Medicine and Health Through Time Flashcards
3 examples of prehistoric surgery
Setting broken bones
Bandaging
Trephining
3 examples of Egyptian surgery
Mummification (extracting soft organs, such as brain and intestines)
Practical first aid ( could reset dislocated joints and mend broken bones)
Excellent at bandaging and stitching wounds
Did the Egyptians and Greeks have any form of anaesthetic?
No, only herbal ANTISEPTICS
Did the Egyptians support dissection?
No, they believed it to be against God’s will. (Mummification was a religious act)
Examples of progression in Greek surgery
Due to frequent WARS, doctors became experienced in practical first aid
Learned about setting broken and dislocated bones (eg. curing a slipped disk)
Ambroise Pare
RENAISSANCE
1536- Discovered by CHANCE that wounds heal better treated with a ‘soothing digestive’ (cool salve)
- Used catgut ligatures to tie arteries during amputations instead of cauterising
1575- published ‘Apology and Treatise’, which led to big changes in surgery (COMMUNICATION)
Paracelsus
RENAISSANCE
- Discovered that laudanum was a pain killer and for many years it was used for things like period pain and headaches
Karl Landsteiner
1901- Discovered blood groups
Ignaz Semmelweis
1847- Cut death rate in maternity by making nurses wash their hands in calcium chloride solution
Queen Victoria
Gave birth under chloroform- allowed knowledge and trust to spread quickly (COMMUNICATION AND GOVERNMENT)
James Simpson
1847- Discovered chloroform as an anaesthetic
Wilhelm Roentgen
Discovered X-rays- led to huge improvements in internal surgery
Richard Lewisoh
1913- Found that sodium citrate stopped blood clotting in surgery
National Blood Transfusion Service
1938
Florence Nightingale
1854- Massively improved hygiene in hospitals during CRIMEAN WAR
Joseph Lister
1865- Cut death rate by introducing carbolic spray - led to aseptic technique in surgery
Aseptic surgery
1890 - Began with instruments being boiled to sterilise them etc.
Carl Koller
1884- Found that cocaine was a local anaesthetic
Humphry Davy
Discovered laughing gas was an anaesthetic when looking at properties of gases (SCIENCE)
Louis Pasteur
1861- Published the germ theory, which linked germs to disease- prevented infection in surgery
Robert Koch
1875- Helped prove the Germ Theory by dying microbes so that he could see them more easily under a microscope, which linked germs to disease- prevented infection in surgery
Andreas Versalius
Studied anatomy, became professor of surgery and anatomy at Padua. He was allowed to do dissections.
-Did his own dissections and wrote books based on his observations using accurate diagrams to illustrate
his work. His most famous book was ‘On The Fabric of the Human Body’ written in 1543.
-He was able to point out some of Galen’s mistakes. Vesalius said there were no holes in the septum of the
heart and that the jaw bone is not made up of two bones.
-Vesalius encouraged doctors to dissect and look for themselves
William Harvey
Discovers the circulation of the blood, disproving Galen’s ideas.
- Identifies the difference between arteries and veins.
- Becomes doctor the King, his ideas are very influential.
- To spread his ideas he writes “An Anatomical Account of the Motion of the Heart and Blood”.
- However, bleeding operations still continue after Harvey as people are unsure of what else to do.
- Blood groups are discovered in 1901, which makes blood transfusions successful.
Mary Seacole
Mary Seacole
From a poor background in Jamaica. Seacole volunteers to help as a nurse in the Crimean War, she is
rejected, but goes anyway self-financing her journey.
She nursed soldiers on the battlefields and built the ‘British Hotel’.
Goes bankrupt when she returns to England – but receives support due to the press interest in her story
and she writes an autobiography
Robert Koch
German scientist. He began linking diseases to the microbe that caused that specific disease.
Koch developed a solid medium to grow cultures, and dyeing techniques to colour microbes, which he
viewed through high-powered microscopes.
He identified anthrax spores and the bacteria that cause septicaemia, tuberculosis and cholera.
Louis Pasteur - Chicken Cholera Vaccine
Hearing of Koch’s, Pasteur came out of retirement and competed to find new microbes and combat them.
Pasteur looked for cures to anthrax and chicken cholera. Both he and Koch worked with large teams of
scientists. Charles Chamberland was in Pasteur’s team.
Chamberland was told to inject chickens with chicken cholera, but it was the day before his holiday and he
forgot. He left the germs on his desk and injected the chickens when he returned from his holiday.
The chickens survived, Pasteur and Chamberlain tried again with new germs, but the chickens survived.
The cholera had been weakened by being left out, and the weakened cholera made the chickens immune.
Chamberland’s error had produced a chance discovery.
Louis Pasteur – Anthrax Vaccine
Louis Pasteur – Anthrax Vaccine
How was the problem of pain overcome?
Nitrous Oxide or ‘laughing gas’ was discovered by Sir Humphry Davy. It was never really widely used as Davy’s
findings were published in a book that was not well known, the book was given an obscure name.
Ether used by J.R. Liston during a leg amputation. However, it had very unpleasant side effects.
Chloroform used by James Simpson and some friends at his home. They realised that it could be used as
during surgery. However, it led to unexplained deaths. The dose given could not be measured or controlled.
Reasons for opposition to anaesthetics:
They were uncomfortable for patients.
Some doctors believed that pain was good for healing.
People didn’t understand how they worked.
Didn’t understand the side effects that new substances could have on the body.
How was the problem of infection overcome?
Joseph Lister and the discovery of antiseptics:
Heard that carbolic spray was used on sewage. He knew sewage had a similar smell to gangrene.
He had read the work of Pasteur on his germ theory.
He was prepared to take risks.
Reasons for opposition to Lister’s ideas:
Lister’s methods slowed down surgery.
The spray was uncomfortable for doctors to use, it affected their skin.
Pasteur’s germ theory was not widely accepted in 1857.
Surgeons did not copy his methods correctly and were therefore disappointed with their results.
The final development of aseptic surgery:
By the late 1890s Lister’s antiseptic methods led to aseptic surgery. This is the removal of all possible germs
from theatres to ensure absolute cleanliness. The following methods were introduced…
Operating theatres and hospitals were rigorously cleaned.
All surgical instruments were steam sterilised.
Sterilised rubber gloves were first used and surgeon’s hands were scrubbed.
Edward Jenner
Jenner was a country doctor. He heard that milkmaids didn’t get smallpox, but instead a milder cowpox.
Jenner investigated and discovered people who had already had cowpox didn’t get smallpox.
In 1796 he took a small boy and injected him with pus from the sores of a milkmaid with cowpox. Jenner
then injected James with smallpox. James didn’t catch the disease!
Opposition to the Smallpox Vaccination
Jenner could not scientifically explain how it worked.
Inoculators were afraid of losing money.
Many were worried about side effects; they worried about giving themselves a disease that from cows.
Some members of the Church believed that vaccination was not natural.
Louis Pasteur’s Germ Theory – 1857
Scientists thought microbes were caused by disease and appeared because of illness. This was the theory
of spontaneous generation. Instead of blaming microbes, people looked for miasmas.
Louis Pasteur was employed in 1857 to find the explanation for the souring of sugar beet used in
fermenting industrial alcohol. His answer was to blame germs in the air.
He proved there are germs in the air by sterilising water and keeping it in a flask that didn’t allow airborne
particles to enter. This stayed sterile – but sterilised water kept in an open flask bred microbes again.
Methods of aseptic surgery
Operating theatres and hospitals were rigorously cleaned.
All surgical instruments were steam sterilised.
Sterilised rubber gloves were first used and surgeon’s hands were scrubbed.
How was the problem of bleeding in surgery overcome?
Once William Harvey had discovered the circulation of the blood, the first blood transfusions were attempted.
Early blood transfusions often ended disastrously because…
Blood groups had not been discovered.
They could not prevent the blood from clotting.
Infection could be passed on.
Public Health Problems in the Early 1800s
During the late 1700s and the first half of C19th, conditions in British towns became worse than ever.
Houses were built as close together as possible as more people crowded into factory towns to work.
Towns could not cope with the need to provide people with water and sewage disposal facilities.
In these squalid conditions, diseases spread easily and rapidly.
The conditions were so bad that many people’s health may have even become worse than ever before
The Battle to Improving Public Health
Some thought that the government should force local councils to clean up their towns.
However, many believed that the government shouldn’t interfere – this attitude is called laissez-faire.
They believed the government should allow each local area to control its own affairs.
This meant that local ratepayers made all the decisions. Local ratepayers didn’t want the government to
force them to pay for improvements to their towns.
Edwin Chadwick
In 1842 he was asked by the government to report on the living conditions and health of the poor.
Chadwick concluded that poverty was caused by ill health which was caused by the terrible conditions in
which people lived.
He said that ratepayers can cut their taxes and save money in the long-term by looking after the poor and
to spend money improving their health.
In his “Report on the Sanitary Conditions of the Labouring Population” he said industrial towns should:
o Organise drainage and refuse collection
o Provide a pure water supply
o Appoint a Medical Officer of Health
For over 30 years an argument went on about the need for town councils or the government to take action.
Towns such as Liverpool and Manchester did start to build sewage and water-supply systems.
1848 Public Health Act
The government did nothing at first about Chadwick’s recommendations.
However, in 1848 there was another outbreak of cholera, this put pressure on the government to do
something. Parliament reluctantly agreed to pass Public Health Act.
Although it was not compulsory. The government set up a Board of Health to encourage, but not to force,
local authorities to improve conditions.
They gave local authorities money to make improvements in their areas if they wanted to and had the
support of local ratepayers.
Only a few local authorities took any new measures.
By 1872 only 50 Medical Officers of Health had been appointed.
The Board of Health was abandoned in 1854.
1853 John Snow
In 1854 John Snow proved that there was a link between cholera and water supply. He used research,
observation and door-to-door interviews to build a detailed map of a cholera epidemic in Broad Street.
Nearly all the deaths had taken place within a short distance of the water pump.
Near to the pump, there was a brewery and none of the people there had cholera. The brewery had its
own water pump, and the men had been given free beer. They didn’t use the Broad Street Pump at all.
After collecting evidence, John Snow removed the handle from the Broad Street pump.
There were no more deaths. It later came to light that a cesspool near to the pump had a cracked lining
which allowed the contents to contaminate the drinking water.
Snow put pressure on water companies to clean up their water supplies.
1858 Great Stink
For years human waste made its way from the latrines in London into the River Thames.
In 1858 the hot weather caused a ‘great stink’. The putrid smell was right under Parliament’s nose.
Parliament considered moving and had to coat their curtains with a deodorant to get rid of the smell.
The Great Stink prompted Parliament to sort out London’s sewage and drainage system and to clean up
the River Thames.
Within a year Sir Joseph Bazalgette had begun to build an extensive system of sewers and drains that are
still in operation today
1867 Second Reform Act
Working class men were given the right to vote.
For the first time, it wasn’t just the ratepayers who got a say in improving public health.
MPs were forced to improve the living conditions of the poor.
1875 Second Public Health Act
Unlike the 1848 Public Health Act, the 1975 Public Health Act actually forced local authorities to introduce the
following measures:
Provision of clean water
Proper drainage and sewage
The appointment of a Medical Officer of Health
Result of the Public Health Act of 1875
Improved the standards of housing
Stopped the pollution of rivers from which people got water
Shortened working hours in factories for women and children
Made it illegal to add ingredients that made food unhealthy
Made education compulsory
What Medical Progress Did the First World War Bring About?
Surgeons had the opportunity to experiment with new techniques. Surgeons developed techniques to
repair broken bones, and perform skin grafts – plastic surgery.
Soldiers promised good housing when they returned. This helped to get rid of unhealthy slum housing.
Surgery of the eye, ear, nose and throat all improved rapidly. Brain surgery also advanced
The Development of X-rays
X-rays were first discovered 20 years before the war.
Hospitals installed X-ray machines, but it was the First World War which confirmed their importance.
More were manufactured to meet demand and they were installed in hospitals along the Western Front.
X-rays immediately improved the success rate of surgeons in removing deeply lodged bullets and shrapnel
which would otherwise have caused fatal infections.
Blood Transfusions
In the renaissance, Harvey proved blood circulates and this encouraged experiment with transfusions.
It sometimes worked and sometimes failed. Scientists didn’t know about different blood groups.
Blood groups were discovered in 1901 by Karl Landsteiner. The discovery made transfusions successful.
During the First World War vast amounts of blood was needed. On-the-spot donors were impractical.
Many soldiers bled to death in the trenches before blood could get to them.
The search began for a better method of storage and transfusion. Doctors discovered how blood can be
bottled, packed in ice and stored where it was needed. This discovery helped to save many lives.
The Discovery and Development of Penicillin
Fleming discovered mould killed germs. Writes articles but publishes them in book with an obscure name.
2 Chain and Florey begin research in Oxford after reading an article by Fleming. They experiment with mice.
3 Penicillin is first tested on a human being in Oxford.
4 U.S. and Britain fund production of penicillin.
5 Enough penicillin is produced to treat all the allied forces wounded in the D-Day invasion of Europe.
Factors Leading to the Development of Penicillin
Government – British government funded Florey’s research, U.S. government funded mass production.
Technology – microscopes and bacteria growing mediums.
Scientific experiment – testing on mice.
Individuals – Florey and Chain were skilled scientists supported by a skilled team of researchers.
War – the growing casualties of World War Two added to the urgency to mass produce penicillin.
Chance – Alexander Fleming discovered penicillin by chance in 1928.
Impact of the Second World War
Blood transfusion –blood could be stored for longer, civilians donated blood.
Diet – rationing improved some people’s diet, government encouraged healthy eating.
Drugs – penicillin was developed as the first antibiotic.
Poverty – evacuation took children out of urban areas. Highlighted contrast between rich and poor.
Surgery – developments in the use of skin grafts and treatment of burns.
Hygiene – government posters education people about health and hygiene.
Influence of WW2 on NHS
WW2 broke down social distinctions and brought people together.
The raising of armies made powerful people take notice of the health problems of the poor.
Evacuation of children increased awareness of how disadvantaged many people were.
After the Second World War people looked for improvements in society. Such feelings led to the 1945
victory for the Labour Party.
Introduction of the NHS
Sir William Beveridge published his famous Beveridge Report in 1942. In it he called for the state provision
of social security “from the cradle to the grave”. The report became a bestseller.
Aneurin Bevan was the Labour Minister for Health who introduced the National Health Service.
National Insurance was introduced to pay for the NHS. Doctors and dentists were wooed with a fixed
payment for each patient. They were also allowed to continue treating private fee-paying patients.
The NHS Still Has A Few Problems…
Governments have reduced how much of the NHS is free – charging for prescriptions and dental health.
Long waiting lists and doubts about the quality of treatment have led to paying for treatment outside NHS.
Longer life expectancies have meant more need for care of the elderly and increased costs for the NHS.
