History Medicine

Question 1

Name six factors for change in medicine.

Answer 1

Government,
War,
Science/tech,
Individuals,
Communication,
Chance.

Question 2

What can be said about understanding of disease and the human body in the mid 1800s?

Answer 2

Belief in miasma (bad air) causing disease, and also in spontaneous generation creating disease.
Limited understanding of the body, doctors could only use criminals for dissection, so difficult to study diseases.

Question 3

What can be said about surgery in the mid 1800s? [6]

Answer 3

• Operations were carried out very fast and patients were awake.
• Only dealt with obvious physical problems on the outside of the body.
• People would often go to their local barber or blacksmith.
• No anaesthetic (trauma and pain)
• Poor hygiene and bad conditions (infection)
• No effective methods to stop blood loss.

Question 4

Name four developments in anaesthetics.

Answer 4

• In 1846 Liston begins using ether. This did however irritate the lungs and was flammable.
• James Simpson discovered chloroform, and wrote articles about the success. Even Queen Vic used it. People did oppose it because it could be overdosed.
• John Snow invented the chloroform inhaler.
• Deaths rose with anaesthetics because infection was worked deeper into the body in longer surgery. “The black period”.

Question 5

Describe one feature of the work of Joseph Lister.

Answer 5

Comes up with a carbolic acid spray to sterilise wounds and equipment during surgery. He realises that he is killing germs in the air from Pasteur’s work. The death rate in his work goes from 46% to 15%. Begins to start creating aseptic conditions. By 1890 most doctors used antiseptics.

Question 6

What changes were made in the sealing of blood vessels? [3]

Answer 6

• Blood vessels usually sealed by cauterisation (painful).
• Liston realised that ligatures carried infection and prevented smooth healing.
• In 1881 Lister uses Catgut, which had fewer infections and dissolved in the body.

Question 7

How were blood groups discovered? Was there an impact?

Answer 7

• In 1901 Landsteiner discovered A/B/O, 1902 AB. Drs realised that patients had to be given the correct blood type.
• Understanding improved but limited impact because no way of storing blood.

Question 8

Describe how X-rays were discovered. What was one impact?

Answer 8

• Discovered by Wilhelm Rontgen in 1895. By 1896 many hospitals had machines. Now bullets and shrapnel could be located, which reduced infection.

Question 9

What were some problems in WW1 that required surgery? [3]

Answer 9

• Gas gangrene infection.
• Broken legs, and shrapnel wounds lead to amputation: 240 000 soldiers lost a limb.
• Head wounds.

Question 10

What surgical advancements were made during ww1? [4]

Answer 10

• Surgical technique improved.
• Thomas splint invents the splint: survival goes from 20% to 82%.
• Brain surgery attempts.
• Skin graft knowledge develops.

Question 11

Name a feature of the work of pasteur (germs)

Answer 11

He discovered microorganisms growing in beer and solved the problem by boiling the liquid. The 1860 scientific competition made this theory famous.
Pasteur connected microorganisms to disease after investigating with silkworms.

Question 12

Name one feature of the work of Koch

Answer 12

He discovered that specific microorganisms cause specific diseases. He focuses on the anthrax bacteria after experimenting with mice.

Question 13

How did Koch help solve problems with infection?

Answer 13

He discovered that bacteria in the blood caused blood poisoning and recommended that instruments should be sterilised with heat. He published his findings. By the 1880s hospitals become more rigorously cleaned.

Question 14

Describe one feature of the work of Paul Ehlirch.

Answer 14

He worked on Koch’s research team, reasoned that if certain dyes could stain bacteria, perhaps certain chemicals could kill them.
He developed the first Magic bullet, Salvarsan for syphillis.
Found by chance: Dr Sahachiro Hata found it in the 606th compound.

Question 15

How did Fleming rediscover penicillin? What was his problem? [4]

Answer 15

He found it on a petri dish in his lab killing the bacteria around it.
He bred enough of it to test it on 8 mice who had deadly streptococci.
He tested it on a human first in 1941, and it worked but ran out.
It was incredibly difficult to produce it in large quantities, and he could not get support or funding.

Question 16

What did Florey and Chain do to produce penicillin? What factors helped them?

Answer 16

They traveled to the USA, who once the war started gave 80 million to drug companies. Mass production began in 1943. After the war it was made available for civilian use. Technology in mass producing it, and Gov’ support.

Question 17

What were some of the impacts of penicillin?

Answer 17

It roughly halved the average time wounded Allies spent in hospital.
It could treat many infections and diseases including streptococcus, scarlet fever, and gonorrhoea.

Question 18

What and when was the second magic bullet?

Answer 18

1932 Gerhard Domalk tried out prontosil which has an effect on blood poisoning. This was supported by the invention of electron microscopes.

Question 19

How did Koch help improve scientific experimentation? [3]

Answer 19

• He developed ways to stain and examine bacteria - identification.
• Developed a solid medium for growing bacteria.
• He also practiced thorough experimentation technique, e.g. 20 generations of mice for anthrax.

Question 20

What was a feature of Pasteur’s work with vaccination? [2]

Answer 20

• He invents a method for vaccinating chicken cholera with a weaker strain - useful for French farmers.
• Then a vaccine for anthrax after experimenting with sheep.

Question 21

Why was there opposition to antiseptic methods and the work of Lister?

Answer 21

• Carbolic acid was unpleasant to work with and made instruments slippery.
• There was reluctance to accept the link between Pasteur’s germ theory and antiseptic methods.

Question 22

What were some improvements in organisation from WW1?

Answer 22

Huge numbers of injured lead to appreciation for speed of treatment.

• Casualty clearing stations and base hospitals are made with specialised doctors.
• Ambulances at home and in the war.

Question 23

How did WW1 and WW2 create developments in mental health? [3]

Answer 23

• Many soldiers had shellshock - headaches, shaking, nightmares.
• Craiglockheart mental hospital established - better understanding.
• WW2: 18 psychiatric hospitals set up just for servicemen.

Question 24

How did the wars create changes in blood transfusion? [4]

Answer 24

• Huge amounts of blood needed pushed scientific experiments.
• Developments in reducing clotting: Turner adds glucose citrate to increase blood life by 4 weeks.
• Result: blood banks ready before WW2.
• 700 000 donors gave blood during WW2.

Question 25

What were the developments in surgery in WW2?

Answer 25

• Technique improves with skin grafts on burnt pilots.

- Dwight Harken carried out the first heart surgery: 130 successful surgeries removing bullets and shrapnel.

Question 26

What were hospitals like in the mid-nineteenth century? [4]

Answer 26

• Little government intervention into public health - most people were cared for at home by the family.
• First ‘Cottage hospitals’ (small country hospitals) appear in 1860s.
• London had many charity hospitals
• Only the wealthy could afford good treatment.

Question 27

How did Florence Nightingale help improve nursing technique? [3]

Answer 27

• She worked at the Scutari Hospital in the Crimean war from 1854 in very unhygienic conditions, with men having to lie on the floor, and more dying for typhus or cholera than injuries.
• She collected data and proved that better sanitation would help the death rate.
• With fresh water and fruit the death rate went from 60% to 2.2%

Question 28

How did Florence Nightingale help support the role of women in nursing? [4]

Answer 28

• She worked against society and her family’s views, as nursing was not considered a suitable occupation.
• She was acknowledged in her achievements and people donated money to her.
• She established the Nightingale Training School and Home for Nurses.
• She made nursing a suitable career for respectable women.

Question 29

What were attitudes to women becoming doctors in the mid 19th century? [3]

Answer 29

• The Church said that only men can be physicians.
• Surgeons need a uni degree, and universities were barred for women
• Medical Registration Act of 1852: all doctors must belong to a medical college, all of which were barred for women.

Question 30

How did Elisabeth Garret become a doctor?

Answer 30

• She attends lectures and becomes a nurse in her free time, but could not register as a member of any medical college.
• Her rich father threatens to sue the College of Apothecaries, and they accept her, but change the rules so none can follow.

Question 31

What achievements did Garret make?

Answer 31

• Opened St. Mary’s Dispensary London, providing care for women.
• Became the first female member of the British Medical Association 1873.
• Influenced the passing of the 1876 Act of Parliament - Unis must accept female student doctors.

Question 32

What was a feature of the work of Sophia Jex-Blake?

Answer 32

• She and 4 other women study at Edinburgh Uni. They couldn’t do practical work but finished the degree.
• Influenced the passing of the 1876 Act of Parliament - Unis must accept female student doctors.

Question 33

What was womens’ role in medicine before WW1? [3]

Answer 33

• 1% of doctors were women.
• Most General Hospitals did not accept women doctors.
• Women were mostly General Practitioners, with no experience of surgery.

Question 34

How did WW1 change womens’ role in medicine?

Answer 34

• Heavy casualties required the army to ask for help, e.g. 80 female doctors were sent to Malta.
• However, after the war, women were still expected to be General Practitioners.
• Many developments in nursing, e.g. FANY.
• Progress was slow - by 1931, 10% of doctors were female.

Question 35

What was a development in nursing during WW1?

Answer 35

Queen Alexandria’s Imperial Military Nursing Service was set up - main group of trained nurses working with the army.

• Nurses went form 300 to 10 000 by 1918
• Created many highly trained nurses.

Question 36

What was public health like in the mid 19th century? [3]

Answer 36

• Deaths from disease is very common.
• Poor housing with terrible overcrowding; by 1850 half to the population lived in cities and towns.
• No building regulations or proper legal requirements for sanitation, so landlords built cheap houses without sewers/ water supply… etc.

Question 37

What was the impact of Cholera on 19th century England? [4]

Answer 37

• Between the 1830s and 60s, cholera created widespread panic, and was responsible for nearly 40 000 deaths.
• It is a water-borne disease, with a prolonged and painful death.
• London’s waste went directly into the Thames, which became like a giant sewer. The entire city’s drinking supply was taken from the Thames.
• People thought cholera was from miasma or a punishment from god.

Question 38

How did Edwin Chadwick help solve the problem of cholera?

Answer 38

He worked tirelessly promoting public health, and the miasmatic theory.
This lead to Parliament passing the Cholera Bill in 1846 to encourage property owners to clean buildings and connect them to sewers.

Question 39

How did Chadwick bring about awareness for public health?

Answer 39

He recorded evidence and published it in the Report on Sanitary Conditions in 1842.
The well off knew little about the slums were horrified. This lead to further investigation, e.g. William Farr created a system of recording deaths with death certificates.

Question 40

Why was it hard to make changes to public health?

Answer 40

• There was much social prejudice and the well off blamed the poor for the bad conditions.
• Working men had no voice to press for reform, and could not until 1884.
• The money to enable change would mean a rise in rates which was unpopular among the voters.
• Opposition from both landlords and ratepayers.

Question 41

What was the impact of the Public Health Act of 1848? [3]

Answer 41

• It established local General Boards of Health, which could control water, sewage, paving… etc.
• However, towns did not have to reform if they wanted to, and change was difficult to achieve.
• 10 years later, only 1/6 of the country had Local Boards of Health.

Question 42

What was a feature of the work of John Snow?

Answer 42

• His investigations in Broad street explained how cholera was spread through water.
• His views were not widely accepted, but eventually, in 1866 the Sanitary Act is passed.
• The SA made towns employ health inspectors, and local governments began to make changes and regulations.

Question 43

What was a feature of the work of Bazalgette? [3]

Answer 43

• The ‘Great Stink’ of 1858 gives the incentive for a new system.
• Parliament grants 3M pounds for Bazalgette’s sewer Project. 2000 sewers were built by 1865.
• London was able to avoid further cholera outbreaks afterwards.

Question 44

What was the impact of the Public Health Act of 1875?

Answer 44

• It increased the government’s role and attitude towards the government’s responsibilities for public health.
• It enforced national standards of public health, e.g. Local Authorities had to provide sewers and clean streets.
• Lead to more Acts such as the Food and Drugs Act, which set food standards.

Question 45

What health problems remained in the 20th century, and what factors influenced further change?

Answer 45

Despite improvements in hygiene and housing, the general standard of health remained poor. This was due to poverty, and ignorance of hygiene.
Change was brought about by war: 1/3 of volunteers for the Boer war were ‘unfit for service’, and a change in voters: the Liberal Party was more sympathetic to the working class.

Question 46

How did Liberal Reforms improve public health? What was the problem?

Answer 46

• 1907 School Medical Service provided health checks on children to prevent the spread of diseases like T.B.
• 1911 National Insurance Act was a free sickness benefit.
• It didn’t help everyone, e.g. mostly targets the old and young, and the Insurance Act only helps the worker not the family.

Question 47

How did Beveridge influence public health?

Answer 47

He recommended that everyone should be protected against ‘the Five Giant Evils’,

• The government should take responsibility for total welfare of the people from ‘cradle to grave’.
• Everyone could receive free healthcare paid for by National Insurance contributions and taxes. This created the Welfare State and the National Health Service.

Question 48

How did war influence the work of Beveridge?

Answer 48

Reports on the health of evacuees from WW2 and evidence about how poorer people were actually better off after rationing lead the Government to ask Beveridge to make a report on how to handle public health.