Medicine: 18-19th Century

Question 1

Reasons for medical process in the 18th and 19the centuries:

1. Church
2. Government
3. New technology
4. University
5. Questioning
6. Industry

Answer 1

• Many were Christians but the Church had little power over people’s lives (fewer would believe in superstitious causes and treatments)
• There was a monarch but an elected gov. ran the country (gov. would have to start improving health to get votes)
• New forms of travel (e.g. railway) and communication meant ideas spread quickly (new medical research could be shared and developed)
• Many university educated individuals made key discoveries (several medical breakthroughs made)
• People asked questions and challenged old ideas (idea of miasma was challenged)
• Industrialisation meant new machines, chemicals and materials were made (better research equipment meant new treatments could be developed)

Question 2

How significant was Edward Jenner in the history of medicine?

Smallpox

Answer 2

• Spread quickly through coughing and killed 1/3 of those infected
• Left horrific scars which left victims outcasts from society if they survived

Question 3

How significant was Edward Jenner in the history of medicine?

Inoculations

Answer 3

• Built up a person’s immunity to the disease but was too expensive for most
• Some people died from the small dose of smallpox or also became carriers of the disease

Question 4

How significant was Edward Jenner in the history of medicine?

Jenner’s vaccine

Answer 4

• He realised local dairy maids rarely caught smallpox but believed they caught the milder cowpox instead
• 1796 he cut open a cowpox pustule on a dairy maid’s arm, injected it into 8 year old James Phipps, inoculating him with a mild form of smallpox
• A few days later and James Phipps never caught smallpox
• Jenner tested his theory 23 more times after this
• 1798 published his results and sent it to the Royal Society

Question 5

Jenner’s discovery was significant:

Answer 5

• Encouraged other scientists to solve medical problems and use scientific methods
• Inoculation was only other treatment for smallpox and was very expensive and risky
• Vaccination was risk-free and free since government gave money to pay for free vaccinations

Question 6

Jenner’s discovery was not significant:

Answer 6

• People didn’t like idea of treatment linked to animals
• They thought that they would develop cow features
• Didn’t believe Jenner as he wasn’t a famous doctor
• Governments were slow to make vaccinations compulsory

Question 7

Who was Robert Koch?

Answer 7

• German doctor
• Part of government-funded research team
• Motivated by national rivalry against France after recent Franco-Prussian War
• He competed with Pasteur to make scientific discoveries

Question 8

What did Robert Koch discover?

Answer 8

• Discovered The specific bacteria that caused anthrax (1876) then the specific bacteria causing tuberculosis (1882)
• The process of isolating these different germs allowed other doctors to produce vaccines for different diseases

Question 9

What did Robert Koch do to test his theory?

Answer 9

• He extracted the anthrax bacteria from an infected sheep then injected it into a mouse, watching the mouse develop anthrax
• He repeated the scientific method many times to prove it was correct

Question 10

What did scientists believe were the causes of disease in 1855?

Answer 10

• Miasma
• Spontaneous generation (scientists observed with microscopes that decaying matter produced microorganisms, which leads to rotten food)

Question 11

What did Pasteur discover in 1857?

Answer 11

• Wine industry had payed him to investigate why barrels of wine were going off
• He used microscope on wine and found microorganisms
• This means that microorganisms was the cause of decay, not the product of decay

Question 12

When did Pasteur publish his ‘Germ Theory’ and what did other scientists think of it?

Answer 12

1861

• Pasteur said that if wine is effected by germs, humans can be too
• Many leading scientists and politicians doubted this as he had little proof

Question 13

What experiment did Pasteur conduct in 1864 to prove his Germ Theory correct?

Answer 13

Swan necked flask experiment

-Proved that germs must exist in the air and are not produced by decay

Question 14

Who influenced Pasteur’s work in 1880?

Answer 14

• Koch had previously found ways to isolate germs, proving Pasteur’s Germ Theory (on germs causing disease) correct
• Pasteur studied Koch and Jenner’s work to help him isolate and weaken the germ causing chicken cholera
• He successfully developed a vaccine

Question 15

When did other scientists start believing and using Pasteur’s work?

Answer 15

1885

• Pasteur used air to weaken a disease
• He used this weakened strain of a disease to create a Rabies vaccine which he used to save the live of a boy bitten by a rabid dog
• Scientists started to use his work to develop many more vaccines

Question 16

What did Florence Nightingale do?

Answer 16

• Although she came from a wealthy family, she trained as a nurse.
• When Crimean War broke out in 1854, she took 38 nurses to Crimea.
• At the army hospital in Scutari she was appalled by the dirty conditions and concentrated on cleaning the hospital and patients.
• This was so effective that the death rate in the hospital fell from 40% to 2%. She invented the pie-chart to present her data.
• She wrote about this to the British government.
• Being seen as a heroine helped her raise money to set up her first Nightingale School For Nurses In 1860.
• She wrote Notes On Nursing’s in 1859 and Notes On Hospitals In 1863.

Question 17

There was change in hospital care due to Florence Nightingale:

Answer 17

+ Nightingale made nurses keep wards and patients clean, therefore preventing the spread of infection in hospitals.

+ She improved equipment and sanitation: water was clean, sewers, drainage and toilets were improved.

+ Nightingale ensured that ventilation was improved so that fresh air could circulate and patients could breathe clean air.

+ Hospitals went from being a ‘gateway of death’ where patients did not expect to leave, to a place for them to recover.

+ Her work was published due to her wealthy family having connections in The Times, so more people were alerted on sanitation.

+ Nightingale wrote a book on nurse training and set up a school for nurses. This turned nursing into a profession and trained them to care for patients and keep hospitals clean.

Question 18

There was continuation in hospital care due to Florence Nightingale:

Answer 18

• Nightingale still believed in the miasma theory for the causes of disease.
• When Pasteur’s germ theory was published she refused to let nurses be taught about it because she feared it would get in the way of their duties of keeping hospitals and patients hygienic and clean.
• The poor still had to pay to use hospitals until 1867 (when the gov used taxes to pay for hospitals, which took time to develop).
• Partially the reason she became famous and her ideas became noticed was because she came from a wealthy family, so had connections in The Times.

Question 19

What was James Simpson’s discovery?

Answer 19

• Simpson was a Professor of Midwifery and wanted to find a better anaesthetic to help women during childbirth because anaesthetics like ether had dangerous side effects like coughing during surgery.
• 1847 whilst experimenting at home with his colleagues, he found that chloroform was an effective anaesthetic.
• Chloroform has no side effects that has and is stronger than alcohol and laughing gas.

Question 20

James Simpson’s discovery was an important breakthrough:

Answer 20

+ He published his findings in the paper.

+ 1857 Queen Victoria used chloroform during the birth of her 8th child.

+ Lead to more deaths from blood loss and infection as doctors attempted more complex operations as they felt like they had more time without patients screaming.

Question 21

James Simpson’s discovery was not an important breakthrough:

Answer 21

• Chloroform had already been discovered 15 years prior.
• The young, fit and fearful were dying as they breathed in more chloroform at a time.
• Chloroform slows down heart cells and only half a teaspoon is enough to kill.
• Simpson didn’t accept the dangers of chloroform despite the fact that hundreds of patients were dying.
• John Snow invented the inhaler to regulate the dosage and make Chloroform safe.

Question 22

What was Joseph Lister’s discovery?

Answer 22

• Pasteur’s discovery convinced him that germs must be the cause of infections in wounds so he searched for a way to stop them.
• 1864 Lister read about carbolic acid killing germs in sewage and thought he could use it on wounds.
• He also encouraged using carbolic acid as hand wash.
• Lister developed a spray to kill germs in the air around the operating table.

Question 23

Joseph Lister’s discovery was an important breakthrough:

Answer 23

+ Carbolic acid was an effective antiseptic which prevented infection in surgical wounds.

+ The surgical death rate fell from 46% to 15%.

+ Later his ideas were developed into aseptic surgery.

Question 24

Joseph Lister’s discovery was not an important breakthrough:

Answer 24

• Many were slow to start using carbolic acid.

- They thought the idea of germs was ridiculous until Koch proved it to test Pasteur’s theory.

Question 25

What were the 3 main problems with surgery in the 1800s?

Answer 25

1) No knowledge about germs.
2) Blood loss.
3) Infection.

Question 26

Why did public health need to improve by the end of the 19th century?

What caused the cholera epidemic?

Answer 26

• Industrial revolution in England meant lots of people in towns to find work.
• This caused overcrowding + insanitary living conditions. E.g. 8-9 people would share 1 house within 10 feet of each other, so disease would spread fast.
• Also, waste from toilets (380 people per toilet) overflowed into streets and rivers were treated as sewers so water supplies were contaminated with cholera.

Question 27

Responses to the cholera epidemic of 1853-1854:

Answer 27

People believed that the main cause was miasma, so methods used to try to stop cholera included:
•burning barrels of tar
•cleaning houses
•scattering chloride of lime (used for water treatment today)
•burning victims’ clothes
•smoking tobacco
•bleeding + purging (4 humours)
•prayed + wore charms (God’s punishment)
This shows more continuity from the Renaissance.

Question 28

Why did public health improve by the end of the 19th century?

1854 - John Snow

Answer 28

• Snow didn’t believe in miasma theory + thought cholera came from contaminated water.
• 1854 cholera outbreak in London which Snow was determined to stop:
• He interviewed local residents around Broad Street, where 500 people had died in 10 days.
• He found that those who died had all drunk from the same water pump on Broad Street.
• He plotted the pattern of the cholera outbreak on a map to prove his findings.

Question 29

Why did public health improve by the end of the 19th century?

John Snow’s impact

Answer 29

• His work persuaded the local council to remove the pump handle + deaths stopped in the area (a cesspit has been leaking into water supply).
• Snow had proven that contaminated water caused cholera but nothing was done to clean the water supply.
• Without the germ theory people still didn’t understand why contaminated water made you ill, so miasma was still the most popular theory.

Question 30

Why did public health improve by the end of the 19th century?

1861 - Pasteur’s germ theory

Answer 30

• Pasteur proved there was a scientific link between dirt + disease.
• Snow’s work now made sense + the miasma theory finally faded away.
• It was understood that it was the bacteria in contaminated water which caused illness.

Question 31

Why did public health improve by the end of the 19th century?

Germ theory impact

Answer 31

• 1848 government had passed Public Health Act which said that local councils could improve public health if they wished.
• Many had a laisssz-faire attitude - thought it was not their responsibility to interfere in the lives of the poor.
• Tax payers also reluctant to pay for improvement when they lived away from the worst areas.
• Germ theory meant that with scientific proof more tax payers were willing to cover the costs of public health improvements, so some cities finally took action.

Question 32

Why did public health improve by the end of the 19th century?

1867 - Working men given the vote

Answer 32

• Working men were given the vote for the first time which doubled the number of people who could vote in Britain.
• This meant if politicians wanted to win elections they had to make promises + pass laws to win the votes of the working class.

Question 33

Why did public health improve by the end of the 19th century?

1871 and 1875 - Government action

Answer 33

• 1871 government made vaccine for smallpox compulsory.
• 1875 government passed another Public Health Act, except it made it compulsory for local councils to:
• improve sewage + drainage
• provide fresh water supplies
• appoint sanitary inspectors who would check up on public health facilities.