Medical progress

Model answer

Place A is Canterbury. Sick people went there because they believed that if they prayed at the shrine of St Thomas Becket, who was murdered in the cathedral in 1170, the saint would ask God to heal them; many bought 'Canterbury water', thought to contain a trace of his blood.

Model answer

Source A is very useful to an historian studying medieval surgery because it shows what the best surgeons could achieve. Bradmore removed an arrowhead lodged deep in the prince's skull by designing a new instrument, small hollow tongs with a screw, which shows real practical skill and ingenuity. He cleaned the wound with white wine and used rose honey, which we now know are both good at preventing infection, even though nobody in the fifteenth century knew about germs. The daily dressings show careful aftercare. This fits what I know about the practical skill of some medieval surgeons: Theodoric Borgognoni had also recommended cleaning wounds with wine, and war gave surgeons plenty of experience with arrow and sword wounds.

The provenance adds to its value. It is Bradmore's own account, written soon after the event by the expert who carried out the operation, so it is detailed and precise. We also know that it succeeded, because the prince survived to become King Henry V. However, Bradmore wrote it to record his method for other surgeons and to show his skill, so he may have presented it in the best light, leaving out difficulties. The source also leaves things out: it does not mention pain relief, even though dwale existed, and the prince must have suffered greatly.

The biggest limitation is that this was an exceptional case. The patient was the heir to the throne, treated by a leading London surgeon with every resource available. Most surgery in medieval England was minor work, such as bloodletting and lancing boils, carried out by barber-surgeons, and ordinary soldiers rarely received such care; many died from blood loss or infection.

Overall, Source A is very useful for showing the skill and methods of the best medieval surgeons, but it is not typical of surgery as most people experienced it.

Model answer

One way in which hospitals in the two periods were similar is that both were founded and paid for by charity from wealthy people, not by the government. In medieval England, kings, bishops, nobles and merchants founded hospitals as an act of Christian charity and to help their souls; St Bartholomew's in London was founded by Rahere in 1123. In the eighteenth century the new voluntary hospitals, such as Westminster (1720), Guy's (1724) and the London Hospital (1740), were also founded and run by wealthy benefactors and subscribers. Thomas Guy, a rich London bookseller, left a fortune to build Guy's Hospital. In both periods hospitals depended on the generosity of individuals, and the government took no responsibility for them.

A second similarity is that both kinds of hospital were selective about whom they admitted. Many medieval hospitals refused lepers, the insane, pregnant women and those who could not be cured, partly from fear of infection and because places were limited, and patients had to leave once they were well. Eighteenth-century voluntary hospitals also usually refused patients with infectious diseases, the incurable, pregnant women and young children, and patients often needed a letter of recommendation from a subscriber to be admitted. In both periods hospitals were mainly for the 'deserving' poor who could be helped to recover, while the wealthy were treated at home.

These similarities show that, even after the dissolution of the monasteries, the idea of the charitable hospital continued for centuries, although by the eighteenth century physicians and surgeons worked in hospitals and trained students there. Hospital care only became a responsibility of the state with the NHS in 1948.

Model answer

Individuals have been very important in the development of medical treatment, because many of the greatest new treatments are linked to particular people. However, individuals rarely succeeded alone: their ideas depended on science and technology, on communication, and often on war and government to turn them into treatments that reached patients. So individuals were important, but not the main factor on their own.

In the Middle Ages treatment was shaped by individuals who had lived long before. Hippocrates and Galen created the Theory of the Four Humours, so medieval physicians treated patients by bleeding, purging and using Galen's Theory of Opposites. Islamic individuals such as al-Razi and Ibn Sina added to this knowledge, and Ibn Sina's Canon of Medicine was used in European universities for centuries. This shows that individuals could hold treatment back as well as move it forward, because their authority discouraged new ideas. Religion was equally important in this period: prayer, pilgrimage and the king's touch were seen as treatments, and the Church supported Galen.

From the sixteenth century individuals began to change treatment. Ambroise Paré found a better way to treat gunshot wounds in 1537. Edward Jenner developed vaccination against smallpox in 1796, James Simpson discovered chloroform in 1847, and Joseph Lister introduced antiseptic surgery in 1865. In 1909 Paul Ehrlich's team found Salvarsan 606, the first 'magic bullet' to cure a disease, syphilis.

However, other factors were often decisive. Jenner's vaccination only became widespread when the government made it compulsory in 1853, and it spread quickly because Jenner published his findings in 1798. Lister built on Pasteur's germ theory and published his methods in The Lancet. Ehrlich's success came from science and technology - chemical dyes and the systematic testing of hundreds of compounds - rather than from one person's inspiration.

The story of penicillin shows this most clearly. Alexander Fleming noticed mould killing bacteria in 1928 - an individual's discovery, helped by chance - but he could not turn it into a usable drug. Howard Florey and Ernst Chain did so between 1938 and 1941, but only war made mass production possible: the British and American governments backed it, and American factories produced enough for the D-Day landings in 1944. Since 1948 the NHS has made treatments free, and today new drugs come from large research teams and pharmaceutical companies rather than lone individuals.

In conclusion, individuals such as Jenner, Lister, Ehrlich and Fleming were vital, because they made the key breakthroughs in treatment. But they depended on science and technology to make their discoveries, on communication to spread them, and on war and government to turn them into treatments for ordinary people. Individuals were therefore an important factor, but science and technology, working with government, was more important across the whole period.