Early modern public health (c.1500–c.1750)

OCR Paper 1 covers The People's Health as a thematic study from medieval to modern. The early modern period is often tested with a comparison to medieval OR a "how significant" question about the Great Plague of 1665. Key argument: beliefs changed little (miasma still dominant), but responses became more organised.

Living conditions c.1500–1750

Towns grew significantly but without modern infrastructure:

• Water supply: rivers and wells; still frequently contaminated by nearby cesspits and tanneries.
• Waste: "night-soil men" emptied cesspits; animals still kept in towns; pig-keeping in backyards common.
• Overcrowding: multi-family tenement occupation; apprentices and servants sharing rooms.
• Life expectancy: c.35–40 years average; infant mortality remained very high (1 in 3 died before age 5).

Some modest improvements from medieval:

• Some towns passed "nuisance" by-laws requiring cleaner streets (though enforcement was poor).
• More printed health advice following the printing press (1440s onwards).
• Apothecaries (chemists) became more common.

Disease and medical understanding

Medical theory was still dominated by Galen's four humours and miasma theory — both wrong.

Vesalius (1543, De humani corporis fabrica) published detailed anatomical drawings based on dissection, challenging Galen's anatomy — a significant step, but most practitioners ignored it.

William Harvey (1628) proved blood circulates — another breakthrough that took decades to influence treatment.

Despite these advances, medical practice for the poor remained: herbal remedies, bleeding, purging, prayer, and quack medicine.

Plague 1665: The Great Plague of London

The final major outbreak of bubonic plague in England:

• Killed c.100,000 Londoners — roughly one-quarter of London's population.
• Cause: still believed to be miasma — bonfires lit in streets, aromatic herbs burned.
• Responses by authorities:
  • Quarantine of infected households — red cross on the door with "Lord have mercy upon us".
  • Plague orders: infected people confined for 40 days; "searchers" (usually poor women) examined the dead to determine cause of death.
  • Bills of Mortality published weekly — early disease surveillance.
  • Dogs and cats killed as suspected carriers (in fact, this helped rats spread more freely).
• Wealthier citizens fled London (including King Charles II and his court) — leaving the poor behind.
• Plague ended mysteriously after 1666 (possibly: Great Fire of London destroyed rat habitats; climate change; changing rat species to brown rat with fewer flea-contact opportunities).

Significance of 1665

The Great Plague was the last major plague epidemic in England — but this was largely luck (natural factors) not deliberate public health success. The miasma-based responses neither prevented nor ended it.

Quack medicine

"Quacks" (short for quacksalver — one who boasted of cure-all remedies) were widespread:

• Sold patent medicines (e.g. Plague Water, Venice Treacle) at markets and fairs.
• Made extravagant claims with no evidence.
• Popular because mainstream medicine could rarely do more — and quacks were cheaper than physicians.
• The Royal Society (founded 1660) and Royal College of Physicians tried to regulate medicine but had limited reach outside London.

Continuity and change: medieval vs early modern

Feature	Medieval	Early modern
Disease theory	Miasma + God's punishment	Still miasma + God's punishment
Medical knowledge	Galen/Hippocrates	Vesalius (anatomy), Harvey (circulation) — but slow adoption
Plague response	Prayer, flight, isolation	More organised (Bills of Mortality, plague orders)
Treatment	Bleeding, purging, prayer	Same + quack medicine + apothecaries
Role of state	Very limited	Slightly greater (plague orders, quarantine rules)

Key OCR argument: Medical knowledge advanced (Vesalius, Harvey) but medical practice for most people changed little. The state took slightly more responsibility during epidemics, but disease theory (miasma) stayed wrong.

Common OCR exam mistakes

1. Saying the Great Fire of London ended the plague on purpose — it was accidental.
2. Confusing Vesalius (anatomy) with Harvey (blood circulation) — both challenged Galen but on different issues.
3. Overstating how much changed — for most poor people, early modern healthcare was barely different from medieval.
4. Forgetting that Bills of Mortality were an early form of disease surveillance — shows some rational, empirical response.