19th cent medicine Flashcards
1
Q
who was paul ehrlich?
A
- student of koch
- 1889 - set out to find chemicals that could synthesise antibodies - known antibodies could attack specific microbes - magic bullets
- tried to find a magic bullet for syphilis - failed 600 times - until produced Salvarsan 606
2
Q
what was the discovery of anaesthetics?
A
- laughing gas identified as possible anaesthetic by humphry davy - but ignored by surgeons at the time
- james simpson - tried to find safe alternative to ether for childbirth - discovered effects of chloroform - made it painless - after queen vic gave birth 8th child - widely used
3
Q
what were living conditions like in 19th + 18th centuries?
A
- people moved countryside to towns to work in factories - overpopulation
- houses built close together
- many houses no bathroom and had to share one outside
- water companies set up water pumps on street - water supply often contaminated
4
Q
what was the cholera epidemic?
A
- affected Britain every few years between 1831 - 1866
- causes extreme diarrhoea - sufferers often due from loss of water + minerals
- didn’t know cause - thought miasma
- government started regulating burial of dead - ineffective
- 1832 - over 21,000 died from cholera in that year in britain
5
Q
who was edwin chadwick?
A
- govt laissez-faire
- social reformer - published report on living conditions- found that much poverty and ill-health was caused by the terrible living conditions
- suggested govt pass laws for proper drainage + sewerage systems - funded by local taxes
- report + another cholera epidemic in 1848 pressure on parliament to pass PHA 1848 - set up a CBOH to encourage local councils to improve conditions
6
Q
who was john snow?
A
- showed there was a connection between contaminated water and cholera in 1854
- studied a cholera outbreak in an area of london - noticed all victims used same water pump - so removed the handle and ended outbreak
7
Q
how did early anaesthetics lead to a rise in death rates?
A
- surgeons found unconscious patients easier to operate on - meaning could take longer on work
- longer operating times - higher death rates from infection because surgeons didn’t know poor hygiene spread disease
unhygienic methods:
- surgeons didn’t know clean clothes - save lives - often wore same clothes years - covered with pus + dried blood
- operations in unhygienic conditions ex. patients house
- operating instruments - unwashed + dirty
8
Q
who was joseph lister?
A
- applied Pasteur’s GT to surgery
- used carbolic acid as a chemical that could kill bacteria - stopped germs from infecting wounds in surgery
- death rate of his patients fell - 46% - 15%
- covered surgical instruments, bandages + surgeons hands in it + reduced chance of infection
- faced opposition - didn’t like its use - found unpleasant on skin or breath in
- antiseptics - surgeons less fear of patients dying from infection
9
Q
what is asepsis? and what does it include?
A
- aseptic surgical methods aim to stop any germs getting near the wound
- surgeons use sterilised instruments + operating theatres got smaller to reduce chance of infection
- surgeons expected to sterilise hands + wear surgical gloves
- these developments advanced by wars - ex crimean war - provided test cases for surgeons to try out new techniques
10
Q
what was the great stink? who was joseph bazalgette?
A
- lot of waste in london drained into water sources - including river thames
- hot weather in summer - caused bacteria to grow in waste - produced bad smell ‘great stink’ - 1858
- to reduce stink - joseph b appointed to build new london sewer system - transported waste away from thames
- sewer system officially opened in 1865 - design became blueprint for most cities in western europe
- to this day same sewers backbone of london’s mondern s system
11
Q
how did public opinion begin to change in the 19th century?
A
- most people 19th cent believed in laissez-faire style govt
- thought govt shouldn’t interfere in PH - but began to change
- evidence from chadwick, snow + pasteur’s germ theory showed cleaning towns could stop spread of disease
- 1867 - second reform act passed - gave nearly 1 mill more men vote - most industrial workers - have more say in PH politicians had to address workers’ concerns to stay in power
- several reformers helped change attitudes towards health. ex. william farr - statistician - used stats to press for reforms where death rates ↑
12
Q
how did govt take action in 1870s?
A
- govt finally took action to improve public health
- 1875 - disraeli’s govt passed another PHA - forced councils to appoint health + sanitary inspectors - also made councils maintain sewerage systems + keep towns clean
- 1875 - PHA more effective than 1848 because compulsory
- Disraeli also brought in artisans’ dwelling act - let local councils buy slums with poor living conditions + rebuild them to fit new govt backed housing standards
- 1876 - laws against pollution of rivers introduced
13
Q
what was the impact of the first-world war on X-rays?
A
- originally x-rays often located in hospitals miles away from battlefields - polish scientist marie curie developed mobile x-ray units - allowed doctors to transport equipment
- originally equipment for x-rays included glass tubes - unreliable + often stopped working - then coolridge invented more reliable tube - ‘coolridge’ tube - still used today
14
Q
how did the first world war impact blood transfusions?
A
- 1900 - ladnsteiner discovered blood groups - helped doctors to work out that a transfusion only worked if donor’s blood type matched receivers
- hustin discovered sodium citrate stopped blood clotting so it could be stored - important as many soldiers died from blood loss
15
Q
how was penicillin discovered?
A
- chance
- returning from holiday, fleming removed tops from some old Petri dishes - noticed bacteria he had grown were being killed by a mould - penicillin - used the word antibiotic to describe it
- published findings in articles
- but no one willing to fund further research
- unable to take work further
16
Q
who were florey and chain?
A
- chain devised the freeze-drying technique to purify penicillin
- florey knew penicillin vital in treating wounds of soldiers - british chemical firms too busy making explosives went to america
- american firms not keen to help - until america joined war in 1941 - in 1943 british businesses also started mass producing penicillin
- after war cost fell - making more accessible for general use
17
Q
what has the pharmaceutical industry done?
A
- pharmaceutical companies have played important role in researching and developing new medicine - also mass produce these drugs to sell worldwide
- chemotherapy (treatment of cancer using drugs) - began to be developed during WW2 - pharma companies have been developing since 1960s
- 1987 - pharma companies began mass-producing a drug called AZT - first approved drug to treat HIV - since then developing more effective drugs
- SARS - incurable + sometimes fatal virus - but pharma companies produce treatments that reduce symptoms
18
Q
what is antibiotic resistance?
A
- when a type of bacteria adapts so isn’t affected by antibiotics anymore
- makes it difficult to treat disease using antibiotics - stops them from working properly
- increased levels of disease + time taken for patients to recover
19
Q
how does antibiotic resistance happen?
A
- this resistance develops when doctors + patients overuse antibiotics
- the more antibiotics are used - the more likely bacteria will become resistant to them
20
Q
how have transplants been made more successful?
A
- 1905 - first successful transplant for the cornea of the eye performed
- first complete organ to be successfully transplanted was the kidney
now: livers, lungs, pancreases + bone marrow can be transplanted - first successful heart transplant carried out by SA surgeon Christiaan Barnard 1967
21
Q
what has technology led to in medicine?
A
- advances in science + tech have led to improvements in the treatment of diseases like cancer
- discovery of radiation in 1896 by bacqueres + marie & pierre curie led to creation of radiation therapy - use of radiation to kill cancer cells
- development of lasers in 1950s led to laser surgery - to correct vision problems - lasers also used in cancer treatment + dentistry
22
Q
how has technology improved modern surgery?
A
- keyhole surgery useful for investigating the causes of pain or infertility - can also be used for vasectomies, removing the appendix + other minor operations
- keyhole surgery leaves patients with smaller scars + allows them to recover quickly - with fewer risks of infection
23
Q
what are alternative treatments some people use?
A
- mistrust in modern medicine + technology means some people use alternative therapies instead
- acupuncture - method of putting needles in specific points of the patients skin to relieve pain
- homeopathy - treatment using extremely weak solutions of normal substances
24
Q
what is the difference between alternative treatments and mainstream treatments?
A
- alt treatments not gathered from scientific research
- as a result - little scientific evidence they work efficiently - some docs believe they do more harm than good
- but some doctors now working with alt therapists to see if a mix of alt and mainstream medicine might result in benefits to patient
25
Q
what helped push for liberal reforms?
A
- overcrowded housing - long hours work and low wages - many could not afford healthcare or even three meals a day for children
- booth’s report - showed 30% of london living in poverty + showed some wages so low weren’t enough to support family
- Rowntree’s report - showed 28% of people in york could not afford basic food + housing
- most people’s health poor due to lack of access to good healthcare
- when Boer war broke out army officers found 40% of volunteers physically unfit for military service - mostly related to poverty-related illness + living conditions
- govt realised needed to improve basic healthcare to have efficient army
26
Q
what were the liberal reforms?
A
- liberal government introduced free school meals paid for by local taxes - 1906 - helped with poor diet
- local education authorities started giving children at their schools free medical inspections - maintained good health
- passing of the national insurance act - introduced health insurance for workers - workers no longer discriminated - healthcare accessible for all
27
Q
how did world wars create pressure for social change?
A
- raising mass armies made government and military officials more aware of the health problems of poor - bc so many recruits in poor health
- powerful people more concerned with solving problems when at war because of need for strong army to defend country
- after second world war people looked for improvements in society - such feelings led to 1945 victory of labour party - which promised healthcare for everyone + full employment
28
Q
how did housing and health improve after second world war?
A
- during WW2 - destruction from bombing + lack of construction led to severe housing shortages - so labour govt built hundreds of thousands of homes
- governments in 1950s-60s demolished over 900,000 old, cramped slums - around 2 million inhabitants rehoused
- 1961 - report called ‘homes for today and tomorrow’ gave specific standards for new housing - including adequate heating, a flushing toilet and enough space inside and outside - final step in tackling issues that caused public health problems
29
Q
what was the Beveridge report?
A
- Beveridge said that the govt had a duty to care for all its citizens - not just poor or unemployed
- to achieve this Beveridge suggested the creation of a welfare state - a system of grants and services available to all British citizens
- 1945 - labour elected on condition they implement Beveridge’s proposals - one of first acts was to pass new NHI to support anyone who couldnt work - whether bc of sickness, unemployment or old age
30
Q
what was the national health service?
A
- labour govt implemented Beveridge’s last proposal - an NHS
- Bevan was the labour minister of health - after a lot of negotiation introduced NHS
31
Q
arguments for NHS?
A
- treatment free for all patients - accessible to everyone
- NHS guaranteed hospitals would receive govt money rather than having to rely on charities for money
32
Q
arguments against NHS?
A
- conservatives opposed idea as believed cost would be huge
- doctors did want to be controlled by govt - and worried would lose income
- many doctors threatened to go on strike to protest against NHS
33
Q
long-term significance of NHS?
A
- NHS contributed to dramatic improvement in people’s health
- rise in life expectancy - much higher than before NHS
