Industrial Medicine Flashcards
Ideas rejected by Edward Jenner.
-Edward Jenner rejected the use of inoculation.
-He gathered evidence of over 1000 cases where smallpox inoculations had failed.
Ideas developed by Edward Jenner.
-Edward Jenner regularly treated milkmaids for cowpox and noticed when there was a smallpox epidemic.
-Those who had already caught cowpox did not catch smallpox. He concluded that the two must be connected.
-In 1796, he tested his theory on a local boy, James Phipps by injecting him with cowpox.
-Six weeks later, he injected Phipps with smallpox but he did not catch it. He continued to test this on other local people.
Edward Jenner’s important work.
-In 1798, Jenner wrote up his findings in ‘An Enquiry into the Causes and Effects of the Variola Vaccinae’.
-Jenner made sure that the instructions for his new method were very detailed so that other doctors would be able to follow him.
-He wanted other people to use the vaccination to prevent smallpox from spreading.
Suspicion towards Edward Jenner’s vaccination
Suspicion- Jenner was unable to explain how and why his vaccine worked which made people suspicious.
-Infecting someone with an animal disease was seen as extremely strange so a lot of people were against it.
Opposition towards the smallpox vaccination.
The Church- They believed using animal infections in human medical trials was against God’s will.
Inoculators- They thought that the new vaccination threatened their businesses.
In turn, they used their money and position in society to encourage the media to print negative things about the vaccination.
The Royal Society- They refused to publish Jenner’s work because there was a lot of opposition to it in the scientific community.
The British Government’s reaction to the vaccination.
-From the first half of the 19th century, the British Government favoured the use of the vaccination.
-It was safer and more reliable than inoculations. It was also cheaper as patients did not need to be quarantined like with inoculation.
-They played an important role in promoting the vaccine. They provided funding and set up a society to promote vaccination. They also made it compulsory for everyone.
Government intervention in the problem of smallpox.
1840- The government made inoculation a crime.
The government agreed to provide children with vaccination at the taxpayer’s expense.
1852- The government made the smallpox vaccination compulsory.
1871- Public vaccinators were appointed.
1872- The British government began to enforce the compulsory vaccination.
The short term impact of the smallpox vaccine in Britain
-However, the vaccination was slower to be popular in Britain due to the anti-Jenner propaganda promoted by inoculators.
-Sometimes people still contracted smallpox or died of infection because the doctors carrying out the procedure smallpox and cowpox samples or reused needles and this discouraged people as well.
-After the Royal Jennerian Society was founded in 1803, 12,000 British people were vaccinated in two years.
The short term impact of the smallpox vaccination worldwide
-The vaccine saved many lives.
-It quickly became popular overseas and by 1800, 100,000 people around the world had been vaccinated.
-In 1805, Napoleon had his entire army vaccinated.
The long term impact of the smallpox vaccination.
-By the end of the 19th century, vaccination against smallpox had become normal. Opposition continued but the number of people saved showed the method worked.
-From 1872, the number of smallpox cases fell dramatically after the government began to enforce the compulsory vaccination.
-Other scientists were inspired to look for new vaccines but Jenner’s was created from observation so no other vaccine could be created in the same way.
-In 1979, The World Health Organisation announced that smallpox had been completely wiped out. This would not have been possible without Jenner’s early work.
The problems with early Victorian surgeries.
-Surgeries had to be performed quickly before the patient to bled to death.
-Although opium had been used to calm patients down, without anaesthetics, there was no way of preventing the pain caused by surgery (which sometimes sent patients into shock).
-Even if the patient survived, infection often set in as surgeries weren’t performed in germ free environments.
-The surgery was often performed in front of students or the public and surgeons would wear clothes from home.
James Simpson’s discovery of chloroform.
-James Simpson was convinced that there were better anaesthetics to be found than laughing gas.
-He gathered a group of friends together and they inhaled the vapours of various chemicals to see what might work.
-After sniffing chloroform, the entire party passed out so clearly it was an effective anaesthetic.
Success of chloroform.
-James Simpson wrote articles about his discovery of chloroform and its use became more popular.
-In 1853, chloroform was administered to Queen Victoria during the birth of Prince Leopold which made it even popular in Britain.
-More surgeries could take place and deeper, more complex surgeries became possible.
Problems and opposition to chloroform.
-The dose had to be carefully controlled, as it was easy to overdose a patient and kill them.
-The chemical sometimes affected the heart which caused some healthy and fit young people to die shortly after inhaling it.
-The Victorians believed that pain relief was interfering with God’s plan, particularly in childbirth, which was meant to be painful.
-Some doctors believed their patients were more likely to die if they were unconscious during surgery rather than awake and screaming.
Short and long term impacts of chloroform
-In the short term, it was an important development in anaesthetics and saved many lives.
-In the long term, Lister’s discovery led to deaths during surgery because of the carelessness of some surgeons.
The ‘Black Period’ of Surgery (1850-1870s).
-During this time, chloroform was used for longer and more complex surgeries.
However this meant that the problems of bleeding and infection became even bigger resulting in more blood loss and deeper infections.
-The death rate actually increases and more people began to distrust the use of chloroform.
-Afterwards, some surgeons went back to using ether and Nitrous Oxide.
Joseph Lister’s discovery of carbolic acid.
-Joseph Lister was an English surgeon. By studying infected wounds he realised that the flesh was rotting.
-Lister compared his results with Pasteur’s who identified germs as the cause of decay.
-He theorised if microbes in the air caused wine and vinegar to rot, perhaps microbes caused flesh to rot too.
-He began to look for a chemical that would clear bacteria from wounds.
-He was a ware of the use of carbolic acid in sewage treatment so in 1865 soaked added a bandage soaked in carbolic acid on a wound. It healed cleanly.
Success of carbolic acid.
-Lister developed a series of steps to ensure that wounds did not become infected. These included spraying carbolic acid in the air during operations.
-Lister published his work in ‘The Lancet’, a medical journal.
-He detailed 11 different cases where carbolic acid had been successful in surgery. He also travelled around Europe and the US to showcase his methods.
-In 1871, Lister operated on Queen Victoria to remove an abscess on her arm using carbolic spray. News of Lister’s successful treatment of the queen boosted faith in his methods.
Problems and opposition to carbolic acid.
-News of Lister’s success spread more quickly than Germ Theory. However this meant that the science behind the new method wasn’t fully understood.
-Consequently, not all surgeons were willing to use the carbolic spray. They still did not believe that the air was full of germs.
-Carbolic spray dried out the skin and left behind an odd smell. Some surgeons argued that, since it made their hand sore, it could not be doing patients any good.
-Lister focused on encouraging his colleagues to use the carbolic spray on patients instead of scientifically proving his theory. He was a ‘doer’ rather than a ‘thinker’.
The short and long term impacts of carbolic spray.
-In the short term, surgery did not change much because of much initial resistance from medical professionals. Even Lister himself stopped using carbolic spray in 1890.
-In the long term, carbolic spray was only popular for a short amount of time but attitudes towards antiseptic and aseptic methods changed and introduced to surgery.
-Surgeons finally understood that performing safe surgery was not only possible, but their duty.
-By 1900, instruments were steam cleaned, operating theatres were scrubbed spotless, rubber gloves and surgical gowns were introduced and surgeons used face masks during operations.
Changes in Hospitals in the Early 18th Century
-Some doctors offered their services for free to these new hospitals so that they could practise their skills.
-Patients admitted were the ‘working poor’- respectable working class people unable to afford to pay medical bills. For the first time, poor people had access to a trained doctor.
-As more people attended, hospitals became less sanitary. They became less strict about turning away infectious patients. They became places where sick people were treated and not places where people could rest and pray.
-Doctors visited regularly and there was often a surgeon or an apothecary on site. A small staff of untrained nurses cared for patients.
Continuity in Hospitals in the Early 18th Century
-By 1700, there were only 5 hospitals left in the country, all of which were in London.
-However, some new hospitals began to appear in the 18th century, founded using donations from the wealthy.
-Hospitals were still not places that people often chose to be treated at. The rich received medical treatment, and even surgery, at home which was much safer.
-Doctors went from ward to ward without washing hands or changing their clothes
Describe Florence Nightingale’s Background
-Florence Nightingale came from a wealthy family.
-She strongly believed that it was her mission from God to serve the sick
-She trained as a nurse in Germany and then in Paris.
-In 1853, she became Superintendent of nurses at King’s College Hospital in London.
Ideas rejected by Florence Nightingale.
-She rejected the idea that hospitals should only be used as a place of last resort for the desperate and those near to death.
-Instead she believed that hospitals should be clean and organised enough to give patients the chance to rest and recover, with properly trained nurses.
-She rejected the idea that upper class women (like her) were not meant to learn a profession. She refused to accept that she should live like women were ‘meant to’.
Ideas developed by Florence Nightingale in the Crimea.
-Florence was disgusted by the conditions in the Crimea. In turn, she began cleaning patients, walls, floors, bedding and equipment. She also provided good meals.
-She reorganised hospitals and demanded that cleaning supplies be sent regularly. She divided the work carefully between nurses and organised a rota for cleaning and changing sheets and feeding patients.
-She used statistics to record the results of changes and within 6 months, the mortality rate had dropped from 40% to 2%.
-This gave her respect and made her popular in Britain that she was able to use to influence change in British hospitals.
Ideas developed by Florence Nightingale in Britain.
She wrote a book of advice on how hospitals should be designed called ‘Notes on Hospitals’ to prevent disease from spreading.
-This was the ‘Pavilion style’ and it improved ventilation, made rooms larger, introduced painted surfaces for easy cleaning and had separate wards for different diseases.
-She wrote a book of advice on how to train nurses called ‘Notes on Nurses’ and in 1860 set up the ‘Nightingale School for Nurses’ at St Thomas’ Hospital in London.
-There, nurses were trained thoroughly before gaining a nursing qualification. This work had a large impact on the way hospitals ran and the ways nurses were trained.
Florence Nightingale’s important work.
-From 1854, she wrote many letters to the British government about her work in the Crimea.
-Her upper class position allowed for her to be able to influence the government in the way she did.
-In 1859, she wrote ‘Notes on Nursing’.
-In 1863, she wrote ‘Notes on Hospitals’.
Florence Nightingale’s overall impact on medicine.
-Her work influenced a new generation of hospital buildings. They used her designs and recommendations.
-By the end of the century, the role of hospitals had changed.
-They were no longer places for the desperate and dying but instead became organised and hygienic places where the sick were treated.
-She proved it was possible to influence the government- if you had the right connections.
