Medicine Flashcards
Women in 1850
Women could not be doctors, women could be nurses
* Doctors had to go to Uni (closed to women)
* Doctors had to belong to a college (all closed to women)
Florence Nightingale
Improvements at Scutari
- Arrived November 1854
- Spring 1855 death rate had fallen from 60% to 2.2%
- Deaths peaked in January 1855 with 3,168 that month
Florence Nightingale
Improvements in England
- 1859 Wrote 2 books called “Advice on Nursing”
- 1860 Established ‘Nightingalge training school for nurses’:
1. Nurses should have practical training
2. Nurses should live in a moral, disciplined home
Elizabeth Garret
Path to Doctorate
- Attended classes for men before being banned from Middlesex
- Joined society for Apothecaries in 1865
- Went to Paris University to gain Medical degree
Elizabeth Garret
New Hospital for Women
- Founded 1872 by Garret
- Staffed entirely by women
- 1873 Garret joined BMA, was the last woman for 19 years as they voted against further women being allowed
1876 Medical act
Allowed women to enter medicine, numbers remained low anyway
WW1
QAIMNS
- Founded in 1902 during boer war
- 300 women in 1914
- 10,000 members by 1918
WW1
FANY
- Launched in 1907
- Specialists in First Aid
WW1
Women Doctors
- Women were not permitted at the front
- Dr Louisa Garret and Dr Murray led an all womens war hospital in London
- Lack of staff at home meant more women qualified, 610 by 1911 and 1500 by 1921
WW2
QAIMNS and FANY
QAIMNS:
* Given military ranks
* Served in a range of Countries in high danger
FANY:
* Attached to the 24,000 poles that escaped Poland
* Served as radio operators
WW2
Women Doctors
- Less impactful than WW1
- Femal medical students 2000 in 1939 to 2900 in 1946
- Women worked closer to battle than in WW1
‘Sanitary conditions of the Labouring Population’
- Published 1842
- James Chadwick
- Highlighted the terrible conditions under which poor people were living
- Suggested this was limiting economic growth
Broad Street Pump
- 1854, John Snow
- Proved Cholera was a water-borne disease
- Deaths from an outbreak were centralised around this pump
- When the handle was removed the deaths stopped
Causes of liberal reform
Demands of empire
* Men too weak to fight in war
* Boer War highlighted
* some areas up to 69%
Politics
* Rivalry with Conservatives and Labour pushed liberals further left
* Labour 2 seats 1900, 29 by 1906
Cause of reform: Demands of Empire
- Britain needed strong army
- Concern over health of troops
- In Boer War up to 69% of soldiers unfit to fight
- Boer war 1899
- Committee on Physical Deterioration
Cause of reform: Politics
- Rise of socialism in Britain
- Conservatives promies changes
- 1900 Labour Party formed
- Labour, 2 seats in 1900, 29 by 1906
- Threat led to Liberals being even further left leaning
2 Liberal Reforms for Children
- 1908 Children and young people act. illegal to abuse kids, commitees set up to ensure welfare, different childrens prisons, child care regulated (Difficult to enforce, conditions still harsh)
- 1912 School clinics, Medical treatment for Children free in schools (Standard of care varied)
Liberal Reform for Elderly
1908 Old Age Pensions act, Over 70s received 5s a week. Claimed by 650,000 people in first year, saved elderly from workhouse, same benfits nationwide. (raised taxes, not generous and could be refused to some people, rich were in uproar)
2 Liberal reforms for Workers
National Insurance Act 1911
1. Part 1, sickness benefit of 10s for 13 weeks. 16 million in scheme, included doctor fees, saved families from ruin. (Decreased after 13 weeks off, forced contribution of 4d a week, no family cover)
2. Part 2, Unemployed workers got 7s 6d a week. 2.5 million workers recieved, helped those in seasonal jobs or short term lay offs. (Families could not survive on this, only for 15 weeks, only for some trades not all)
1848 Public Health Act
- Permissive, Board of Health encouraged action but was not mandatory
- Allowed towns to: establish a Board of Health, employ a medical officer, organise rubbish and sewage removal
- Disbanded in 1878
1848 Public Health Act limitations
- Permissive
- Terms were temporary, Board of Health ended in 1854
- Very high cost of improving conditions locally
- Chadwick was difficult to work with
- Local tax increases not popular
1875 Public Health Act
Authorities had to:
* provide clean water
* dispose of sewage
* ensure only safe food was sold
Must search for dangers to public health “nuisances” and take action to fix it.
1876 River Pollution Prevention Act
Made it illegal for companies to dump waste , including chemicals into rivers
1875 Artisan Dwelling Act
Gave local governments the power to demolish slum housing.
Great Stink
- 1858
- Heat wave caused excrement in the Thames to dry on shores
- Caused incredibly bad smell, near parliament
- Showed that Thames was not a safe waste disposal
1858 Sewers act
- Parliament passed an act to build a sewer system
- Bazalgette assigned to build it
- £3million assigned
- Oval shaped sewers made of brick
Building of the Sewers
- Most finished by 1865
- Entirely finished in 1875, for £6.5 million
- 2000 Km
Beveridge report
1942 Published Will Beveridge
Wanted to address 5 problems:
1. Want
2. Disease
3. Ignorance
4. Squalor
5. Idleness
1946 National Health Act
- NHS Bill
- Doctors would work for the government rather than privately
- They would be paid a salary rather than per patient
Impact of NHS
1948-1949:
1. 187 Million prescriptions
2. 5.25 Million glasses
3. 8.5 Million treated at dentists
Ideas in 1850
- Miasma
- Spontaneous Generation
- 4 humours (blood,yellow bile, black bile, phlegm)
Germ Theory
- 1861 Louis Pasteur
- Employed to find a way to prevent milk spoiling
- Discovered micro-organisms and that they could be killed by heating
- Had little short term effect by 1878
- Disproved spontaneous generation
Effects of Pasteur
- Limited short term impact
- Surgery - 20 years later led to Joseph Listers development of antiseptic technique
- Public Health - 30 years later vaccines could be made and treatment created due to Germ theory in 40 years
Robert Koch
- Born Germany 1843
- Doctor who read Pasteurs work
- Rivalry between Pasteur and Koch during Franco-Prussian war (1870-1871)
Pasteur and vaccinations
- 1879 Chicken Cholera vaccine - confirmed Jennas theory
- 1881 Anthrax vaccine
- 1882 Rabies Vaccine - treated a 9 year old boy
Koch and Anthrax
- 1872 discovered a method of staining microbes
- 1876 able to identify specific microbe for Anthrax and published findings
Koch and Bacteriology
Koch is “Father of bacteriology” as he found methods of staining Microbes
* 1878 Septiceamia
* 1880 growing cultures - Agar jelly
* 1882 TB
Sylvarson 606
- 1909, discovered by Paul Ehrlich team
- Treated Syphillis
Marie Curie
- 1910 - led team on use of radiation for use against cancer
- 1911 Nobel Prize, means of measuring radioactivity
- Outfitted and drove mobile X-ray machines
Prontosil
- Discovered by Gerhard Domagk
- Tested on humans 1935 (on Domagks daughter near death)
- Gained renown when used to treat FDRs son
Penicillin Discovery
- 1928 Alexander Flemming
- Accidental discovery
- First Antibiotic (biological killer of bacteria)
- Flemming did very little with this
Florey and Chain
- Formed research team 1939
- 1941 tested on humans sucessfully, on a policeman near death
- Florey and Chain recieved huge amounts of American Goverment Funding
Mass Production of Penicillin
- 1942, US government invest largely in Penicillin
- 1944, Penicillin used on mass on D-Day
- 1945, US army uses 2 million doses a month
Surgery in 1850
3 main issues:
* Pain - all surgery very painful and had to be very fast
* Blood - large numbers of patients died from blood loss
* Infection - No knowledge of sterlisation or germs
Anaesthetics
Use of Ether
- Ether used in 1847 by Robert Liston
- John Snow later used it
Limitations - High Flammable, irritated lungs, unknown length of effects
Anaesthetics
Chloroform
- 1847 James Simpson discovered
- 1848 John Snow invents Chloroform inhaler
- 1853 John Snow used on Queen Victoria
Limitations - Christian opposition, untested
Longer surgeries meant more blood loss and infection
Anaesthetics
Other Anaesthetics
- 1884 Cocaine (addictive)
- 1898 Heroine (addictive)
- 1905 Novocaine (less addictive)
Antiseptic
Semmelweis hand washing
- Semmelweis encouraged doctors to wash hands after handling corpses before delivering babies. Decreased infection in child birth. Semmelweis seen as crazy and later incarcirated.
Antiseptic
Carbolic Acid
- First used 1860s, Lister
- Added onto surgical wounds
- Noticed more survival in compound fractures and other air-exposed injuries
- 1866-70 Listers death rate fell from 45% to 15%
Limitations to Antiseptic
- Methods were not reproduced correctly, so thought to be false
- Opposition to Germ theory
- Carbolic Acid irritated surgeons skin and was expensive
Antiseptic
Aseptic surgery
- 1878 Koch Steam Steriliser
- By 1887 all instruments had to be sterilised before use
- Ensured no germs ever entered the surgery
Bloodloss
Lister and Catgut
- 1881
- Lister discovered Catgut ligatures
- These prevented blood loss but later dissolved in the body
- Could be soaked in Carbolic Acid
Blood loss
Blood Groups
- 1901
- Landsteiner discovers blood groups
- Makes it possible to give succesful blood transfusions
WW1
Blood
- 1910s discovered that anticoagulant meant blood could be stored
- First non-direct transfusion in 1914
- First blood bank on Western front in 1917
WW1
X-rays
- X-rays discovered 1895 by Rontgen
- Marie Curie payed for mobile X ray machines with her own money
- More machines in Field Hospitals
- Limitations, could not detect clothing in wounds and required patients to be still
WW1
Infection
- A-septic conditions were impossible
- Cut away infection and bathe in saline was preffered method
- This was the Carrel-Dakin method
- Injuries often still led to amputation
WW1
Thomas Splint
- Held femur fractures open to prevent compounding of break
- 1914 80% of femur fractures died, 1916 80% survived
WW1
Skin Grafts
- Shrapnel lead to terrible face injuries
- Harold Gillies assigned to solve issue of facial injuries
- Specific hospital in Sidcup, treated 2,000 patients after the Somme
- Facial reconstruction became a key part of rehabilitation
1920s to 1940s
Blood transfusions
- Soviet Union set up national blood banks in 1930s
- Dr Charles Drew discovered blood could be seperated into blood and plasma 1940s
1920s to 1940s
Plastic surgery
- 1916, Vladmir Filatov developed first Skin Grafts
- 1920 Gillies and Kilner published Plastic Surgery of the face
1920s to 1940s
Burns
- McIndoe made RAF surgeon in 1938
- McIndoe operated highly experimentally on burned pilots, ‘guinea pig club’
- Got East Grinstead residents involved with visits to normalise the patients
