Unit 1: Local and Global Citizenship

Section 1: Development Study: Medicine and treatment

Chapter 3: Medicine and public health from Roman Britain to c13503.1 The Romans and approaches to medicine

Exam practice (page 17) 1. Describe the key features of the Romans beliefs about the causes of disease. [6]

The Romans believed that disease was caused by an imbalance in the four humours. They believed that the body was made up of black bile, yellow bile, blood and phlegm, and that too much or not enough of one of these would cause illness. A fever, for example, showed that you had too much blood. This belief was developed by Galen from the work of Hippocrates, an Ancient Greek doctor. The Romans also believed that bad air could cause disease. They thought it was important to build cities and settlements away from swamps and marshes. This would have helped them avoid diseases like malarias which were caused by mosquitoes, but they didnt understand why. The Romans also believed that dirt and sedentary lifestyles caused disease because they encouraged the population to bathe regularly and exercise in the bath house. However, they would not have understood why this kept people healthy.

Exam practice (page 18) 2. How important was the influence of Hippocrates on Roman medicine? [16]In some ways the influence of Hippocrates on Roman medicine was extremely important. Hippocratess teachings included the theory of the four humours, which taught that the body was made up of four elements and too much of one of these would cause illness. He also taught the importance of clinical observation: watching a patient very carefully and keeping detailed notes of their symptoms and how their illness progressed. This was very important in Roman medicine because both of these theories were used by Galen. Galen had been a doctor at a gladiator school but he ended up in Rome treating the emperors family. Therefore he had a huge influence on Roman medicine, and because Hippocrates had a huge influence on him, that meant that Hippocrates also had a big impact. However, Galen did change Hippocratess ideas in some ways. For example, he added to the theory of the four humours to focus treatment on balance the idea of not just removing too much of one humour, but adding something when there wasnt enough. For example, if somebody was suffering from a lack of blood, they might be treated with hot chilli. The Romans also had some of their own ideas about medicine and the causes of disease; for example, they thought bad air caused disease and they had a particularly strong focus on public health. This didnt have anything to do with Hippocrates. However, overall I would say that the influence of Hippocrates was particularly strong in Roman medicine, because Galen used a lot of his theories in his own work.

Exam practice (page 18) 3. How similar were approaches to medicine and treatment in Roman Britain and Anglo-Saxon Britain? [12]There were many similarities in approaches to medicine and treatment through this time period, even though the Romans left Britain in the fifth century. Herbal remedies were widely used throughout the first millennium, for example.The most important continuity during this time period, however, was the use made of the works of Galen. Galen advocated the use of the theory of opposites when diagnosing and treating disease. For example, he suggested treating a cold with something hot, like chilli; blood-letting was prescribed for a wide variety of ailments. This is because Galen believed that illness was caused by an imbalance in the bodys four humours.Galen was a doctor in Ancient Rome and so his ideas were used widely in the Roman Empire; when the Romans left Britain, his books remained in the monasteries and the Church promoted his work because it fitted in with Bible teachings. Therefore, treatments based on the works of Galen were similar in both Roman and Anglo-Saxon Britain. There were some differences, however. Astrology was much more important by the end of the twelfth century and this influenced diagnosis of disease and sometimes its treatment. Furthermore, most aspects of Roman public health works were lost during the Anglo-Saxon period, and with it the preventative medical ideas of keeping clean and exercising to stay healthy.

3.2 Approaches to public health before 1350

Exam practice (page 20)1. Describe the key features of public health in Roman Britain. [6] The Romans improved public health in Britain hugely after they conquered the country in AD43. They built aqueducts to ensure clean water was supplied to their troops and forts, and this was also shared by the local population who also benefited from the supply. They also created a system of sewers to remove dirty water and waste from populated areas, to keep people healthy. Furthermore, they used the clean water in the bath houses they built. These were built to Roman design and to begin with they were mostly used only by the Romans. However, they were made available for everybody to use for a very small sum of money and over time more of the local population began to use them too.

Exam practice (page 21) 2. After the Romans left Britain the progress they had made in public health did not continue. Do you agree? Explain your answer. [16]When the Romans left Britain it was difficult for their progress in public health to continue. This was because they took their knowledge and expertise with them. For example, there were no longer any engineers left who knew how to build or maintain aqueducts. This meant that when these structures broke they couldnt be fixed, and so over time there was less provision for clean water. The local population used the stone from the bath houses and other structures to build their own homes as there was less emphasis on public health. The new rulers of Britain did not think it was as important as the Romans had. By 1350 there were some quite serious public health problems in towns, where the lack of fresh water and drainage was a problem. The government was not willing to donate funds to fixing this problem. Therefore, the Romans progress was not maintained. However, some things that the Romans did had a long term impact. For example, in the Middle Ages some towns still offered public toilets and baths, in the form of stewes where the public could go and wash. The Romans had been careful not to build near swamps and the idea that bad air could cause disease was still popular. However, I wouldnt call any of these things progress. The Romans made considerable headway during their stay in Britain but after they left this was not continued. In a way it was less important because there were less large settlements, but public health did not really become a key focus for government again until the nineteenth century. Therefore, I agree with the statement.

3.3 The impact of religion

Exam practice (page 23) 1. How far did ideas about the cause of disease change from the Roman period to the end of the Middle Ages? [16]The Church played an important role in caring for the sick during the Middle Ages because it believed that it was part of its Christian duties. Therefore many monasteries and convents provided hospitals. They would look after people, give them a bed to sleep in, food to eat and pray for them to recover. They filled a gap in provision because they looked after people who didnt have family members who could care for them. However, the hospitals would not admit people who had infectious diseases, such as the plague. They mainly looked after the elderly, the disabled, or people suffering from non-contagious diseases such as leprosy. There were very rarely doctors in attendance. Therefore, hospitals provided by the Church were more like rehab units where people could rest and build up their strength, or where they went to die. The sick would not go there for treatment. Overall, the Church played an important role in caring for people, but not in caring for people who were really sick.

3.4 The impact of government and war

Exam practice (page 24) 1. To what extent did medicine and public health change between the Roman withdrawal from Britain and c1350? [16]

In some ways medicine and public health changed a lot between the Romans leaving Britain and 1350. In particular, public health changed. The bath houses and aqueducts which the Romans had built steadily decayed because there were no engineers to maintain them. The stone was sometimes taken and used in other building projects and there was a lot less emphasis from the government on cleanliness and hygiene. Public health problems increased after the population of some major towns like London and York began to grow. Therefore, after the Romans left Britain there was a real change in public health, and it wasnt a positive one. However, in some ways it stayed the same particularly in medicine. This is because the Church liked the teachings of Galen and promoted them in its universities. Galen had been a Roman doctor and his ideas about the human body being perfectly designed fitted in with the teachings of the Bible. Therefore, doctors continued to use the theory of the four humours and Galens teachings on anatomy, amongst other things, until well after 1350. Some things did change. For example, the Church taught that God sent disease; but the teachings of Galen still formed the largest part of the work of the doctor. Therefore, I think that public health changed a lot between the Roman withdrawal from Britain and 1350, but not a great deal changed in medicine.

Chapter 4: Medicine and treatment c1350c17504.1 Medicine at the time of the Black Death

Exam practice (page 26) 1. Why was the Black Death such a problem in Britain from c1350 onwards? [12]The Black Death was a problem in Britain from 1350 onwards because nobody knew what caused it. There was no understanding of the causes of disease or how it was spread, which meant that it spread very quickly and there was no satisfactory cure. Large numbers of the population died and in some places there werent enough people left alive to bury the bodies of the plague victims. The disease was spread by fleas carried by rats that arrived in Britain on trading ships. However, nobody knew this and therefore people tried all sorts of things to avoid catching the Black Death. The most common of these was prayer, to ask God for forgiveness so he would spare you. Burning barrels of tar to drive off the bad air which was thought to spread the disease was also common. Unfortunately these things didnt work very well and so the Black Death continued to be a problem in Britain. Finally, the Black Death was a problem in Britain because there wasnt much effort made by the government to prevent outbreak of the disease. It did take some action, which varied through the centuries, for example quarantining houses where outbreaks had occurred, burning barrels of tar and vinegar in the streets and killing cats and dogs. However, the government only ever reacted to outbreaks of the disease, rather than taking preventative action. Again, this was mainly because it did not know what caused it.

4.2 Ideas about the causes of disease: the influence of the past

Exam practice (page 27) 1. How useful is Source A to a historian who is studying ideas about medicine c1350 to c1750? Use the source and your own knowledge to explain your answer. [8]This source is quite useful for telling us about medicine c1350 to c1750 because it shows details of the four humours, which was the medical theory most commonly practised at the start of this period. The theory was created by Galen in Ancient Rome but you can see that this is a contemporary illustration because it also displays astrological symbols, which doctors matched with the various humours at the start of the Middle Ages. Most doctors in 1350 would have been trained using materials like this because the Church controlled medical training and supported this idea. Because the picture is from a medical encyclopaedia it is a reliable representation of ideas about medicine in the sixteenth century. However, this source does not tell us anything about medicine after the medical Renaissance and the decline in the influence of the Church. Galens theory was discredited at this time and doctors began to look for more scientific reasons for disease. Therefore, the source is only useful for telling us about one medical idea from this time. An historian studying ideas about medicine in this time period would need more sources of information to get the complete picture.

4.3 The impact of the Renaissance on medicine and medical training

Exam practice (page 28)1. Why were art and printing so important in improving medical understanding during the Renaissance? [12]Art and printing were important in improving medical understanding during the Renaissance because they helped doctors and medical professors to share their discoveries and research more efficiently with each other. Printing made it easier and cheaper to mass produce copies of medical research and send it further afield, therefore improving communication among doctors from across Europe. For example, Vesaliuss collection of books On the Fabric of the Human Body contained information about the mistakes in the works of Galen and sold very widely among medical professionals. Art also had an impact because it helped to create more realistic and lifelike images of the human body. Vesaliuss books had over 200 illustrations which were drawn from dissections he had carried out on the human body. This was different from the past, when artists had drawn in a more two-dimensional style and rarely from life. This meant that there were a lot more accurate portrayals of the human body available to doctors, who used this to improve their understanding of anatomy.

4.4 Medical Megastars: Vesalius and Harvey

Exam practice (page 31)1. Why was Vesalius able to prove Galen wrong in the sixteenth century? [12]

Vesalius was able to prove Galen wrong in the sixteenth century because there was a lot of change going on during the Renaissance. One of the biggest changes was in technology. Printing had been invented and it was cheap and easy to publish books. This meant that once Vesalius had carried out his research, he was able to share it with lots of other doctors and medical students, which helped to convince a lot of people that Galen had been mistaken. Another factor that helped Vesalius was changes in art. It has become fashionable to draw bodies from life, which meant that anatomical drawings became much more realistic and backed up Vesaliuss discoveries about Galens mistakes, for example the idea that blood moves through holes in the heart. A third factor that helped Vesalius was a change in beliefs. The Church became less powerful after the Reformation and this made it possible for Vesalius to acquire and dissect dead human bodies. Galen had not been able to do this and so it was the most important factor in helping Vesalius to prove him wrong. This would not have been possible when the Church was more powerful.

Exam practice (page 31) 2. The bullets below show two key figures from the medical renaissance. Choose one and describe the key features of their medical discoveries. Andre Vesalius William Harvey [6]

The main discoveries of Vesalius were related to human anatomy. Vesalius did a lot of dissections as part of his job as professor of surgery at Padua University. He hired artists to create detailed drawings of the bodies and then published these in the books called On the Fabric of the Human Body. The books were used all across Europe by medical students and helped to massively improve peoples understanding of the human body.

The reason why the work of Vesalius was so important was because he proved Galen wrong on several points. For example, he showed that the lower human jawbone was one piece, rather than two, and that the liver was one large organ rather than having five lobes. The work of Galen was promoted by the Church for medical training and the work of Vesalius discredited it, eventually leading to big changes in the way doctors practised medicine.

Harveys discovery of the circulation of the blood eventually proved to be very important. However, it took a long time for his theory to be accepted and this meant that for a long time the discovery had limited impact. This was because understanding that blood circulated around the body didnt give doctors any new ways to treat their patients and therefore Harveys ideas werent widely used. Doctors continued to bleed their patients in accordance with what they had been taught during their training and continued to follow the teachings of Galen. It wasnt until microscopes were developed and people had the technology to see the smaller blood vessels that attitudes changed towards the teachings of Galen and his work started to have more of an impact.

4.5 Public health c1350c1750

Exam practice (page 33) 1. Why did people living in towns have problems accessing fresh water in the period 13501750? [12]

Between 1350 and 1750 fresh water became a problem because towns were getting bigger. This placed a lot of pressure on the water supplies because there were lots more people using water but the rivers had not grown any bigger so there wasnt any extra water available. Also, more people were using the rivers to dispose of their waste and this meant the water became even more polluted. This made getting fresh, clean water even more of a problem.

The problem was made worse because the authorities at the time werent willing to take action to make fresh water more available. Unlike the Romans, who built a complex system of aqueducts and water pipes to provide clean water to their citizens, government at this time didnt think it was their job to provide for the masses, and they certainly werent willing to spend any money on it. Instead they left it up to private companies who usually charged too much for most people to afford. This made the problem worse, as the private water companies were using the same supplies as the rest of the townspeople and this put even more strain on the supply.

Occasionally people attempted to build new systems for the provision of clean water; for example, in 1608 Hugh Myddelton began a project to bring fresh water into London from a river near Ware in Hertfordshire. However, this was privately funded, cost an enormous amount of money and took five years to complete. Technology was not advanced enough and the will to develop it was not there until much later in the history of Britain.

Chapter 5 Medicine and treatment c175019005.1 Medical Megastars: Jenner and vaccination

Exam practice (page 35)1. What do Sources A and B show about changes in attitudes towards vaccination? [8] Source A shows that vaccination was not popular at first and that people thought having the vaccination would cause them to sprout cow heads or become deformed. This was because the smallpox vaccination involved being injected with cowpox, an animal disease, and people thought this was unnatural and dangerous. Furthermore, Jenner was not able to explain why the vaccination worked, which made matters worse. Therefore there was a very negative attitude towards vaccination. However, Source B shows that attitudes have changed significantly because now vaccination is so popular that GPs have run out of it. This means that lots of people must be volunteering to have the flu vaccine, showing a significant change in attitude from Source A. This is probably because, since the germ theory was published, we understand how vaccination works now and there were vaccinations available for a wide variety of diseases, including measles and tetanus. Attitudes are now completely different because we understand how vaccinations work and can see the benefits of having them.

5.2 Medical Megastars: Pasteur and Koch

Exam practice (page 37) 1. How much did the understanding of the causes of disease change between c1350 and c1900? [12]There was a massive change in peoples understanding of the causes of disease between 1350 and 1900. In 1350 most people believed that disease was sent as a punishment from God, for their sins. Another belief was that the body was made up of four different elements, or humours, and an imbalance in these led to illness. A third belief was that disease could be caused by bad air, which wasnt too far from the truth, but people couldnt explain why. This was because there was a lack of technology and people were unable to see germs or bacteria. People continued to believe this for many centuries and it wasnt really until the nineteenth century that there was a major change. By 1900, the understanding of the causes of disease had moved on to a great degree. Developments in science and technology led to the creation of microscopes. This allowed Louis Pasteur to observe the impact of microbes and so developed the germ theory of disease. This had become widely accepted by 1900 and represented a massive change in peoples understanding. Microbes responsible for specific diseases were identified and cures and vaccines started to be developed. Therefore, there was a complete change in the understanding of the cause of disease between 1350 and 1900.

5.3 Improvements in hospitals and medical training

Exam practice (page 38)1. In what ways did the training of doctors change during the period c1350c1900? [12] The training of doctors changed a lot during the period 13501900. This was mainly due to a change in beliefs and attitudes. At the beginning of the period, the Church controlled medical training and insisted that Galen be taught to all medical students. It banned dissection of human bodies, which meant that doctors could only go on what they learned from Galens books. Over time, beliefs changed and science became more important. During the Renaissance, doctors like Vesalius challenged the authority of the Church by carrying out human dissections and sharing his work. As new technology such as the printing press and the microscope became more available, medical students were able to access lots of new ideas rather than relying on the old ones. Surgeons like John Hunter encouraged their students to carry out their own experiments and observations. This led to a more scientific understanding of illness. By the nineteenth century, medical students were completing part of their training in teaching hospitals which gave them hands-on experience before they qualified. Therefore, the training of doctors changed during 13501900 because there was a move from a religious to a scientific focus in training, and from a theoretical understanding to a practical one.

Exam practice (page 39) 2. Why did medical treatment in hospitals improve c1750c1900? [12]There were several factors responsible for the improvement of medical treatment in hospitals during 17501900. One of these was the increased interest and action of the government. During the nineteenth century its laissez-faire attitude changed to an increased interest in medicine and willingness to get involved in improving the health of the population. It introduced a Poor Law which meant that local tax payers were responsible for funding new hospitals and asylums. This made medical treatment more widely available, thus improving it. Individuals like Louis Pasteur and Florence Nightingale played a big part in improving hospitals. Pasteurs development of the germ theory gave hospitals a greater awareness of the link between dirt and disease, which led to cleaner hospitals. Nightingale had worked hard to improve training for nurses and the hospital buildings, which led to an improved standard of medical treatment. Finally, there had been a big change in peoples attitudes during this time period. There were a lot of social reformers who put pressure on the government to improve standards of living among the poor. This led to it getting more involved and passing laws to make hospitals more available and of a higher standard.

5.4 Medical Megastar: Florence Nightingale

Exam practice (page 41) 1. Describe the key features of the work of Florence Nightingale in the field of nursing. [6]The main feature of Florence Nightingales work in nursing was to change the way nurses were trained and how people felt about them. She began by working with a group of trained nurses in the Crimean war, where she showed that she could improve conditions and this would cut the death rate. Her story was published in the British press and this changed peoples attitudes towards nursing, which before had not been a very well-respected profession.Nightingale then wrote a bestselling book called Notes for Nursing and set up a training school for nurses in 1860, where nurses could learn the profession and then go on to work in hospitals, sharing Nightingales ideas. She had a lot of influence over the government and gave advice to hospital designers to help improve the standard of hospital care by ensuring the hospitals had plenty of light and fresh air.Overall, Florence Nightingales work as a nurse was extremely influential and important because she showed what could be achieved through training and hard work.

Exam practice (page 41) 2. How much did the role of women in medicine change between c1350 and c1900? [12]The role of women changed a lot between c1350 and c1900. In 1350, women were quite heavily involved in medicine, but not in an official capacity. They acted as midwives and attended births; local wise women would provide herbal remedies and advice on curing illnesses; and nuns took a big part in care of the sick, because hospitals were usually in convents or monasteries. However, the nuns didnt have any medical training and would have mostly acted as nurses and said prayers for the people in the hospital. Women could not officially become doctors because they were not allowed to attend university. By 1900 this had changed quite a lot. There was a school for women who wanted to practice medicine, set up by Elizabeth Garrett Anderson the first qualified female doctor in England. Nursing had become more professional after Florence Nightingale set up a school to train nurses. Therefore, the role of women was much more professional by 1900. I dont think it is true to say that they had a much larger role in medicine, because in 1350 most people would have been cared for at home by women. However, the role of women in medicine was more official by 1900 as they were allowed to train and qualify as doctors or nurses.

5.5 Problems of public health c1750c1900

Exam practice question 1 (page 43) 1. Why did diseases such as cholera spread so rapidly in industrial towns during the nineteenth century? [12]

Cholera spread so rapidly in industrial towns in the nineteenth century because people didnt know how it spread. Clean water was in short supply in nineteenth-century industrial cities. They were often very overcrowded because people had moved there to find work in the factories. Therefore small towns became much bigger in a short space of time, which meant that the new housing was built without any thought for the supporting water supply and waste disposal. Cess pits were often dug too close to wells which meant that there would be contamination. Open sewers ran directly into the same rivers that supplied the water pumps, which made the contamination worse. People used the rivers to wash their clothes and themselves, and then took water out of them to drink and to cook with. This meant that cholera spread extremely quickly, because it was very contagious. Because people didnt know how it spread, they didnt boil their water before drinking it or know enough to avoid water from wells where lots of people had died. The cities were extremely crowded and it was impossible to quarantine people because the disease spread so quickly and there wasnt enough space. Finally, sometimes government action made the problem worse. For example, the government ordered the drains in London to be flushed clean of the filth that had built up in them, because they thought the strong smell was causing cholera (miasma). However, this put even more human waste into the water supply and caused the cholera outbreaks to worsen. Overall, I think the main reason why cholera spread so quickly was because people didnt know what caused it.

Exam practice question 2 (page 43) 2. The Industrial Revolution only made existing public health problems worse it didnt create any new ones. Do you agree? Explain your answer. [16]In some ways I do agree with the theory that the Industrial Revolution only made existing public health problems worse. This is because the biggest public health problem in the nineteenth century was the lack of clean water. There were no systems for removing waste and there wasnt enough clean water available for people to drink, bathe in and so on. The Industrial Revolution led to massive growth in cities, as people moved there to work in the factories. This made water even scarcer, whilst at the same time creating an even bigger waste problem than there had been before. However, the Industrial Revolution did make some public health problems worse. For example, the quality of the air around many cities became a lot worse, due to pollution from the factories. Respiratory illnesses became more common due to the dusty conditions in the cloth factories. Alcoholism also became more of an issue among the population because a lot of people turned to alcohol to deal with the misery of their everyday lives. Overcrowding also led to an increase in dangerous slum housing, built without regulations, due to the population increases.Overall, I would say that the Industrial Revolution made existing public health problems worse, such as the lack of clean water, but it also created some new ones. Therefore I do not agree with the statement.

5.6 Improvements in public health c1750c1900

Exam practice (page 47)1. Describe the key features of John Snows investigation into cholera in 1854. [6]John Snow was a doctor who developed a link between cholera and dirty water in 1854. He was not able to prove that dirty water caused cholera because germ theory hadnt been developed at that point. Instead, he mapped out all the cases of cholera from the most recent outbreak and investigated the water supplies of homes and businesses where cholera had not caused any deaths. For example, he discovered that all the workers at the local brewery drank beer or water from the brewerys own well, and none of them were affected by the cholera outbreak. By doing this, he was able to prove that all the people who had died of cholera had been drinking water from the same pump, on Broad Street, and he insisted that the handle be removed from this pump to prevent anybody else from drinking from it. After the removal of the handle, the cholera outbreak subsided, thus proving Snows theory that it had been caused by the water in that particular well.

Exam practice (page 47)2. How important was the work of Edwin Chadwick in improving public health in towns in the nineteenth century? [16]Edwin Chadwick was very important in improving public health in towns in the nineteenth century. To begin with, he wrote the Report on the Sanitary Conditions of the Labouring Population in 1842 which gave details of the public health problems that existed at the time, and showed how dirty conditions led to the rich paying higher taxes, because the poor were too sick to work. He made recommendations about how public health could be improved, that were later included in the first Public Health Act which was passed in 1848. This act created a Board of Health to encourage local authorities to improve conditions, of which Chadwick was a member. Therefore, his work was extremely important because it led to the first Public Health Act.However, the first Public Health Act didnt have a lot of impact, and it was only passed at that time because there had been a cholera epidemic. The government didnt really want to force local authorities to make improvements because it cost a lot of money. It wasnt until 1875, after the link had been made between dirt and disease, that a second Public Health Act was passed which forced local authorities to improve conditions. This was passed partly because working class men had the vote which convinced MPs they had to do something to improve their conditions. Overall, although Chadwicks work took a very long time to improve public health, it did form the basis of the reforms that the government pushed through. I dont think these would have become enforced by law if attitudes hadnt changed thanks to more people having the vote and the discovery of germ theory, so Chadwick could not have done it on his own, but I think his work was very important.Exam practice (page 47)3. How useful is this extract (Source A) to a historian studying ongoing public health problems in the nineteenth century? Use Source A and your own knowledge to explain your answer. [8]Source A makes it clear that the ongoing public health problems in the nineteenth century were partially a result of peoples attitudes at the time. The source is from a letter published in a newspaper, so although it is a personal opinion, it is extremely useful for telling us about what people thought of public health measures in the nineteenth century. I can see that the writer is suspicious of being forced to clean up and this helps to explain why cholera and other diseases were such a problem. However, Source A is limited in its utility because it does not tell us the reason why people didnt want to clean up germ theory had not yet been published so people didnt realise the importance of keeping clean. Before Pasteur published his theory in 1861, nobody knew for sure what caused disease and therefore no steps were taken to tackle it. The government did not intervene and people continued to drink and wash in contaminated water. Because washing in dirty water often caused illness, people associated washing with disease. This is the reason why Source A was written and so we need to know this information in order to better understand what the source is telling us. Therefore, Source A is useful for showing us peoples opinions at the time, but we need more information to explain why people felt this way.

Chapter 6 Medicine and treatment c1900 to present day6.1 New drugs: from prevention to cure

Exam practice (page 49) 1. How important for the prevention of disease was Edward Jenners discovery of a smallpox vaccination in 1796? [12]Jenners discovery of a smallpox vaccination was very important for the prevention of smallpox. Before this, some people had tried the method of inoculation exposing themselves to mild cases of smallpox to avoid the disease, but nobody had made the link between milder forms of pox and a resistance to smallpox. Jenners discovery was picked up by the British government who offered the vaccination to everybody for free and eventually made it compulsory. People like Napoleon promoted the use of the vaccine abroad. Many lives were saved as a result. Jenners work also showed that vaccination could succeed, which inspired other scientists. Therefore, Jenners work was important. However, it was not especially important for preventing diseases other than smallpox. This is because Jenner did not understand how the vaccine worked and therefore the theory could not be applied to other diseases. Furthermore, the smallpox vaccine is a special case and later vaccines worked in a different way, which meant other scientists could not use the same method as Jenner. Therefore, his discovery was not very important for the prevention of disease other than smallpox.

Exam practice (page 49) 2. The table below shows two new medical treatments. Choose one and describe the key features of its development. Salvarsan 606 Prontosil [6]

Research teams played a very important part in developing Salvarsan-606. Firstly, the team was made up of scientists from a variety of backgrounds. Some were chemists and others were doctors. This gave them a wide variety of skills to bring to the task. Secondly, as a research team they attracted funding from the government which helped them to focus solely on the development of the magic bullet, rather than having to do other things as well to cover their costs. Thirdly, research teams allowed young scientists to work closely with their older and more experienced colleagues. Paul Ehrlich, for example, had worked on Robert Kochs research team before he became part of the Salvarsan-606 team. Finally, it was important to have more than one person checking the results. This was particularly important in the case of Salvarsan-606 because the working compound was actually identified by Dr Hata. The other scientists had discarded it and said it didnt work, but he proved that it did. So, if it had only been Paul Ehrlich working on the development he might not have discovered it. Prontosil was the first sulphonamide drug and was developed by Gerhard Domagk in 1932. It was used to treat blood poisoning. Domagk worked for a German chemical company and tested thousands of chemicals on animals to try and treat blood poisoning. He finally came across Prontosil, a red dye, and he discovered that, if he mixed it with other substances, it would slow down blood poisoning in mice.Domagk was forced to test Prontosil on humans in 1935 because his daughter pricked her finger on a needle and got blood poisoning. Domagk injected her with the drug and she made a full recovery. His successful discovery was published and, in 1939, he won a Nobel Prize.

Exam practice (page 50) 3. How useful is this speech to a historian studying the development of penicillin? [8]Source A is useful to a point when studying the development of penicillin. It is from a speech by Alexander Fleming, who discovered the mould growing in a petri dish in his lab and observed that it was killing the bacteria around it. Therefore it is likely to be quite reliable because it is an account of his own work. However, the source is limited because it only tells us about the discovery of penicillin: it does not tell us about its development. Although Fleming discovered the drug he was not able to develop it for human use, due to lack of funding; this happened later, in the 1930s, when Florey and Chain found his research and tested the mould further. Although Fleming won a Nobel Prize for penicillin in 1945, which is presumably when he gave this speech, we need to look at more evidence than just this source to get the full story of the development of penicillin. Therefore I do not think the source is very useful on its own.

6.2 The discovery of DNA and its impact

Exam practice (page 51) 1. Describe the key features of the work of Watson and Crick on DNA. [6]Watson and Crick were the first scientists to discover that DNA had a double-helix structure which could unzip to make copies of itself. Watson, a chemist, and Crick, a physicist, had teamed up to try and create a model of DNA. They used the work of Rosalind Franklin, a chemist, who had used x-ray crystallography to get a picture of a DNA molecule. They used this picture to inform their study and teamed up with another expert in x-ray photography, Maurice Wilkins, who helped them to complete their model of the DNA molecule. They published their work in 1953 and were awarded the Nobel Prize in 1962, along with Wilkins.

Exam practice (page 52) 2. In what ways did the discovery of the structure of DNA change medicine after 1953? [12]The discovery of the structure of DNA has led to some important changes in medicine since 1953, because it has allowed scientists and doctors to develop treatments and sometimes even cures for genetic disorders. For example, the Human Genome Project was completed in 2001 mapping the purpose of every gene in the human body. This helps doctors to test people for particular genes to identify diseases which might be hereditary. This sometimes makes it possible for parents to avoid passing on genetic disorders to their children by using IVF. It is also possible to test unborn babies for genetic disorders such as Downs syndrome. More recently, the discovery of the structure of DNA has led to developments in gene therapy, for example using stem cells to treat disabilities like blindness. If DNA had not been discovered, this sort of treatment would not be possible. Therefore, the structure of DNA had a big impact on medicine. However, so far this impact has mainly been limited to genetic disorders and not to other illnesses.

6.3 The development of the NHS

Exam practice (page 53) 1. Why was it possible for the NHS to be launched in 1948? [12]The NHS was launched in 1948 due to government action, changes in peoples attitudes towards healthcare, and the work of individuals such as Aneurin Bevan. The government had begun to move towards national health care when it passed the National Insurance Act in 1911. However, the Act did not include unemployed people and over time the government began to take more action to ensure everybody had the same provision. Peoples attitudes towards healthcare had changed as a result of the Second World War. Poor health among the evacuees had created more demand for nationalised provision, and more people had been able to access free healthcare during the War, which meant they felt entitled to continue getting it afterwards. This encouraged the government to launch a free service. Finally, Aneurin Bevan, who was Minister for Health at this time, was able to convince doctors and local authorities that the NHS was a good idea and that they should support it. Without their support, the government would have found it very difficult to offer all the services it did.

Exam practice (page 54) 2. Choose one of the following and describe the work he did which led to the creation of the NHS. William Beveridge Aneurin Bevan [6]

William Beveridge was very important in the creation of the NHS, because he wrote a report which recommended it. He was commissioned to write a report on what government action could be taken to improve peoples standard of living, and he recommended that a free-at-point-of-service health system be introduced. Beveridge had been very important in the creation of the National Insurance scheme in 1911 and so he was able to use his prior knowledge to help come up with a plan for funding the NHS, and what provision should be included within it. Without Beveridges report, we might have had a very different system in place today.

Exam practice (page 54) 3. How useful is Source A to a historian studying Bevans role in the creation of the National Health Service? [8]

Source A is very helpful in showing us how Bevan won over the doctors, who were initially resistant to the idea of the NHS. Punch was a satirical magazine and so it shows Bevan giving doctors medicine labelled National Health Service; in reality, Bevan won the doctors round with concessions and stirring speeches. Therefore, the source is useful in showing that Bevan was responsible for this aspect of setting up the National Health Service, but it is not entirely reliable in its portrayal of how this was achieved. In addition to this, the cartoon does not show Bevans wider role in creating the National Health Service. As Minister for Health he was instrumental in getting the bill through Parliament and bringing the organisation into existence. The source is not useful for showing us this wider involvement.

Exam practice (page 54)4. Why did the standard of medical treatment improve so rapidly during the twentieth century? [12]The main reason why the standard of medical treatment improved so rapidly during the twentieth century is due to the massive improvements in science and technology that were made. For example, the development of new drugs such as Salavrsan-606 meant that it was easier to treat patients for illnesses such as blood poisoning. The development of penicillin in the 1940s led to better treatments for infections and disease like meningitis, which meant that people were a lot more likely to survive these diseases than they had been in the past. Later on in the century, new technology such as the dialysis machine meant that people were able to receive treatment when their kidneys failed. Transplant surgery was also developed which meant that kidney failure and other illnesses involving major organs could now be treated. Watson and Cricks discovery of human DNA eventually led to gene therapy being developed which also improved medical treatment. Science and technology played a huge part in improving medical treatment so rapidly, but a lot of these things were funded and provided by the NHS, which was launched in 1948. Therefore, you could also say that the government was a really important factor in improving medical treatment during the twentieth century.

6.4 The impact of new technologies

Exam practice (page 56) 1. In what ways has technology affected the treatment available to patients in hospitals since 1900? [12]Technology has had a massive effect on the treatment available to hospital patients since 1900. There have been a lot of new inventions which have led to improved treatment. For example, x-rays allow doctors to set broken bones more precisely. Other types of scans help doctors to diagnose and treat cancer, and are helpful during pregnancy in monitoring the health of the baby and the mother. Treatments like radiotherapy and chemotherapy can also be used to treat cancer. This has improved the survival rate for this disease. Furthermore, the development of keyhole surgery, using fibre optic cameras to see inside a patient and perform the operation without having to make a big incision, has rapidly improved the recovery times because major operations can now be carried out more quickly and with less trauma to the patient. It is also easier to monitor the health of patients in hospital thanks to blood pressure machines and quicker blood tests. Overall, technology has had a really positive effect on the treatment available to patients in hospitals.

Exam practice (page 57)2. What do Sources A and B show about changes in the way doctors in Britain treat blood loss? Explain your answer using Sources A and B as well as your own knowledge. [8] The treatment of blood loss has changed significantly since Source A was published in the seventeenth century. This source shows a doctor attempting a blood transfusion from a lamb to a human. This was published after Harvey had published his work on circulation and therefore doctors understood that blood circulated around the body; however, they did not yet know about blood types and therefore many transfusions between animals and humans, such as this one, were tried.Source B shows a complete change in how blood loss is treated in the present day. The discovery of blood groups by Landsteiner in 1901 meant that doctors were now able to offer patients blood of a matching type, which meant that lost blood could now be replaced. The development of methods of storing blood during the First World War meant that blood loss was no longer the problems for surgeons that it had been previously.

Exam practice (page 59)1. Public health problems had largely been solved by the twentiethcentury. Do you agree? Explain your answer. [16]In some ways I agree with this statement. This is because the biggest public health problem pre-1900 was probably the lack of clean water and the problem of waste disposal. This was particularly a problem after the Industrial Revolution, when cities grew much bigger and more crowded. However, this problem had largely been solved by 1900. New technology and funding from local and national governments had led to the provision of clean water and a network of sewer systems to allow waste to be removed. The germ theory of disease had proved that illness is caused by microbes, which encouraged the government to put measures in place to prevent outbreaks of diseases such as cholera. It had also introduced vaccination programs for diseases such as smallpox which helped to improve public health.However, there were other problems which continued into the twentieth century. For example, standards of living among the poor were still very low. There was a lot of slum housing and families living in cramped conditions. Their diets were usually very poor. The government realised this was a problem when it tried to recruit soldiers for the Boer War and found that a lot of the volunteers were medically unfit. There were other problems of epidemics, such as measles and polio: these could not be tackled until vaccines were developed later in the twentieth century. There was also the problem of expensive health care, which was not fully solved until the introduction of the NHS in 1948. Overall, I would say that the biggest problem of public health had been solved by 1900 but there were more issues that needed tackling after 1900.

2. The governments role in improving public health was moreimportant during the nineteenth century than the twentiethcentury. Do you agree? Explain your answer. [16]The government was very important in improving public health in both the nineteenth and the twentieth centuries. In the nineteenth century, it passed the Public Health Acts of 1848 and 1875, which made local councils responsible for the public health systems in their cities and make provision for clean water and the removal of sewage. These acts had a massive impact on public health, particularly the second one which forced the changes through rather than just recommending them. Nineteenth-century Britain was filled with overcrowded cities where public health was a big problem, due to the lack of clean water and good drainage, so solving these problems made an enormous difference to health. Other measures like the sewer system in London, new building regulations and compulsory vaccination against smallpox also helped to improve public health. In the twentieth century, the government continued to offer vaccination programs against diseases like diphtheria and whooping cough. It introduced the NHS which maintains lots of public health campaigns, for example family planning clinics and vaccination against possible epidemic illnesses like swine flu. The government also has propaganda campaigns to alert people to dangers to their health. For example, cigarette packets carry health warnings and all alcohol advertising must include a message about drinking responsibly. There are also campaigns encouraging people to exercise more. These things will lead to better health among the population and better life expectancy. Therefore, the governments role in improving public health has been important in both centuries. However, I think it was more important in the nineteenth century because the conditions were much worse then, so they had a bigger step to make. Also, in the nineteenth century the governments attitude changed completely from laissez-faire to wanting to get involved in public health; this laid the foundations for its actions in the twentieth century.3. How important was the work of Aneurin Bevan in launching the NHS in 1948? [16]The work of Aneurin Bevan was really important in launching the NHS in 1948, because he was Minister for Health and so it was his responsibility. Bevan was very supportive of the NHS and made lots of speeches to encourage other people to be supportive too. He inspired people to register for the NHS which increased the demand for doctors, encouraging them to sign up too. He was able to make a compromise with the doctors to ensure that they would work for the NHS, as they could continue to practice medicine privately as well to maintain their wages. Without the work of Bevan, the NHS may have been a flop because if the doctors had not signed up there wouldnt have been enough medical provision for all the patients.However, other things were important in the launch of the NHS, too. William Beveridge, a civil servant, had written a report on how to improve living conditions in Britain and he had recommended the creation of a National Health Service in the first place, so without that there wouldnt have been a cause for Bevan to champion. The changing attitudes of the population after the Second World War were also important: the middle classes particularly were keen on the idea of health care for everybody which put pressure on the government to provide it.However, I think that without the vision and drive of Bevan the NHS might not have been so successful so quickly. Therefore, I think Bevans work was very important.

Section 2 Historical Source Enquiry: SurgeryChapter 7 The transformation of surgery c184519187.1 Dealing with pain

Exam practice (page 61)1. Look at Source A. What was the purpose of this representation? Use Source A and your own knowledge. [8]Both of these letter extracts were published in the Lancet shortly after James Simpson began using chloroform during operations. They both show a negative view of it: both extracts suggest that it is part of Gods design to suffer from pain and that chloroform gets in the way of this. The purpose of the source is to discourage people from using chloroform during operations, suggesting that doing so is acting against the Christian religion, because pain is a blessing of the Gospel.It seems a bit unusual that a medical journal would publish objections on religious grounds; however, at the time, many in the medical profession were extremely suspicious of chloroform. In 1848, before these letters were published, Hannah Greener had died of a chloroform overdose whilst having a routine surgery on her toenail, and so many doctors were reluctant to use it. Objecting on religious grounds might discourage people further from trying the anaesthetic.

Exam practice (page 61)2. Look at Source B. What was the purpose of this representation? Use Source B and your own knowledge. [8]The purpose of this source is to encourage people to use chloroform as an anaesthetic. Queen Victoria was an extremely influential person during her reign and the fact that she used, and liked, chloroform during child birth would set an excellent example for other women who might have worried about using it.At this time, only a few years after the discovery of chloroform, there were many objections to it from other doctors. Some were concerned about getting to dosage right and used the example of Hannah Greener, who died after being given too much, as an excuse not to administer the drug. Others objected on religious grounds, claiming that pain was Gods blessing and suffering through it, particularly in childbirth, was character building. Therefore, supporters of chloroform would have welcomed Queen Victorias positive comments and ensured they were published widely, in order to increase support for the use of the anaesthetic.

7.2 Dealing with infectionExam practice (page 63)1. Why were surgeons resistant to Listers new methods? Explain your answer using Source A and your own knowledge. [10]Many surgeons were resistant to the use of Listers carbolic spray because, firstly, they found it difficult to accept that they had a role to play in preventing infection. Most surgeons operated in the same clothes they wore outside and some even took pride in their blood-stained aprons. When Lister suggested a link between dirty clothing and unwashed hands in the operating room, many doctors found this hard to accept, as demonstrated in Source A. Secondly, surgeons were against using carbolic spray because they did not like its smell. It dried out the hands and caused the skin to crack, and it made operations longer and more expensive because additional preparation and materials were needed. Since speed was still important in nineteenth century surgery, because the problem of blood loss had not yet been solved, it seemed like a mistake to slow down the operation even further. Finally, even though Lister developed his spray after germ theory, many people still did not accept it. Because they did not believe that the air was full of microscopic germs, surgeons refused to believe that the spray could possibly reduce the rate of infection in the operating rooms. Therefore, the method could not be accepted until people fully accepted germ theory.

7.3 Dealing with blood lossExam practice (page 65)1. How reliable are Sources A and B as evidence of the changes in blood transfusions by 1918? Explain your answer, using Sources A and B and your own knowledge. [10] The sources are quite reliable when considering how blood transfusions had changed by 1918, because both Sources A and B make it clear that the First World War had something to do with it. From my own knowledge I know that the terrible wounds caused by shrapnel and other fighting during the First World War caused the methods used for transfusing patients in the field to develop more quickly: Source A shows army nurses packing blood and Source B explains that transfusion was given in rush conditions. Furthermore, Source A seems reliable because it is a photograph taken at the time and shows that blood was able to be stored and transported, which was a new development in blood transfusion, which fits with what I know; it was probably used by the army to show the use of new medical technology, as they would have wanted soldiers to feel confident that they could be treated for blood loss. Additionally, Source B is a contemporary source from a medical journal written by a doctor who was using the new methods; to be published in this journal he would have needed to have evidence of his work, which makes his account reliable.Therefore, I feel that the sources are very reliable when it comes to considering changes in blood transfusion by 1918.

7.4 Factors influencing developments in surgery

Exam practice (page 67)1. Source C suggests that better communication, using journals such as the Lancet, was the main reason for the development of surgery. How far do you agree with this interpretation? Explain your answer, using your own knowledge and Sources A, B and C. [16+3 for SPaG)Source C explains that Lister used the Lancet, a medical journal, to publicise his findings and this shows how important improvements in communications were in the development of surgery. If Lister had not been able to share his ideas, then others would not have started to make use of them; aseptic surgery probably would not have been developed as quickly and the risk of infection would not have been low enough to allow plastic surgery to take place safely. Journals such as the Lancet encouraged other doctors to test new methods and encouraged more discussion among medical professionals. On the other hand, Source A shows how important the First World War was in the development of surgery, particularly plastic surgery. Dr Howard Gillies developed this method of using pedicle tubes to help to repair the facial injuries of soldiers who had been disfigured during the war. If the war had not taken place, then this type of surgery might not have been developed. Also, war was extremely important in the development of blood transfusions: a method of storing and transporting blood was developed during the First World War due to the desperate need for transfusions on the front line. Therefore, war was clearly extremely important. However, in order to perform surgery such as Gillies, it is important to have antiseptic conditions so that no infection can take hold in the new skin being grown. Therefore, the development of antiseptic surgery might be considered more important than the development of plastic surgery, and this picture in Source B shows how important new technology was in Listers fight to keep surgeries scrupulously clean and remove the chance of infection. Lister had tried wrapping wounds in carbolic acid-soaked bandages and also washing his hands and instruments in it, but it was not until he started to use a new spraying mechanism to mist a fine spray of the acid in the air that he really saw a drop in his mortality rates. This shows that technology also played an important role in the development of surgery. Overall, though, I think that communication played a vital role in the development of surgery. This is because Listers work with the new technology only became popular when other doctors read about it and started using it, and to begin with it was very unpopular because there werent enough results to prove its effectiveness. Furthermore, work with blood transfusions during the First World War was only possible after Landsteiner discovered blood groups in 1901 and published his work on this for everybody to read. Even though Source C is from an article celebrating the Lancet and will clearly be painting it in a very positive light, I still think that it was the key element in ensuring surgery developed so far by 1918.

Section 3: The American West c18401895Chapter 8: Inhabitants and early settlers8.1 The Plains Indians: their beliefs and way of life

Exam practice (page 69)1. Why were the buffalo so important to the Plains Indians? [12]The buffalo were vitally important to the Plains Indians because they relied on them to provide for every aspect of their lives. For example, the buffalo provided the Indians with most of their food. The buffalo hunt would take place two or three times a year. Some of the meat would be eaten fresh, and the rest would be dried or smoked so that it would keep for a long time. Although the Indians also hunted other animals and ate plants and berries they gathered on the Plains, the buffalo was their main food source. Secondly, the buffalo provided the Indians with the materials they needed to clothe and house themselves. Clothes would be made from the skin, which the Indian women tanned using buffalo brains. They would also use this tanned hide to make the tipi, which the Indians lived in. This was a key part of their lifestyle as it could be packed up and moved very quickly, and also it didnt require a lot of wood, which was scarce on the Plains. Overall, the buffalo were important to the Plains Indians for a lot of reasons, but I think they were most important because they provided the Plains Indians with food, shelter and clothing.

Exam practice (page 70)2. Describe the Plains Indians beliefs about warfare. [9]The Plains Indians did not fight wars for the same reasons as the white Americans. White Americans fought wars over land, but because the Plains Indians did not believe anybody could own the land, they fought for different reasons. For example, they would fight to win horses, or to gain honour and win a wife. This meant that battles were usually very short, and the emphasis was not on killing. Warrior bands would defend their village from attack for long enough to allow the women and children to pack up and escape. Because the object of the battle was not to kill, the bravest act an Indian could perform in a battle was counting coup. This involved touching your opponent with a stick or with your hand. This showed that you were braver than they were.

Exam practice (page 71)3. Choose one of the following and explain how it helped the Plains Indians to live successfully on the Great Plains. The social structure of tribes Attitudes to land and nature [9]The social structure of the tribes was very important in helping the Plains Indians to live successfully. They were very well-organised and made sure everybody was taken care of. For example, polygamy was allowed because there were more women than men: this made sure all the women were provided for. Also, the tipi was owned by the woman, which meant she would always have a place to live, even if her husband was killed during a buffalo hunt. Indian tribes were split into smaller bands. Each band was led by a chief, who took advice from a council of elders and medicine men. This meant that major decisions were discussed carefully and every mans voice was heard. Everybody had their job within Indian society. The men would form a warrior society responsible for organising the hunt, while the women looked after the tipi and made clothing and other necessities. The elderly played an important role in looking after children, but they would stay behind to die when they became too weak to keep up. This helped the Indians to live successfully on the Plains, because everybody was clear about what their role was and everybody worked together to make it a success.

8.2 Migrants and settlers in the West: early settlers

Exam practice (page 73)1. Why did early settlers move to Oregon in the 1840s? [12]Early settlers moved to Oregon in the 1840s due to various push and pull factors. Firstly, they were tempted west by the pull factors. Fur trappers, who had travelled in Oregon a lot from the 1820s onwards, reported that there was perfect farmland and a never ending supply of furs and fish for people that went to Oregon. Also, the government passed a law which said that a farmer who squatted on a piece of land, built and house and cleared the trees was entitled to buy it for a low price, which encouraged more people to move there. This meant that farmers were more willing to take a chance. Secondly, settlers were forced west by the push factors. In the 1830s the United States was in an economic depression. There werent enough jobs in the East and wages fell. This meant that food prices also fell so farmers in the East were not able to break even. They also felt quite crowded in the East as populations had risen dramatically. This meant that they started to look towards the unsettled land in the West to get away from it all and make a new start.

Exam practice (page 73)2. Describe the problems of law and order in California mining towns from 1849. [9]There were many problems of law and order in California mining towns after gold was discovered in 1849. The main reason for this was because there wasnt enough law enforcement. The population of the towns grew quickly and because it took so long for law enforcers to travel from the eastern states, there were not enough people to keep law and order among the miners. There was a lot of racism in the mining camps. There were groups of black, Mexican, Asian and Indian miners who were very unpopular among the white miners. Claim jumping was a common problem and led to law and order problems, because to begin with claims to certain areas were not properly recorded and it was easy to start mining on somebody elses land. This caused big law and order problems. However, both of these problems could have been tackled if there had been more law enforcement officials in the mining towns.

Exam practice (page 73)3. Describe the effects of the discovery of gold in California in 1849 on the growth of the American West. [9]The discovery of gold in 1849 had both positive and negative effects on the growth of the American West. One good thing was that it encouraged more people to move to California. This meant that the area became settled quickly, and the increased migration opened up the routes west and encouraged the American government to fund the development of the transcontinental railroad. This was really key in helping the Americans to achieve their Manifest Destiny and settle the whole of the continent. The increase in people caused problems of its own because California wasnt properly set up for the new communities. Life was hard and there wasnt much law enforcement, which created law and order problems. Mining towns sprang up out of nowhere, often without proper housing or sanitation, which caused health problems. Also, many of the new miners were not trained and did not find any gold, which meant that there was a lot of poverty.

8.3 Migrants and settlers in the West: the journey west

Exam practice (page 74)1. What can you learn from Source A about the journey across the Plains? [4]From this source, I can learn that the journey across the Plains would have taken a long time. This is because Marcy recommends allowing the animals almost as much time resting and grazing as they spend pulling the wagons. I can also infer that sometimes it was difficult to find good grazing land for the animals because Marcy mentions the animals turning out on the best grass than can be found.

Exam practice (page 76)2. What can you learn from Source B about the dangers facing travellers as they crossed the Plains? [4]From this source, I can learn that travellers across the Plains faced danger from Indian attacks. In the source, Jane Gould explains that she has heard about an attack and then she sees some dead people who have been mutilated by the Indians. I can infer that Jane Gould became very anti-Indian because of what she saw. Living in constant fear of attack must have taken its toll on the settlers.

Exam practice (page 76)3. What can you learn from Source C about the problems faced by wagon trains? [4]From this source, I can learn that wagon trains faced attacks from Indians. In the source you can see Indians attacking with tomahawks, machetes and bows and arrows. They are on horseback and they look very fierce. However, I can also see that the wagon trains did a good job of defending themselves against Indian attacks because they had more sophisticated weapons than the Indians, such as rifles.

Exam practice (page 76)4. Describe the difficulties faced by people migrating west in wagon trains in the 1840s. [9]Travelling west in a wagon train was a very dangerous and difficult journey. The pioneers faced many dangers, which included bad weather, stampedes, Indian attacks, lack of supplies and water and getting lost. Bad weather was particularly difficult to deal with because it was very unpredictable. Settlers would try to leave for the journey in April to get across the mountains before the first winter snows, but sometimes they were not successful. There were also high winds and scorching heat, which was difficult to deal with when there wasnt a lot of water. Getting lost was also a problem. Many wagon trains were led by experienced guides but even they tried short cuts or took wrong turns. This could lead settlers a long way out of their way and result in them running out of supplies. The Donner party is a good example of a group who were unlucky enough to experience all these things. They tried to take a short cut but it took longer than expected, and they lost a lot of their supplies. Then they got snowed in in Sierra Nevada and over half of them died.

Exam practice (page 76)5. Getting lost was the biggest problem faced by people migrating west. Do you agree? Explain your answer. [16]Getting lost was certainly a big problem facing the first people migrating west. This was because there werent many points of reference on the trails, which made it difficult to navigate. Most wagon trains were led by experienced guides, like mountain man Jim Bridger, who knew the route well and could find the best way through the Rockies and the Sierras. However, some groups took their chances with less experienced guides, such as the Donner party, who followed a short cut recommended by a trail guide called Lansford Hastings. Tragically, this short cut took a lot longer than expected and the Donner party ended up getting snowed in and resorting to cannibalism. However, getting lost was less of a problem as more settlers made the journey west, because the routes became more established. Even today you can still see ruts in the rock on some parts of the trail, which have been left behind by wagons. A much bigger problem that faced the people migrating west were the harsh weather conditions, which could not be predicted or protected against; the settlers also faced trouble if they ran out of supplies because there were very few places along the way to restock. Furthermore, disease and injury were common and could prove to be deadly cholera was not uncommon, due to poor sanitation. Overall, I would say that getting lost might have been the biggest problem for some of the first travellers west, but most settlers faced other, much bigger problems on the journey.

8.4 Case Study: the Mormons

Exam practice (page 78)1. What can you learn from Source A about the attitudes of gentiles towards the Mormons? [4]From this source, I can learn that the gentiles had a negative attitude towards Mormons because they practised polygamy. For example, the cartoonist has depicted some of Brigham Youngs supposed wives as small, suggesting that he married some very young women before his death. The cartoon also suggests that Brigham Young was rich he has a fancy carpet on the floor and the window blinds are monogrammed with his initials. The cartoonist might be suggesting that Young made a lot of money out of being the leader of the Mormons.

Exam practice (page 80)2. Why was Brigham Young so important to the Mormons successful settlement at Salt Lake City? You may use the following in your answer. The Mormon Church shared out the land. 1849: The Perpetual Emigrating Fund was set up.You must also include information of your own.[12]Brigham Young was so important in the Mormons successful settlement at Salt Lake City because it was his idea in the first place. He chose to lead them there because at the time it was not part of the United States and so they were able to practise polygamy there. He planned the journey well and ensured that everyone was provided for. Once they arrived at the Great Salt Lake, Brigham Young continued to be important because he was an inspiring leader. The Mormons listened to him as they believed he was inspired by God. He made sure the land was carefully shared out among the Mormon families: the biggest families had the biggest pieces of land. He also ensured an irrigation system was in place to make sure everybody had fair access to the water. Finally, Young was important because he came up with a plan to make sure the whole area was settled with Mormons: the Perpetual Emigrating Fund. This fund made loans to Mormons who wanted to travel to live in the area. Young sent missionaries to Europe to encourage people to convert and move to the new Mormon territory of Utah.

Exam practice (page 80)3. Why did the Mormons move to the Great Salt Lake in 1845? [12]The Mormons began their journey to the Great Salt Lake in 1845 due to persecution. They had become very unpopular in the eastern states for many reasons. One of these was that they practised polygamy, which many gentiles felt was immoral. The non-Mormons were also worried that by practising polygamy, the Mormons would be able to increase their population very quickly by having lots of children. There was a lot of fear among the non-Mormons that the Mormons were trying to take over the world, and this was not helped by a rumour that their leader, Joseph Smith, intended to run for president. For this reason, Joseph Smith was shot during an attack by a mob of 200 people. Lots of Mormons began to fear that their town, Nauvoo, would also be attacked and so they started to look for a new place to live where they could follow their own rules. Therefore, the Mormons were pushed west by persecution. The Mormons were also pulled west to the Great Salt Lake because in 1845, this area was still under the control of Mexico. That meant that the Mormons could legally practise polygamy. The Great Salt Lake was also a very remote place which nobody else wanted at the time. The new Mormon leader, Brigham Young, thought it was the perfect place to go because they would be free from persecution and able to build their own society according to their own rules. Therefore, the Mormons were pulled west by the remoteness of the location Brigham Young chose.

Exam practice (page 80)4. Describe the key features of the Mormon journey to the Great Salt Lake. [9]The Mormons were able to make a success of their journey to the Great Salt Lake because their leader, Brigham Young, planned it very carefully. First of all, he organised the wagons into groups of 100, with a captain in charge. Each group of 100 was split into ten groups of ten, each looked after by a lieutenant. This was very well-organised and made it clear who was in charge. It meant there was very little room for argument. Secondly, Young himself went with the first wagon train and stopped every so often to build a rest camp for the people coming on afterwards. The biggest of these was on the banks of the Missouri River and it was called Winter Quarters. There were 1000 cabins built and this is where the Mormons spent the winter. This helped them to avoid the worst of the weather and gave them a place to rest and refuel. Finally, after winter had passed, Young led a smaller Pioneer Band to the Great Salt Lake to start the settlement for the other Mormons. He included a mixture of farmers and craftsmen. This meant that when the Mormons reached the Great Salt Lake they were not arriving in a barren wasteland. Overall, the Mormon journey to the Great Salt Lake was a successful one, thanks to Brigham Young.

8.5 Migrants and settlers in the West: settlers on the Plains

Exam practice (page 81)1. What can you learn from Source A about the idea of Manifest Destiny? [4]From this source, I can learn that the artist felt very positive about the idea of Manifest Destiny. The train and wagon train are both heading forwards towards a green and unspoilt land. In the foreground you can see people working hard to build their town, and the train is full of people which shows that lots of people were eager to settle on the Plains.

Exam practice (page 82)The government was the biggest factor in encouraging people to move to the Plains after 1860. Do you agree? Explain your answer. [16]The government encouraged a lot of people to move to the Plains after 1860. This was because it offered people free land under the Homestead Act of 1862. Settlers could claim 160 acres of land as long as they agreed to live on it and farm it for five years. This was a good deal for people who didn't own anything in the East and so it encouraged a lot of people to move onto the Plains. Later on, the Timber Culture Act offered settlers another 160 acres of land as long as they agreed to plant 40 acres of it with trees, and the Desert Land Act offered 640 acres of land in states where rainfall was particularly low. Therefore, the government was extremely important because it gave the land away to people, encouraging them to move to the Plains. However, the railroads were also very important. Once the railroad had been completed, the railroad companies advertised heavily to let people in the East know about the opportunities available to them on the Plains. They also sold their spare land off very cheaply. It was easier to travel to the Plains and to get supplies once the railway had been finished. Therefore, the railroad was also an extremely important factor in encouraging people to move to the Plains. Overall though, I think that the government was the most important, because it passed the Homestead Act in 1862, whereas the railroad was not completed until 1869. So, although both were important, the government had more impact on settlement during the 1860s.

8.6 Farming on the Plains

Exam practice (page 84)1. Why was it so difficult for the homesteaders to settle on the Plains in the 1860s? [12]There were two main difficulties faced by homesteaders trying to settle on the Plains in the 1860s lack of wood, and lack of water. They faced lots of problems, but most of them stemmed from these two big issues. Lack of water was the main one. This made it difficult for the homesteaders to grow crops. This problem was made worse by the fact that they were trying to grow the same sort of crops that they grew in the East, for example soft wheat, which couldnt stand up to the harsh Plains conditions. Also, because there was so little rain, the ground was really hard and dry, and the ploughs they brought with them couldnt stand up to the soil and broke. This made preparing the ground for crops very difficult. Furthermore, the lack of water made it difficult to keep clean and to give animals enough to drink. Secondly, they faced a lot of problems because there wasnt much wood. For example, they were unable to build fences around their crops. This meant that they were easily trampled and/or eaten by wild animals and their own cattle. Also, there wasnt enough wood to build houses, which meant that they had to build them out of baked mud bricks, or sods. These were difficult to keep clean, especially when there wasnt much water around. Although the main issues were lack of wood and water, homesteaders who tried to adapt did the best, and so perhaps the biggest issue of all was lack of experience and an unwillingness to try new things.

Exam practice (page 84)2. Technology was the most important factor in solving problems faced by homesteaders in the 1870s and 1880s. Do you agree? Explain your answer. [16]Technology was very important in helping homesteaders solve the problems they faced in the 1870s and 1880s. Most of their problems were caused by a lack of wood and a lack of water. The invention of the self-governing windmill helped homesteaders to solve the problem of water shortages because it enabled them to pump water up from deep underground to water their crops. They were also able to use their new ploughs, such as the sod buster, to plough their fields quickly shortly after it had rained, which trapped a layer of water under the soil so it couldnt evaporate. This was known as dry farming. When barbed wire was invented in 1873, the homesteaders used this, rather than wood, to fence off their crops. Using barbed wire helped them to get around the wood shortage problem. However, things other than technology were also important. For example, the government introduced the Timber Culture Act in 1873 which allowed homesteaders to double their land claim if they planted 40 acres of trees. This eventually increased the amount of wood available on the Plains. Also, the homesteaders started to grow different crops which coped better with the dry conditions of the Plains, for example, Turkey Red Wheat which was grown in Russia. Overall, I think that the main reason for the homesteaders success was hard work and adaptability. It was not easy to be a farmer on the Plains and some of the problems, such as extreme weather conditions and plagues of locusts, couldnt be solved. Homesteaders got round this by growing a surplus in good years and adapting to their surroundings as much as they could. For example, they burned buffalo chips instead of wood. Technology certainly helped them to succeed on the Plains, but a number of the new inventions were created by homesteaders who were trying to adapt to their new surroundings, which shows that it was hard work and determination that was really the secret of their success.

Exam practice (page 84)3. Describe the contribution made by women to settling on the Plains. [9]Women were highly valued on the Plains because they kept house and made sure everybody was fed and clothed. This was very important on the Plains, where life could be exceedingly hard. They were responsible for keeping a kitchen garden and growing vegetables and fruit. They would also fish and hunt small game to help feed the family. They would make and mend clothes and gather buffalo chips to keep the house warm and provide a fire for cooking. However, it was not just in the home that women were important. They were also vital for building the community of the Plains. A large number of single women were recruited to be school teachers in Plains townships, for example. Also, women helped to build a network of communication among homesteads and organised social events to celebrate births and harvests, which helped to build the community spirit upon which Plains life was built.

Chapter 9: Development of the Plains9.1 The construction of the railroads

Exam practice (page 86)1. What can you learn from Source A about the building of the railroads? [4]From this source, I can learn that the railroad builders had to hire thousands of Chinese labourers to work on the Transcontinental Railroad. I can infer that this was because there were not enough workers in the West to complete the job. Twelve thousand is a lot of workers, so the project must have been very difficult. I can infer that it was easier to hire Chinese workers who travelled to the West Coast across the Pacific, than it was to hire railroad workers from the East.

Exam practice (page 86)2. Why was it so difficult for the railroad builders to complete the transcontinental railroad? [12]The transcontinental railroad builders faced a lot of problems whilst they were building their railroad. The first of these was the different types of land they had to cover. The railroad had to cross several mountain ranges as well as deep valleys and long deserts. New techniques had to be used to blast through solid rock just to get the railroad out of California. The blasters used nitro-glycerine which was very dangerous, and accidents happened. Therefore the terrain made it very difficult for the railroad builders. Another problem faced by railroad builders was a shortage of workers. This might have been linked to the dangers of the job, which might have put people off. Also, conditions were very poor, because railroad workers lived in shacks by the side of the rails or in railway carriages on the rails they had just completed. Conditions were horrible and pay wasnt good. This meant that fewer Americans were willing to sign up to work on the railroad. In the end, the railroad builders were only able to complete their railway by bringing in extra labourers from China and Ireland. Overall, the main difficulties facing the railroad builders were the terrain and the shortage of workers.

Exam practice (page 87)3. Choose one of the following and explain how the building of the transcontinental railroad changed their lives. The homesteaders The Plains Indians [9]The transcontinental railroad changed the lives of the homesteaders because it made it easier for them to get supplies from the East. New farming equipment could more easily be purchased and goods could be shipped to markets in the East where they might fetch a higher price. This meant that it was easier for the homesteaders to make a success of their farms after the transcontinental railroad had been completed. The transcontinental railroad also increased the number of homesteaders living on the Plains. This was because the railroad companies advertised heavily about how amazing life on the Plains was, to encourage people to move West and use the railroad. Furthermore, the railroad companies sold off the land they had been granted to build the railroad but didnt need. They sold this land very cheaply to homesteaders looking to start a new life on the Plains. Therefore, the railroads changed the lives of homesteaders by increasing their numbers and therefore building bigger communities on the Plains.

9.2 The rise and fall of the cattle industry

Exam practice (page 89)1. Describe the factors that led to the spread of cattle ranching onto the Plains. [9]There were several reasons why cattle ranching spread to the Plains. The main reason was that there wasnt enough space in Texas. This is because during the American Civil War, the cattle in Texas bred uncontrollably and by the end of the war there were about 5 million of them, and there wasnt enough grass to go round. This meant that the cattle ranchers had to look to the Plains to find enough grazing land for their herds. Once they had started to graze their cattle on the Plains, the ranchers discovered that the low winter temperatures killed the ticks which caused Texas Fever, and that encouraged more ranchers to keep their herds on the Plains. Therefore, the weather was another factor which led to the spread of cattle ranching to the Plains. Finally, the transcontinental railroad encouraged more ranchers to move to the Plains. It provided an easy way for the ranchers to transport their cattle to the markets in the East. It was easier to raise the cattle on the Plains than it was to raise them in Texas and drive them north to the railway. Therefore, this was another important factor in the spread of cattle ranching to the Plains.

Exam practice (page 89)2. Why did open range ranching decline after 1883? [12]The cattle industry declined after 1883 for two main reasons. Firstly, demand had declined. Secondly, there had been a run of particularly bad weather. These two factors combined to force a decline in the cattle industry. By the 1880s, demand from the East for beef had started to fall. This meant that the price paid for each cow fell too, so ranchers didnt want to sell their cows. They kept their cows alive on the open range, hoping that the price would increase. This meant there was even less grass to