
Were expensive so mainly treated the rich
Barber Surgeon
Trained with an apprenticeship
Cut hair and amputate infected limbs and warts.
Cheap so used by all
Wise Woman/Midwives
No formal training, learnt from mothers etc.
Cured using herbs etc.
Very cheap so everybody used them
Quack Doctor
No training
Created their own cures and sold these at fairs
Very cheap but unlikely to work.
Monks
Used cures they learnt from books
Mainly cured used herbs and prayer.
Treated all as part of their Christian duty.

3. Medieval Treatments: use the information on the previous page to fill this in.
Background
When the left Britain in 450ad they took all of the knowledge that they had with them. This led to medicine going backwards as WARS prevented people from discovering knew ideas. The CHURCH played a vital role in bringing back knew ideas from the Islamic Empire, which had kept much more of the Roman ideas.
The Christian Church
Treated people with non-infectious diseases at as part of their Christian duties.
They did not understand about the need for so people shared beds.
Only of hospitals treated the sick. The rest looked after the poor and needy.
They did NOT treat, pregnant women, the insane, wounds or infectious diseases.
Banned so knowledge of the anatomy was limited.
Healers
Healer
What they did and who they worked for
Physician/Doctor
Trained with an apprenticeship
Cut hair and amputate infected limbs and warts.
Cheap so used by all
No formal training, learnt from mothers etc.
Cured using herbs etc.
Very cheap so everybody used them
Quack Doctor
Used cures they learnt from books
Mainly cured used herbs and prayer.
Treated all as part of their Christian duty.

4. How did the factor of WAR aid surgical progress?
HOW DANGEROUS WAS SURGERY IN THE MIDDLE AGES?
PROBLEMS WITH SURGERY
Medieval surgery was very dangerous –there was no way of preventing _________, _____ ______ or _________. It was therefore only rarely attempted and for minor procedures.
There were a few university trained highly paid surgeons, but surgery on the whole was NOT respected.
Bloodletting was the most common treatment.
What?
Why?
How was it dangerous?
Who treated the sick?
B________ S__________
Q_________ D________
W______ W_________
M_________________ A__________________
Explain the following treatments and how they could be dangerous:
T__________
A__________
T_____ P______
C__________
R_____ C______
Key individuals:
CHALLENGE:
How did the factor of WAR aid surgical progress?
JOHN OF ARDERNE
HUGH OF LUCCA

5. HOW DID SURGERY PROGRESS THROUGH THE RENAISSANCE?
Believed surgery could only be successful if doctors had a proper understanding of anatomy.
Performed dissections on criminals who were executed.
Write books including accurate diagrams of his work – “Fabric of the Human Body” (1543) and “Six Anatomical Pictures” (1538)
His books were printed and distributed around Europe (inc. GB) – this shows the importance of the PRINTING PRESS.
He proved lots of Galen’s theories wrong (such as the lack of holes in the septum of the heart)
He encouraged others to question Galen, and look at anatomy – in the long term this was very significant.
VESALIUS
Born 1514
Medical professor at Padua in Italy
Harvey studied animals and humans. Found he could observe living animal hearts in action, and his findings would apply to humans.
BEFORE Harvey, people thought there were 2 kinds of blood, through 2 completely different kinds of blood vessels (this came from Galen.)
Harvey realised Galen was wrong – he realised there was too much blood for Galen’s theory, and thought that blood must circulate.
Harvey’s idea, shown in books, gave doctors a map of how the body worked and changed their understanding of anatomy.
Not everyone believed him – it was a long time before doctors used his ideas in their treatments. EG – people continued to use bloodletting even though Harvey proved this to be wrong!
HARVEY
Born 1578
A British doctor who studied at Padua, then worked in London at “Royal College of Physicians”
Became Royal Physician to James 1 and Charles 1.
As an army surgeon, Pare treated many serious injuries caused by war – his experience treating these wounds led him to develop improved surgical techniques.
BEFORE Pare, gunshot wounds often became infected. Drs didn’t know how to treat them – usually they would burn the wound with red-hot irons, or pour boiling oil into it.
PARE – once ran out of oil and resorted to a cool SALVE instead – these patients did better than the others.
PARE – invented LIGATURES to tie off blood vessels. Less painful so patients didn’t die of shock – did increase risk of infection.
PARE published his ideas, but his ideas were resisted by doctors who didn’t trust surgeons. When he became surgeon to King of France, then he was taken more seriously.
PARE
Born 1510
French barber-surgeon for a public hospital, then in the army.
While at anatomy school, was present at more than 2000 dissections, as this was now a popular method of teaching surgeons. He had an unrivalled understanding of the body.
He made several important discoveries about venereal diseases, a major cause of illness at this time.
He developed a new approach to treatment of gunshot wounds.
1785: during an operation he introduced a new way to treat an aneurysm in a man’s thigh. He tied off the blood vessel so blood would flow through other vessels – preventing amputation.
He encouraged others to learn as much about the body as possible to understand illness, experimenting, and testing treatments on animals first.
JOHN HUNTER
Studied at anatomy school in London.
Became an army surgeon in France and Portugal.
Popular teacher in England.

6. Bullet point your ideas below!
HOW DID SURGERY PROGRESS THROUGH THE RENAISSANCE?
Use the notes to discuss below what the major changes were, and how similar this was to before.
VESALIUS
HARVEY
PARE
JOHN HUNTER
How similar/different was surgery around John Hunter’s time to before the Renaissance?
Bullet point your ideas below!
Similar !
Different!

7. Use the information above to fill in your plan below:
3.Compare surgery in the Middle Ages with surgery at the time of John Hunter.
Types of Surgery: in both periods surgeons tended to operate on the outer parts of the body and not do internal surgery. In the Middle Ages as the wound man shows injuries to the main torso were fatal. Barber surgeons did some bleeding and the cutting off of growths. In the 18th-century doctors did not operate deep inside the body but they could remove stones, growths and set bones.
Knowledge of infection and Pain relief: in both periods surgeons worked in a similar way, they had to operate quickly because there were no really effective anaesthetics and the surgeon wanted to limit the amount of pain the patient suffered. In the Middle Ages they had opium and hemlock which could dull the pain but not completely take it away. In John Hunter’s time as in the Middle Ages they were still operating quickly to reduce the amount of pain. For example…they are similar because in both periods surgeons did not know about germs and infection. A dominant view in the Middle Ages was that pus formation was necessary to proper healing. Only a few original thinkers like Theodoric of Lucca, and later Henri de Mondeville, challenged the idea and used wine as a disinfectant. In John Hunter’s time, surgeons still worked in their ordinary clothes and allowed a large audience in a public place, so there was no knowledge or concern for infection.
Access to Barbers Guilds and training: they are similar because in both the Middle Ages and the 18thcentury surgeons learned from having a long apprenticeship to an established surgeon or barber surgeon. There was no substitute for learning through watching and doing. In the Middle Ages the barber-surgeon guild got privileges from Henry VIII in 1540 to use criminals for demonstration dissections and controlled entry to the profession. In the 18th century John Hunter’s brother, William ran a dissection school. And John Hunter himself was apprenticed to Percival Pott and William Cheselden at Chelsea Hospital.
Use the information above to fill in your plan below:
Similarity 1: A similarity between surgery in the Middle Ages and the Time of John Hunter is….
Similarity 2: Another similarity is…

8. Surgery: Anaesthetics
Information fact file on Laughing Gas
In 1799 Sir Humphry Davy discovered that Laughing gas reduced the sensation of pain. Forty years later dentists used it to ease the pain of tooth extractions and surgeons were experimenting with alternative substances.
The problem with laughing gas was that it didn’t always knock the patient out.
The first successful attempt was in 1846.
Information fact file on Ether
Ether was first successfully used in 1846 by John Collins in Massachusetts General Hospital.
A year later JR Liston in London used Ether to anaesthetise a patient during a leg amputation.
Ether had severe drawbacks because it irritated the lungs, causing the patient to cough during the operation. It was also unstable and produced inflammable vapour.
Information fact file on Chloroform
James Simpson was Professor of Midwifery at Edinburgh University
One evening in 1847 he invited several colleagues to his home. They sat around the table experimenting with different chemicals. “I poured some (Chloroform) fluid into tumblers in front of my assistants, Dr Keith and Dr Duncan and myself. Before sitting down to supper we all inhaled the fluid, and were all ‘under the table’ in a minute or two, to my wife’s consternation and alarm”
Simpson by chance had discovered a very useful anaesthetic. He soon started to use it to help relieve women’s labour pains during childbirth.
He wrote about his discovery and other surgeons started to use it in their operations.
People’s reaction to this amazing discovery (by many surgeons) was intense opposition. Some had medical arguments – such as chloroform was a new and untested gas. No one knew if there would be long-term side effects on the body/mind of the patient.
They did not know what dose to give to different patients. The first death from chloroform scarred surgeons and gave opponents powerful evidence against the use of anaesthetics Hannah Greener died whilst being given chloroform to remove a toe nail.
However, in 1857 Queen Victoria publicly praised ‘that blessed chloroform’ when she used it during the delivery of her eighth child. After this anaesthetics became a standard part of surgical practi5ce

9. Task : Use the information on the previous page to complete the grid.
Person
Substance
Details and problems:
Humphry Davy
J.R. Liston
James Simpson

10. Task read the info and answer the question below.
Revise Anaesthetics:
Why are Anaesthetics important? Anaesthetics were significant in the 19th century as it meant that patients no longer suffered pain and died of shock. This enabled surgeons to begin to develop more complicated procedures. Types of Anaesthetic: Since James Simpson started using chloroform in 1847, patients no longer were conscious during the operation, so they weren’t at risk of dying from shock of the pain. Anaesthetics such as chloroform were easy for surgeons to handle and less explosive and inflammable than ether so they could be used during difficult labours, which meant that women did not have to suffer pain when giving birth. Impact Today: Today modern anaesthesia is significant as it uses a mixture of chemicals to produce gradual loss of pain and consciousness, thus modern anaesthetics allow brain surgery with consciousness, which in turn enables doctors to gain knowledge about the body. They now use both local and general anaesthetics so people having key whole surgery or day surgery can have only a local anaesthetic which means there is less stress on the body and more operations can be done.
1. When were anaesthetics first developed?
2. What did anaesthetics prevent people dying from?
3. What did anaesthetics allow surgeons to do?
4. Who developed chloroform as an anaesthetic and when?
5. Why was Chloroform better than Ether?
6. How did Chloroform help during Labour?
7. What is modern anaesthesia made of?
8. How does this help with brain surgery?
9. What 2 types of anaesthetic are there?
10. How does this help?

11. The creation of the NHS! William Beveridge The Beveridge Report 1942
Aneurin Bevan
Creator of the NHS 1946
The Beveridge report (1944)
In 1942 William Beveridge was asked by the government to write a report on the state of Britain. He wrote a report which called for a WELFARE STATE, to end the 5 giants/evils that made people poor.
It was considered right that the state should help people from ‘Cradle to Grave’.
The Welfare state would provide: free education, free healthcare, unemployment benefit and pension.
Beveridge suggested this should be paid for by National Insurance.
This led to the NHS which is ;Free at the point of delivery’. This included both men and women as well as children. At the beginning it included dentists and glasses but due to cost these were quickly dropped for adults.
1946- National Health Service introduced.
The Welsh Labour politician, Aneurin Bevan, spearheaded the establishment of the NHS in Great Britain.
National Health Service Act (1948) - despite opposition from doctors, who insisted on the right to continue treating some patients privately, Aneurin Bevan brought in the NHS on 5 July Doctors, hospital, dentists, opticians, ambulances, midwives and health visitors were available, free to everybody.
Opposition to the NHS
Some doctors were against it because they thought they would loose money.
Doctors were worried they would lose money because of the loss of private patients (doctors can still work privately today because of this).
People believed it would make the poor lazy (especially the benefits)
People were worried by the cost
Aneurin Bevan the Minister for Health, promised to pay doctors a salary and he allowed them to have fee paying private patients as well as working for the NHS.
Disease
Want
Ignorance
Idleness
Squalor

12. How do I answer this question?
Source Analysis:
Annotate this source to explain the meaning of each key feature:
How do I answer this question?
Focus on the CONTENT of the source.
What can you see/learn?
What can you infer/suggest?
What is the message?
Then assess the PURPOSE:
PROVENANCE!
Which means PURPOSE!
What reaction does the author want?
Why have they created the source?
Look at the DATE – to help with purpose.
A cartoon published in It shows Aneurin Bevan giving doctors medicine they don’t like.
Provenance:
Purpose: Why was it created
Is it useful?
What is the message of this source?

13. FACTORS THAT IMPACTED THE PROGRESS OF MEDICINE SINCE MEDIEVAL TIMES
WAR
Destroys the Roman public health systems
such as Aqueducts and baths and made communications difficult meaning that medical ideas were difficult to spread.
Improves surgery during the Renaissance
This is because it led to development of new techniques by Barbour surgeons and afforded them an opportunity to see inside the body because of wounds.
Improves medicines as physicians are forced to react to circumstance.
French doctor Pare, who produced an ointment of egg-yolk, rose oil and turpentine to treat infection and replaced the cautery iron with silk ligatures to tie up wounds
Nursing
1854 Crimean war: Florence Nightingale shows that clean hospitals reduce deaths
SCIENCE AND TECHNOLOGY
Science is anything involving experiments or careful observation. Technology is the use of equipment.
In the 16th century printing allowed new ideas to spread, such as ‘The Fabric of the Human Body’ in 1543 and Pare’s Work on Surgery
William Harvey used scientific method using glass rods and dissecting cold blooded animals to prove the heart acted as a pump.
Science: Robert Koch use scientific method to stain bacteria purple and identify the germs that cause specific diseases such as TB.
Louis Pasteur used scientific method holding public experiments.
Paul Erhlich used scientific method testing 606 experiments of arsenic solution to create the magic bullet Salvarsan 606.
The new Freeze drying technology developed by Florey and Chain allowed the mass production of penicillin.
GOVERNMENT
INDIVIDUAL GENIUS
OTHER FACTORS YOU COULD CHOOSE.. Chance,, communication

14. Exam Question:
Has war been the main factor in the development of medicine in Britain since medieval times?
Start with the factor named in the question.
Then write 2 more paragraphs about different factors.
Come to a conclusion. ‘compare and link factors’
Factors:
War
Science and technology
Individuals
Religion
Government
Complete the colour code on factors:
In the Medieval period monks and nuns treated the sick and started the first type of hospitals.
War was useful as it helped Barbour surgeons practice new techniques and improve amputation.
The Church was very powerful and banned dissection, this prevented surgeons and doctors learning about the anatomy.
War was useful, as Barbour surgeons saw more of the anatomy due to open wounds from gunshots and swords.
The government during the black death ordered the streets in London to be cleaned.
Monks and Nuns translated all medical textbooks such as the work by Galen and Hippocrates.
War helped Pare improve surgery by developing ligatures to replace the red hot cautery iron as a way to stop blood loss and seal wounds.
Scientific methods and developments allowed William Harvey to complete dissections on the heart to prove Galen wrong.
The Church ran universities to train doctors and teach them about the work of Galen and Hippocrates.
The new development of the Printing press helped Vesalius to spread his ideas on the anatomy through his book the Fabric of the Human Body.
Vesalius stole criminal bodies to dissect and performed dissections and got artists to draw detailed drawings. He proved Galen wrong about 200 ideas about the anatomy.
Pare when he ran out of boiling oil to treat gun shot wounds, used an old Roman ointment with egg yolks and rose oil. This was clever thinking and worked better than pouring boiling oil into wounds.
War in the Middle Ages was disruptive as it destroyed all the Public Health systems and Roman ideas and so lots of ancient ideas about medicine were lost.
The Church banned people from questioning Galen and locked Roger Bacon in prison, the power of religion however faded and by the Renaissance dissection was allowed.
KEY:
War
Science and technology
Individuals
Religion
Government

15. You have 50 minutes to complete this section.
Exam skills:
What will my paper look like?
How long do I spend on each question?
SPAG:
You need to use full stops, capitals, paragraph and use key terms for the 16 marker.
You have 50 minutes to complete this section.
Question Mark
Time for question
Total number of paragraphs: 8
10 minutes
2 paragraphs 16
20 minutes
4 paragraphs: Which means:
3 factors and a CONCLUSION.

16. How useful? – in terms of content and author and aim.
Become an exam expert!
Answer these questions using the info on the previous page:
How long is your exam?
How many questions are there?
How much do you write for an 8 marker?
How long do you spend on a 16 marker?
Which question do you get spag marks for?
Explain the significance…
Significance:
Does not mean importance it means IMPACT!
You need 2 paragraphs:
Then- what was the impact at the time!
Now- what has change- what is the impact since.
How useful? – in terms of content and author and aim.
Ask:
1. What d we know?
2. What does it say?
3. What can we infer from it- educated guess?
4. Why was it created?
5. What is it’s purpose?
Start with the factor named in the question.
Then write 2 more paragraphs about different factors.
Come to a conclusion. ‘compare and link factors’
Complete the ‘How To answer’
How Useful?
Explain the significance?
16 marker: FACTORS