Medicine Flashcards
Why was strong stubborn theories a barrier to progress in Britain?
Some people thought that the outbreak if disease was a divine punishment for sinful living.
Others believed in the theory of the four humours, which was an ancient concept.
They also believed in miasma, which was drifting clouds in air that carried rotting matter, in the form of a bad smell.
What was the theory of four humours?
Blood, phlegm, yellow bile and black bile, They thought that disease was caused by an imbalance in the humours, and could only be restored by restoring balance.
Why were these theories widespread and deeply held?
People did not devote time and thought to studying. They thought that they already knew what was causing disease.
Training and treatment of doctors based on these theories of causation, so discouraged young doctors from questions flaws/assumptions, which led to little progress
Existing attitudes were a barrier.
Why was there a lack of progress in identifying and developing cures?
Lack of funding - no consensus that government should fund research in 1848
Lack of development in technology- no macroscopic by 1848
Ignorance of human body - small number of dissections, but religion objected to performing dissections.
Who is Florence Nightingale and her significance (at Scutari)?
Florence nightingale was a nurse during the Crimean War (1853-6)
Because of a scandal concerning high death rate in Scutari, she was asked to take a team of handpicked nurses to improve matters.
When was the Crimean war?
1853-56
Conditions of medical wards in Scutari before Nightingale?
Soldier died due to infection in unsustained numbers rather than due to the severity of wounds.
Disease spread easily in wards
How did the death rate change in Scutari due to Nightingale?
After nightingale, death rate fell from 40% to 2%
What were Nightingale‘s innovations?
Hygiene, Ventilation, food and organization
Systematic and regular cleaning of hospital wards and equipment
Frequent cleaning of wounds and changing dressings.
Regular washing of patients and changing of dressing.
Ventilation of wards allowed fresh air to enter and circulate/
Insistence on restructuring the layout of hospitals, with space between beds.
Sub-division of hospitals into different wards
Establishment of kitchen to provide fresh food
Rating of money to ensure fresh medical supplies sent from Britatin
Why is it important not to mythologize Florence Nightingale?
She believed in miasma
She did not realise that the hospital was built on a cesspool (affected water supply and air quality)
In 1855, gov sanitary commission improved drains and water supply (could be argued that it helped with the death rate)
What were the 3 main problems in surgery by 1848?
Pain - alcohol was used as a painkiller, or patients were knocked unconscious
Infection- Ignorance of causes of infections, so doctors did not clean hands sterilise equipment or change clothes. This meant operations were very unhygienic, and most people were more likely to die due to infection.
Bleeding - The surgeons can not see what they are doing.
Blood loss - by 1848, methods for restriction were harmful, tourniquets clamps caused nerve damage when left too long (cauterization) and ligatures led to infection if applied with dirty hands.
Who was James Simpson and what did he discover?
He discovered Ether as an effective anaesthetic had had problems with dosage and side effects so discovered chloroform and chloroform mask.
What is chloroform and how was it democratised?
An anaesthetic and was democratised when Queen Elizabeth used it for childbirth and recommended it public good example of how persistence of individual and prestige of another individual can result in lasting change.
What were the problems with anaesthesia?
Dosage - before chloroform mask had been invented safe dosages could not be determined as it depended on factors.
Confidence of doctors - death rate increased as a result of anaesthesia. Doctors could perform more evasive and complex surgeries which were fatal, as blood loss and infection had not been solved.
What were the problems with public health in 1848?
Rapid industrialisation had led to overcrowding in cities as people left countryside for work in cities.
Poor quality of housing and poor sanitation in cities as toilet facilities were basic and sewers ran into rivers.
What were the consequences of the problems in public health in 1848?
Promoted spread of disease, high death rate, short life expectancy among industrial workers.
Who was Edwin Chadwick and what did he do?
Tasked by government to produce report on sanitary conditions.
His report in 1842 recommended local authorises provide clean water, build proper drains and sewers, and collect rubbish from houses and streets. He achieved limited success because he was stubborn and arrogant.
What really lead to the Public Health Act 1848, and what did it do?
The cholera outbreaks due to poor hygiene and unsanitary conditions, would have even middle and upper class people dying.
It could no longer be ignored, so an Act of a Board of Health was created and towns collected rubbish and built sewer systems.
How significant was the Public Health Act in 1848?
Local authorities were only permitted to make improvement if they wished to they were not forced. This is because actions required money which required local taxes, so some authorities were unwilling to pay; there was no link between hygiene and disease.
The board of health was not permanent and lasted 5 years, Chadwick was forced out in 1854
Why was cholera a major threat?
The persistence of outbreaks (1842, 1848) which killed 50,000 people.
Cholera was a major killer with typhus, but it was most feared because prevention did not work (miasma)
What was the significance of John Snows work on cholera?
Snow hypothesised that cholera was caused by food or liquid taken orally and tested this theory.
He was right but his finding did not lead to rapid change, because people did not believe that dirty water caused cholera (miasma beliefs)
It showed that to break a harmful change of continuity and caused lasting change an important individual had to make a related breakthrough.
What leads to Snows work gaining greater acceptance?
Pasteur‘s germ theory proved water carried disease.
What factors contributed to Pasteur‘s germ theory?
Advancement in technology; powerful microscopes
Role of individuals and funding
When and what was Pasteur‘s germ theory?
1861 theory proposed that germs caused disease.
1878, book published on germ theory with specific application to medicine.
What is the significance of Pasteur‘s work?
Significance became apparent with massive, lifesaving advances in human understanding of the causes of disease, treatment, surgery and public health division.
Directed the nature of subsequent scientific and medical research.
Significantly increased funding from both private and government for medical research.
Institutions were now willing to provide money.
Who is Joseph Lister, and what did he discover?
He observed that infection remained a major killer.
He observed cattle feeding on grass with carbolic acid did not fall ill, so he spray carbolic acid on the wounds and bandages of a boy with a broke leg.
It was a successful experiment
Practiced and advocated more generally the use of carbolic to wash surgeon‘s hands and instruments before surgery and its use on bandages post surgery as well.
He developed a device for spraying solution, reckoning it would kill airborne microbes during surgery.
What was the significance of Lister‘s antiseptic breakthrough?
Short term- ideas not accepted immediately many people even within medical community rejected ideas on invisible microbes and when he was not carrying out the operation himself methods did not work.
Long term - due to additional weight of Pasteur‘s advances, Lister‘s antiseptic breakthrough gained wider acceptance.
This was a historical significant change and a life saving device.
What is the significance of the Public Health Act 1875?
Why - due to the reform act of 1867 that let more people vote for parliament to pay more attention to medical issues.
This meant governments had to change their laissez-faire attitude, due to attitudes changing due to medical advances and fear of another outbreak.
Significance = first time parliament had passed national laws to enforce public health standards nationwide. This showed how reliant the national government was on local authorities, who had to raise taxes.
The acceptance of higher taxes, helped pay for improvements.
What did the public health act of 1875 make local authorities responsible for?
Supplying clean water and dealing with sewage
Building public toilets and lighting the streets
Regulating new housing standards and inspecting conditions in rented accommodation
Employing health and sanitary inspectors to enforce the new rules including food quality
Who is Elizabeth Garret and what did she do?
Determined to qualify as a doctor, wealthy
When society of Apothecaries refused to accept her as a member did not explicitly exclude women as made sexist assumption that none would apply, threatened them with a lawsuit which they new her father could afford. After changed rules to ban any other women from joining
Same thing applied with British Medical Association in 1873
Opened st. Mary’s Dispensary for medical treatment for women in 1866
Taught herself French to gain medical degree in Paris
London School of medicine for women was renamed the Elizabeth Gareth Anderson hospital after her death 1918
What was impact of Elizabeth Garret for role of women in medicine?
Other women became inspired by her who were harassed and taught separately and forced to pay additional few but 1876 Act of parliament forced universities and medical societies to accept women it is one thing to pass a law another for attitude and prejudices to change
What and when was the act of parliament for women and its limitations?
1876 Act of parliament forced universities and medical societies to accept women it is one thing to pass a law another for attitude and prejudices to change
number of female doctors increased after 1876 but it remained very low
Who is Robert Koch and what did he do?
German Doctor
significant in researching anthrax using technology funded by German government
developed new methods to maximise the efficiency of his research e.g use of Petri dishes and agar jelly to grow cultures
Used industrial dyes to stain microbes to be more easily studied under microscope
Identified with team in Berlin and government funding the microbes that caused tuberculosis and cholera
What is the context for the work of Koch and Pasteur?
Franco-German rivalry created international competition even in medical advancements
German government funded creation of Berlin Institute of Infectious diseases where Koch and team provided worked
What is Koch impact and was it long term or short term?
Impacts were not immediate or short term but in long term Koch played significant role in bringing about change in medicine because his discoveries helped others within same field develop magic bullets and antibiotics
What were the key impacts of the public health act(1875)
Better sewage system - reduced contaminated water and therefore reduced spread of diseases like cholera
Clean drinking water - reduced spread of cholera and typhoid
Better housing conditions ensure healthy ventilation so fewer airborne illnesses
Improved street lighting- people could avoid rubbish and dirt
Compulsory medical officers - people placed in charge of public health in every local authority
Who discovered the blood groups and when?
Karl Landersteinetin in 1901
What were the blood groups and what did they allow?
A B O AB
Doctors realised that if patient gave wrong blood group could die so knowing group reduced risk of incompatible transfusions so increased success rate of surgeries
Saved way for safer blood transfusions and laid foundation for modern blood typing techniques
When was it discovered type O could be administered to anyone?
1907
Limitations of blood transfusions?
Despite improvements in surgery the blood donor had to be present for transfusion to take place as blood clots once it leaves the body so until scientists discovered how to stop blood clotting there was no significant improvement in surgery
Who discovered the Magic bullet and what did it do?
Paul Ehrlich a member of Koch’s team
Magic bullet concept was where specific chemicals could target and destroy disease causing agents without harming healthy cells
What was Salvarsans 606?
A magic bullet that targeted syphilis
When was Salvarsan’s 606 created and why was it historically significant?
First chemical cure for a diesease 1909
Who discovered X- rays and when ?
Wilhelm Conrad Roentgen in 1895
Significance of x-rays?
Allowed doctors to visualise internal structures of the body with our invasive procedures enabling earlier and more accurate diagnoses
Improved orthopaedics dentistry and surgery
Valuable for locating fractures tumours and foreign objects aiding precise treatment planing
What were scientists slower to comprehend with X-rays?
potenital safety measures and harmful effects of radiation
What was Marie Curies impact on medicine?
Her research laid groundwork in the field of radiation therapy in cancer treatment
Her work inspired development of techniques for targeted radiation to treat tumours
Received second Nobel Prize in chemistry
When was the liberal government in power?
1906-11
What is the context for the public health measures of the liberal government of 1906-11?
Despite rapid advancements in science and medicine millions of British citizens were living in poverty with a poor diet and poor general health, often with growth stunted as a result of bad nutrition and cramped living conditions
Government shocked and alarmed when heated that more than 1/3 men volunteering to fight in Boer Wars were unfit for military service British empire ruling 1/4 of the world
In major cities like Manchester as high as 75% so survival of army depended on improvement of public health
When was the Educational Act and what did it ensure?
1906
Aimed to provide school meals and gave government grant to pay 50% of the cost of the meals other 50% BY TAXES
One thing to raise money another compel local authority to provide meals
Was there progress in real terms due to the educational act?
General health of many children as a result of having ablest one meal a day but many children were still left malnourished and vulnerable to disease
