Medicine Unit 1 - Progress in the mid-19th century Flashcards
1
Q
Four Humours
A
- Blood, Yellow bile, Black bile, Phlegm
- Treatments based on Theory of Opposites e.g. suffering from blood, treatment was something cold and wet
- Is wrong but was believed previously
2
Q
Miasma
A
- The idea that disease was carried in unpleasant smells and harmful fumes in the air
- Based on since high rate of disease in poor areas w/people in dirty, unhygienic conditions
- Also knew disease spread more quickly in hot weather
- Logical but incorrect
3
Q
Spontaneous generation
A
- Scientists knew microorganisms existed but carried out little experiments and little research
- Link between microorganisms and disease unknown
- Came with the theory that rotting material e.g. excrement created disease / spontaneously generated
4
Q
Doctor’s knowledge
A
- Understanding of the body limited
- Doctors would observe few dissections during training - most believed in life after death and wanted to be buried
- Doctors mainly used bodies of criminals that were executed
- Difficult to plan any research on symptoms of disease or study specific conditions e.g. diabetes
5
Q
Factors affecting progress
A
- Lack of understanding closely linked with level of technology available
- Problem of funding for research and development of new ideas - government didn’t feel responsible for issues and charity relied on funding
- Many doctors wanted to keep on doing what they always had done and didn’t;t want to learn new ways - no proof their methods were wrong
6
Q
Florence Nightingale background
A
- Came from wealthy middle-class background
- Family shocked when she wanted to be a nurse - very-low status job at the time
- No formal training for nurses in Britain - visited various hospitals in Britain during 1840s
- Spent 3 months in 1851 at centre in Kaiserwerth Germany - training for nurses began in 1833
- 1853 - superintendent of small nursing home in London
- Met Sindey Herbert - Secretary for War - 1847 - asked her to take a team of 38 nurses to work in military hospital at Scutari
- Britain fighting against Russia in Crimean Peninsula in Black Sea
- Many British soldiers injured
7
Q
Conditions at Scutari
A
- 10,000 patients
- Many men shared beds of lied on the floors and in the corridors
- Clothes infested with lice and fleas
- Diseases e.g. typhoid fever and cholera common
- Many patients with diarrhea
- Difficult to get enough medical supplies to the hospital
- Food supplies limited and of poor quality
- Roof leaked and wards dirty and infested with rats and mice
- Hospital was above an underground cesspool - affected water supply and air in the hospital
8
Q
Nightingale’s actions
A
- Nightingale & nurses scrubbed surfaces clean & washed all sheets, towels, bandages and equipment
- Believed in miasma and therefore opened windows to improve air flow
- Cleaned kitchens and improved quality of food
- Fund of money raised by Times newspaper to buy 200 towels, clean shirts, soap, plates and cutlery
9
Q
Impact of Nightingale’s work
A
- Army medical staff resisted idea of nurses coming out to work in Crimea - felt women’s medical knowledge was limited
- Hard a habit of making a final round w/lamp ‘The Lady with the Lamp’ - popular w/patients and back in Britain
- Death rate at Nightingale’s hospital higher than at other hospitals
- 1855 - government sanitary commission rapid the drains and improved the supply of drinking water - death rate fell dramatically
10
Q
The Problem of Pain
A
- Before 1840s - paint relief available as alcohol, form of opium or being knocked unconscious
- Usually patient was awake & screaming - patients had to be held down
- Best surgeons were the quickest
11
Q
Blood loss and infection
A
- Tourniquets used for the problem of blood loss to reduce flow in the artery
- High rate of patients dying from infection even if surviving surgery
- Many operations were in patient’s home
- Little understanding of infection - surgeons wore old clothes stained w/blood & pus - surgeons might wash hands
- Equipment wiped clean or washed briefly - not sterilized
- Sponges used to wipe blood and rinsed out - bandages washed & reused
- Lots of people would be in the operating room - assistants and wealthy that supported the hospital would watch
12
Q
Use of ether
A
- Scientists began investigating chemical properties of gas & nitrous oxide known to reduce pain even when conscious
- Used in dentistry 1844-5 by Horace Wells
- William Morton - US dentist - experiment using ether in 1846 and found it had a stronger effect
- Robert Liston - used ether in operation to amputate leg in 1846 - patient didn’t have to be held down & woke up unaware that operation occurred
- Side effects - vomiting, irritated lungs therefore coughing - could leave patient asleep for hours or days - gas was highly flammable - dangerous around candles or gas
- Simpson wanted to find a better anesthetic and started inhaling various gases
13
Q
Simpson & use of chloroform
A
- Continued and discovered chloroform as an effective anesthetic
- Didn’t have the same side effects as there
- Simpson - Professor of Medicine & Midwifery at Edinburgh University - used it in 1847 for women in childbirth
- Used chloroform for Queen Victoria in Scotland for her 8th kid in 1953 after becoming her official physician
- Patients began asking for chloroform
- Died 1870 - 50,000 lined the route to his funeral and money collected for a statue
14
Q
Impact of chloroform
A
- Problems associated with the use of chloroform
- Christian Church opposed to chloroform use in childbirth because it is supposed to be painful
- Many doctors opposed to its use because of unknowns on its affect for babies
- Difficult to get dosage correct - enough for sleeping but not enough to die
- Doctors felt that unconscious people were likely to die that one who was slept away by pain
- Surgeons felt confident enough to attempt longer and more complicated operations deeper in the body
- John Snow able to solve problem by inventing the chloroform inhaler in 1848 - controlled dosage but infection and blood loss - death rate rose causing the ‘Black Period’ in surgery
15
Q
Problem of Infection
A
- Chloroform let for longer, more complicated operations deeper in the body but hygiene & infection still unknown - more germs taken into the body
- Many patients developed gangrene around the surgery wound & infections often developed into sepsis until the patient died
16
Q
Living conditions
A
- Groups of houses in poor areas often in narrow, dark streets called courts w/hundreds of people
- Families often lived in a single room & 50 or more might live in one house
- Houses usually damp w/little light or ventilation
- Ground floor and cellar could be flooded and a single toilet for 100 people
- Water collected from a single pump and shared by 20-30 families
- Water often taken form polluted rivers and only available for a few hours for 3-5 times a week
17
Q
Killer diseases
A
- Vaccination developed to prevent smallpox
- No prevention or treatment for typhus, typhoid fever or influenza
- Many who survived often died due to weakness when catching another illness like pneumonia
- Cholera - killed very quickly and symptoms were pain and muscle spasms, extreme vomiting, diarrhea until dearth due to dehydration
- 20,000 died during an epidemic from 1831-1832
18
Q
Dealing with cholera
A
- Lack of understanding shown by MPs ordering a day of prayer when there was another epidemic in 1848 - matters left to local authorities - adapted measures based on miasma e.g. barrels of tar burned in street
- Belief it was spread by miasma made many seem it would affect mainly the poor
- Dr. Robert Baker’s report on 1832 epidemic in Leeds described housing - many streets bare earth and became muddy and filth collected & 19 streets had no sewer and another 10 only had a sewer covering part of the street - sewers only finished where 30,540 lived
- Stagnant water created offensive smells
- Human excrement collected to sell to farmers
19
Q
Edwin Chadwick & the 1848 Public Health Act
A
- Worked in workhouses and published 1842 report called The Sanitary Conditions of the Laboring Population - suggested better to spend money from taxes on improving housing and living conditions of the poor & included recommendation on removing rubbish & sewage
- 1848 Public Health Act set up - General Board of Health set up, towns allowed to set up local Board of health & employ medical officer to organize rubbish removal & sewer system building - appointed three commissioners for Board of Health - Chadwick was one and was made commissioner for London’s Metropolitan Commission of Sewers from 1848-1849
- Impact of 1848 Act was very limited - terms of the act were temporary since Board of health needed after 5 years in 1854 & local authorities not forced to improve hygiene and hence didn’t do anything & Chadwick was arrogant & aggressive, hence his ideas were hard to accept for many & many didn’t want to pay increased taxes with no evidence that disease was linked to to hygiene
20
Q
John Snow and the Broad Street Pump
A
- Epidemic in 1854
- Dr. John Snow suggested cholera was being spread in polluted water in 1849
- Investigated an outbreak in Soho London using mapping and found deaths were concentrated around a pump in Broad Street
- Theory confirmed when handle was removed so no water could be collected & deaths from cholera stopped
- Link between cholera and infected water put pressure on water companies, local authorities & parliament to improve water supplies but microbes still understood
- Very little done until 1858 when the rivers began to dry up & rubbish and excrement was exposed causing the ‘great Stink’
- MPs discussed moving their meetings but then passed an act to provide the money for a new sewer system - Joseph Bazalgette chosen to design it
- Most significant improvements didn’t occur until Pasteur and Germ Theory in 1861
