CiM: Progress in the mid-19th century

Question 1

4 Humours (2)

Answer 1

People thought illness was caused by an imbalance in the body’s humours
Incorrect understanding of disease prevented progress in treatment and prevention

Question 2

Miasma (3)

Answer 2

The idea that disease was carried in unpleasant smells by harmful fumes
People understood correlation between disease and poor hygiene, as it would occur in dirty and smelly poor areas
Miasma was logical

Question 3

Spontaneous Generation (3)

Answer 3

Microorganisms were too small to be seen without a microscope, little scientific research carried out at the time
People couldn’t link microorganisms and disease
Theory believes rotting material (e.g. dead animals) created maggots, fleas and disease

Question 4

Factors affecting progress (3)

Answer 4

Insufficient technology -> less curiosity around germs and microorganisms
Lack of funding -> less research and development, hospitals relied on charity as gov. did not feel responsible
Fixed attitude -> Doctors didn’t want to learn new treatments, and there was no proof that their methods were wrong

Question 5

Conditions at Scutari (6)

Answer 5

-Men shared beds or lay on the floor
-Clothes infested with lice and fleas
-Typhoid fever and cholera, along with diarrhea were common
-Food and medical supplies were limited (and of poor quality)
-Roof leaked, and the wards were dirty and infested with rats and mice
-The hospital was built above an underground cesspool (human waste), affecting water supply and air

Question 6

(Other nurses and) Nightingale’s actions in Scutari (4)

Answer 6

-Scrubbed surfaces clean and washed all sheets, towels, bandages and equipment
-Opened windows to improve flow/circulation of air (as she believed in miasma)
-Cleaned kitchens and improved quality of food
-Bought new supplies (towels, clean shirts, soap, plates and cutlery) using money raised by the Times newspaper

Question 7

Impact of Nightingale’s work (3)
Why may she not have been so impactful? (1)

Answer 7

-Habit of final checkup at night gained her the nickname “The Lady with the Lamp”, making her very popular in Britain
-Changed perspective towards nurses, as the army did not believe women could cope with conditions there
-Changed perspective towards medical knowledge of women
-Not so impactful because death rate only fell dramatically when gov. sanitary commission repaired drains for water supply

Question 8

Dangers in surgery (3)

Answer 8

Pain - Only types of pain relief were alcohol, opium, or being knocked out. Patient awake and screaming in most operations, so surgeon had to work quickly to prevent death from shock, while assistants held patient down
Blood Loss - Wound wrapped tightly to reduce blood flow in artery to slightly reduce this issue
Infection - Even when a patient survived the operation, a high % died afterwards due to infection

Question 9

Conditions increasing infection (4)

Answer 9

-Many operations carried out in patient’s home (unhygienic)
-Little understanding of infection, surgeon would wear old clothes stained with blood and pus
-Surgeon rarely washed hands, unsterilized equipment, reused bandages
-Many people in the operating theatre; medical students and wealthy people watched (unhygienic)

Question 10

Chloroform (5)

Answer 10

-Anaesthetic with insignificant side effects needed
-James Simpson experimented with various gases, regardless of danger
-Discovered chloroform in 1847 after sniffing party
-Widespread usage, even used by Queen Victoria during childbirth
-John Snow invented a chloroform inhaler in 1848 to control dosage

Question 11

Problems with Chloroform (3)

Answer 11

-Christian Church opposed use during childbirth as Bible said childbirth must be painful
-Many doctors opposed use during childbirth as effects on the baby were unknown
-Dosage difficult to get right

Question 12

Living conditions in Brits in poverty (4)

Answer 12

-Many people would share houses, which were usually damp, with little light or ventilation
-In bad weather, they could flood and toilets were shared by around 100 people
-Water collected from a local pump, taken from polluted rivers and only available for a few hours 3-5 times a week
!- In these conditions disease spread rapidly

Question 13

Standards of Housing Leeds report (4)

Answer 13

-Streets were bare earth, filth collected when muddy
-Many streets did not have sewers
-Stagnant water created offensive smells
-Loads of excrement built up in streets

Question 14

Edwin Chadwick (3)

Answer 14

-Chadwick published a report in 1842, suggesting spending tax money on improving housing and living conditions of the poor, and keeping them healthy. He recommended providing clean water and removing rubbish and sewage
-Initial support of idea was small, but further cholera epidemics affecting all classes pushed for 1848 Public Health Act
-He was a very difficult and arrogant person, so people did not want to accept his ideas

Question 15

1848 Public Health Act (3)

Answer 15

-Set up General Board of Health
-Allowed towns to set up local Boards of Health if mortality rate was higher than 23/1000 people
-Towns could employ a medical officer, organize trash removal and build a sewer system

Question 16

Limitations of the Act (5)

Answer 16

-Terms of the act only lasted 5 years, ending in 1854
-Did not force local authorities to improve hygiene, many taking no action
-23/1000 mortality rate meant high requirements for a local Board of Health
-People did not want to agree with Chadwick as he was a very difficult person
-Attitudes were slow to change and many did not like to spend taxpayer money on the poor (esp. with no proof that disease was linked to hygiene)

Question 17

John Snow and the Broad Street Pump (5)

Answer 17

-Investigated 1854 cholera outbreak in Soho, noticing all deaths were centered around Broad Street Pump
-Showed deaths did not occur when people did not drink from the pump
-Found that a cesspool wall cracked and leaked polluted water into the pump
-Demonstrated that cholera was waterborne, putting pressure on water companies and authorities.
-However, people still didn’t know how other diseases spread, as link between microbes and diseases not yet found