Progress in medicine in the mid 19th century

Question 1

What were the reasons for a lack of understanding of the causes of disease?

Answer 1

• Four humours
• Miasma
• Spontaneous generation
• Technology
• Funding
• Attitudes

Question 2

How were people treated based upon the four humours?

Answer 2

With opposites e.g. phlegm then chili which is hot and dry

Question 3

What was miasma theory?

Answer 3

The theory that bad smells and air caused disease

Question 4

What was spontaneous generation?

Answer 4

The theory that rotting material causes maggots, flies and disease

Question 5

What was the issue with technology?

Answer 5

If microscopes had been stronger, perhaps scientists would have been more curious about germs

Question 6

What was the issue with funding?

Answer 6

The government did not feel responsible for R+D and hospitals usually relied on charity funding, meaning that there was little money left over for research

Question 7

What was the issue with attitudes?

Answer 7

Many doctors wanted to keep doing what they had always done; they didn’t want to have to learn new ways

Question 8

What conditions did Florence Nightingale find on her arrival to Scutari during the Crimean war in 1854?

Answer 8

• Patients sharing a bed or on the floor
• Patients infested with lice and fleas
• Diseases like cholera and typhoid were common
• It was difficult to get medical supplies, with food supplies being limited and of poor quality
• The roof leaked
• Wards were infested with mice and rats

Question 9

What changes did Nightingale make to Scutari?

Answer 9

• Cleaned all surfaces, equipment and bedding
• Improved the food
  -Used funding in Britain to buy new supplies
• Constantly checked in on patients during the night (where her nickname “the lady with the lamp” comes from)
• Opened windows to improve air flow through wards

Question 10

What did Nightingale do on her return?

Answer 10

She was seen as an expert on nursing and hospitals, due to reports of her work being published in newspapers in Britain. At this stage she was less of a frontline nurse and more of a manager. In 1859 she published notes on hospitals and notes on nursing

Question 11

When did Sir Humphrey Davey discover that nitrous oxide or “laughing gas” reduced the sensation of pain?

Answer 11

1799

Question 12

When did dentists use laughing gas?

Answer 12

1840s

Question 13

Who performed the first successful surgery using ether in 1846 and where?

Answer 13

Senior Surgeon John Collins Warren and Boston Massachussets

Question 14

When J.R.Liston use ether?

Answer 14

1847

Question 15

Who argued for the need of hand washing in 1847?

Answer 15

Hungarian doctor, Ignaz Semmelwies

Question 16

Who discovered chloroform in 1847?

Answer 16

James Simpson

Question 17

Why was the use of chloroform as an anaesthetic widely accepted in 1857?

Answer 17

Queen Victoria used it for her 8th childbirth. It then becomes standard surgical practice

Question 18

What progress did nitrous oxide or “laughing gas” make?

Answer 18

Patients couldn’t feel pain

Question 19

What were the problems with nitrous oxide or “laughing gas”?

Answer 19

• Dosage
• Patients remained conscious

Question 20

What progress did ether make?

Answer 20

• Unconscious patients
• Doctors were willing to use it

Question 21

What were the problems with ether?

Answer 21

• Vomiting
• Irritated lungs
• Flammable and operating theatres were lit with candles
• Patient slept for hours or days due to dosage

Question 22

What were the problems with chloroform?

Answer 22

• The Christian Church opposed chloroform for childbirth
• Unknown effects on the baby
• Dosage - too much kills - John Snow invented the chloroform inhaler
• Unconscious patients were thought to be more likely to die than conscious ones
• Surgeons attempted deeper, longer operations

Question 22

What progress did chloroform make?

Answer 22

• Unconscious patients
• Better side effects

Question 22

What did Edwin Chadwick argue in the Report on The Sanitary Conditions of the Labouring Population of Great Britain and when?

Answer 22

• 1842
• Slum housing, inefficient sewage and impure water were causing unnecessary deaths
• Middle-class people lived longer because they could afford to have their sewage removed and fresh water piped into their homes. The average lifespan of the professional class in Liverpool was 35 whilst it was only 15 for the working class
• The private companies that removed sewage and supplied water were inadequate and that the government should do these - “a supply of piped water and a new sewage system using circular, glazed clay pipes and a relatively small bore instead of old, square, brick tunnels”

Question 23

What were the clauses of the 1848 Public Health Act?

Answer 23

• Set up a general board of health for 5 years
• Allowed towns to:
• Set up their own local boards of health (once more than 1/10 ratepayers agreed to it or if the death-rate was higher than 23 per 1000 in the town)
• Appoint a medical officer
• Organise the removal of rubbish
• Build a sewer system

Question 24

What did John Snow show during the 1854 cholera outbreak?

Answer 24

• There were 500 deaths within 200m of the Broad Street Pump
• In houses closer to another pump only 10 died - these families confirmed that they had got their water from the Broad Street Pump

Question 25

What happened at the local workhouse?

Answer 25

Only 5 died out of 535 because it had its own supply well

Question 26

What happened to the workers at the local brewery?

Answer 26

They were not affected because they drank free beer

Question 27

What happened to the women in Hampstead?

Answer 27

She died after drinking water from the Broad Street Pump because she liked the way it tasted

Question 28

Who was probably the first case of cholera in the 1854 outbreak?

Answer 28

A baby who lived at 40 Broad Street - her mother Sarah Lewis had soaked her dirty nappies in water which was then emptied into the cesspool in front of her house. The brick lining of the cesspool was found to be cracked, leading to polluted water leaking into the Broad Street Pump, 1m away

Question 29

When did John Snow request the removal the the Broad Street Pump to the parish Board of Guardians?

Answer 29

7th Sept 1854

Question 30

What happened after the pump handle was removed?

Answer 30

Very few cases were reported

Question 31

What did Snow argue for in the House of Commons Select Committee?

Answer 31

That cholera was not contagious nor spread by miasma but was water born. He advocated the government invested in massive improvements in drainage and sewage

Question 32

When did Snow present his findings to the House of Commons Select Committee?

Answer 32

1855