The Impact of the Theory of the four Humours on Medicine

1. The Impact of the Theory of the four Humours on Medicine GCSE Questions and answers Mrs Strange

2. Choose the section you want by clicking the icon or just watch the whole Power Point Targets of questions, mark schemes and previous questions asked Have a go yourself !

3. What types of questions will you be asked in the compulsory section? • The first question asks you what you understand from the source. • The second question asks what changes/progress can be seen. • The third question looks at contradicting sources • The fourth question generally asks you to agree or disagree with an interpretation. • However in 2007 this changed and the interpretation was seen in part 1c instead of as a ‘view’. Question 1d was aimed at a more direct question so candidates focused on the need to combine sources with historical knowledge.

4. Mark scheme for 1a Targets: Comprehension and inference from an historical source • Level 1: uses content (1-2 marks) • Level 2: uses simple inference from source (3-4 marks) • Level 3: complex inference from source (5 marks)

5. Examples of Questions asked for 1a . Using Source A only (5 marks) • 2007:What does source a suggest about surgery around 1800? • 2006: What does source A suggest about the understanding of anatomy of humans before the Renaissance? • 2005: What does source A suggest about surgery in 1900? • 2004: How does Source A help you to understand the importance of religion in treating the sick in the Middle Ages?

6. Mark scheme for 1b Target: Identify change/progress from a source • Level 1: describes the content (1-2 marks) • Level 2: shows simple reasoning of progress/change (3-4 marks) • Level 3: developed reasoning of progress/change (5-6 marks)

7. Examples of questions asked for 1b – asks for source and own knowledge (6 marks) • 2007: How much can you learn from source B about the development of anaesthetics in the 19th century? • 2006: How does source B show understanding of the human body improved during the Renaissance? • 2005: How does Source B show progress in surgery since 1900? • 2004: Source B shows a hospital nearly a thousand years later. How does it show that religion was still important in the treatment of the sick?

8. Mark scheme for 1c Target: Explaining the difference between sources • Level 1: uses the content of the source (1-3 marks) • Level 2: based on simple reasoning for the disagreement (4-6 marks) • Level 3: developed reasoning including type of source/ setting in context (7-9 marks)

9. Examples of questions asked for 1c – uses both sources and own knowledge for 9 marks • 2007: Source C suggests Lister’s work led to great progress in surgery. Source D suggests it did not. Why do you think these two interpretations disagree about the importance of Joseph Lister? • 2006: source C describes Vesalius as a great thinker whereas source D describes him as a madman. Why do you think thesetwo views disagree about Vesalius? • 2005: Source C suggests there has been progress in fighting disease through the use of medical drugs since 1900. Source D suggests there has been no real progress. Why do you think these two sources disagree about the progress made in fighting disease? • 2004:Source C states the Roman Catholic church banned dissection. Source D shows a dissection taking place after the ban. Does source D mean that source C is wrong?

10. Mark scheme for 1d Target: evaluating an interpretation of the past • Level 1: extracts information to agree or disagree or gives general statements about it (1-4 marks) • Level 2 Develops the argument using sources or own knowledge (5-8) • Level 3: develops one or more arguments using both sources and knowledge (9-12) • Level 4: for level 3 but gives supported judgement. Will discuss long and short term effects. (13-15) • ***Look at the change of style in 2007

11. Examples of questions asked for 1d – use the sources provided and own knowledge (15 marks) • 2007: How safe had surgery become by the end of the nineteenth century? Use sources A-D and your knowledge. • 2006: The improved knowledge of anatomy during the Renaissance had great effect on development of medicine through time. Do you agree or disagree? • 2005:Science and technology have been the most important factors in the development of medicine since 1900. Explain why you agree or disagree with this interpretation. • 2004: The impact of religion meant there was noprogress in medicine during the middle Ages. Do you agree or disagree with this interpretation?

12. The Greeks

13. Source 1: A Greek painted vase from 400 BC shows a patient visiting a doctor. What does this source tell you about treatment at the time?

14. Source 1: suggested answer • This vase comes from about 400 BC when the Hippocratic doctors were practising • We see the doctor in the centre about to bleed a patient – treatments reflecting the use of the Four Humour Theory. • It shows natural methods of treatment • The idea was to keep the humours in balance so the patient would be well • The patient would be bled and the bowl would be used to catch the blood • The source is limited as we don’t know details of the illness or outcome of the treatment.

15. Source 2: From Hippocratic writings Vomiting should be encouraged during the winter months as this is the time when phlegm dominates and diseases are to be found in the head and chest. The emetic should consist of ground hyssop in six pints of water drunk after adding vinegar and salt. During the summer enemas should be used as this is the hot season when the body is more bilious. Use this source and your knowledge to explain what theory was being used and how the treatment would help the patient

16. Source 2: Suggested answers • Theory of the four humours used • This shows the link between the humour and a particular season • Suggests phlegm more out of balance in the winter when they observed more would be produced. • Treatment is based on an emetic to make the patient sick and therefore balance the humour again • Links bilious nature of yellow bile to the hot summer months and advises that the way to cure this would be enemas in the summer when this humour would be out of balance. • Shows that Hippocratic doctors were using symptoms and observation but misunderstanding symptoms for the cause of the illness.

17. Aegestratos was unable to sleep because of headaches. As soon as he came to the temple he fell asleep and had a dream. He thought that the god cured him of his headache and, making him stand up, taught him wrestling. The next day he departed cured, and after a short time he competed at the Nemean games, and was victor in the wrestling. What to ask yourself What do you recognise in the text? What is going on in the source? What is the message of the source? What does it tell me about medicine at the time? Is it a typical source for this time? Where does it come from? Can we trust it? What else do I know that helps me to make sense of the evidence? Source 3: Carved on a stone tablet found at an Asklepion. What does this source tell us about Greek attitudes to healing?

18. Source 3: suggested answer • It shows a belief in the power of religion/supernatural beliefs especially in Asklepios the god of healing • Strength in the belief in that the patient went on to win feats of strength • Attitude to physical health – important to be well and strong • The message for people is you too can be healed at an Asklepion • Typical of the time – asklepions all over Greece and would have carvings on them • We can trust their belief in the treatment there and their opinions but not that the treatment worked • Also know that there was a dual approach to medicine in that people might consider natural as well as supernatural treatments.

19. Source 4 From a book written by Hippocrates in the 5th century BC Man’s body has blood, phlegm, yellow bile an black bile. These make up his parts and through them he feels illness or enjoys health. Source 5 From a carving at the temple of Asklepios at Epidarus in the 4th century BC Ambrosia of Athens became blind in one eye. She had laughed when she heard of cures for the lame and blind. But that night she dreamt that Asklepios was standing beside her saying he would cure her if she would dedicate a silver pig as an offering of thanks. Asklepios seemed to cut into her diseased eyeball and when she awoke in the morning she was cured. Source 4 & 5: conflicting sources.Read the two sources below and answer: Source 5 shows that supernatural approaches were used a century after natural approaches. Does this mean the Theory of the humours had limited impact on medicine in the ‘ancient World?

20. Sources 4 &5 suggested answer • The fact that source 5 (supernatural cure) comes from a later time than source 4 does not mean the theory had limited impact • The sources reflect people still turned to the asklepions for physical problems even after Greek doctors starting observation and treatment based on the 4 humours • The 4 humours co –existed with traditional temple medicine • Both supernatural and 4 humour theory were incorrect and nothing was known about the germ theory till the 1860s • The impact of the 4 humours remained strong for about 1500 years due to Galen and his approach and importance in the Roman Empire • However even in Rome Asklepion medicine continued (started after epidemic of plague)

21. The Middle Ages

22. Source 6 A 12th century text written by a French priest and teacher, Peter Abelard The infirmary of your convent must be equipped with everything necessary for looking after the sick. Medicine must be provided, and this is best done if the sister in charge has some knowledge of medicine. One of the sisters should know about blood letting, otherwise it will be necessary for a man to come in to the convent for this purpose. Question: How does this source show that religion supported the four humour theory?

23. Suggested answer for source 6 • The Roman Catholic Church set up hospitals and medical schools • It supported the Hippocratic ideas and the work of Galen who promoted them this is because Galen believed in one god and the Church saw his ideas as fitting in with theirs • Nuns and priests provided care in convents and hospitals – usually ‘hospitality’ but some treatments were given • In this case the nun should know how to bleed the patient to balance his humours • It is known that monks were regularly bled – up to six or seven times a year so the Church supported this practice

24. It was believed that the volume of blood, one of the primary humours, needed to be kept in check, either by natural bleeding or by the human intervention of "bloodletting." This was done by the application of leeches and, far more commonly, by phlebotomy or venesection, that is, a small incision in a vein. As physicians delegated this procedure to surgeons and barbers, who were less knowledgeable about anatomy, it became increasingly important to have "maps" of the veins to be incised for specific purposes. A blood letting man

25. Medieval doctors still believed in the theory of the Four Humours. Did they use it in the same way as doctors in the ancient world? • Explain how medieval doctors followed ideas of Galen and Hippocrates but then go on to describe differences: • People had blood removed when perfectly healthy as a way of keeping humours balanced – did not wait to be ill • Carried out by barber surgeons – body maps like the previous image were produced and used • Used laxatives but linked these ideas of purging and bleeding with astrology. Guided by planets which was a new idea. Books like the vademecum were used.

26. Think over the following interpretations of the Four Humours. Look over your work and sources in your text books to find sources to support or disagree with these statements. • The Four Humour Theory held up the progress in medicine before 1600? Do you agree or disagree with this interpretation? • The Four Humours theory was more of a hindrance than a help to medicine. Discuss. • The Four humours had no lasting effect on medicine in ancient and medieval times. Discuss.

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