Progress in the mid 19th century

Question 1

What were the three theories of disease before the progress of the mid-19th century?

Answer 1

1. Four Humours - the four bodily fluids; phlegm, blood, black bile and yellow bile have to be balanced to stay healthy.
2. Miasma - disease is carried by bad smells
3. Spontaneous Generation - rotting material causes disease

Question 2

What were the methods to prevent blood loss before the 19th century?

Answer 2

1. ligatures - tying off open arteries - often caused infection as they had no knowledge of antiseptics
2. Cauterisation - using a hot metal rod to seal off arteries - usually effective but extremely painful for the patient
3. tourniquets - wrapping a piece for cloth tightly around the limb to prevent blood flow

Question 3

What were living conditions like before the 1848 Pubilc Health Act?

Answer 3

Sanitary levals and living conditions were very poor.
E.g. streets were filthy,
food was sometimes tampered with (flour + sand) (meat + paint), water was collected by many families from the same pump this water might have been from polluted rivers,
cramped living - many families to one room,
no ventilation,

Question 4

What was Public Health like before the 1848 Public Health Act?

Answer 4

Had to pay for every doctor visit and every prescribed medicine, this meant many did not go or left it too late as they could not afford it.

Instead they relied on homemade remedies and the care from women in their family

Question 5

When was chloroform first discovered and by who?

Answer 5

1831 - by Samuel Guthrie in USA and Eugene Soubeiran in France

Question 6

When did the first cholera epidemic begin?

Answer 6

1831

Question 7

Why were there previously little advancements in medicine?

Answer 7

1. little funding - hospitals had tor ely on finding from charities as the government did not view finding for research as a priority
2. attitudes - doctors were reluctant to accept new discoveries as they had no evidence that what they were doing was wrong
3. Religion - believed in the after life so their were limited dissections
4. Technology - hadn’t advanced enough to be a blessing to see microorganisms

Question 8

Who made a cholera epidemic report from Leeds? When and what did they find?

Answer 8

1832 - John Baker
1. streets were filthy
2. 19 streets had no sewer
3. stagnant and smelly water

Question 9

What were the causes of the Cholera outbreak?

Answer 9

In poor condition disease could spread easily:

1. industrialisation - mass rural-urban migration meant that many new homes had to be built in a short amount of time - low housing standards and cramped living
2. lack of understanding - believed in miasma
3. laissez-faire - matters were left to local authorities, all that was done was burning barrels of tar in the streets
4. 20 -30 families collected from the same local pump which carried potentially infected water form polluted rivers

Question 10

Who made the report, “The Sanitary Conditions of the Labouring Population”

Answer 10

Edward Chadwick, who was involved in workhouses (where people went if they had no money to support themselves) and saw the dire conditions that people lived in

Question 11

What did Chadwick’s report suggest?

Answer 11

spend taxes on improving the living and housing conditions of the poor to keep them healthy as otherwise when they became ill they would have to be supported

1. clean water
2. remove rubbish
3. remove sewage

Question 12

What was the first discovered anaesthetic, who discovered it and when?

Answer 12

1846 - William Morton discovered ether as an effect anaesthetic

Question 13

Who used ether in a leg amputation and what did they discover?

Answer 13

1846 - Robert Liston used ether in a leg amputation
Pros : patient was unaware that the operation had taken place

Cons: ether was flammable (dangerous in gas lit operating theatres), irritated the lungs, caused vomiting, difficult to dose

Question 14

When did the black period in surgery begin and what was the cause?

Answer 14

1846 - black period in surgery began

Now that the problem of pain had been solved, surgeons completed longer, more complicated and deeper operations which meant there was more risk of infection.

Question 15

Who when and how does someone discover chloroform as an effective anaesthetic?

Answer 15

1847 - James Simpson after waking up slumped on the ground after inhaling various gases the night before (CHANCE)

Question 16

What was chloroform used for?

Answer 16

1847 - Simpson starts using chloroform as a pain relief as he is the Professor of Medicine and Midwifery at Edinburgh University

Question 17

Who famously used chloroform and what effect did it have?

Answer 17

After Simpson becmae Queen Victorias personal physician she used it during the birth of her 8th child.

Drew publicity to the miracle pain relief and had the royal stamp of approval which led to it being widely used as an anaesthetic

Question 18

Pros about Chloroform?

Answer 18

1. not flammable
2. did not cause vomiting or lung irritation
3. miracle pain relief

Question 19

Cons about Chloroform?

Answer 19

1. difficult to dosage (although this is solved with the chloroform inhaler in 1848 by John Snow)
2. Church opposition - Eve was told childbirth would be painful
3. Doctor opposition - doctors though that a patient away was more likely to survive than one asleep
4. Doctor opposition - unknown effects on the baby
5. Surgeons felt more confident to complete longer, more complicated and deeper operations and problems of infection and blood loss meant that death rate rose (Black Period in Surgery)

Question 20

How was dosage solved for Chloroform?

Answer 20

1848 - John Snow invented the Chloroform inhaler which could control dosage

Question 21

1848 Public Health Act

Answer 21

1. Set up a general board of health
   
   • three comissioners (Chadwick was one)
2. Allowed local authroities to:
   
   • set up their own general board of health
   • employ a medical officer
   • organise the removal of rubbish
   • build a sewer system

Question 22

What was the cause of the 1848 Public Health Act?

Answer 22

1. Cholera Epidemic which affected all classes, grew attention to the issue for hygiene
2. 50,000 people had died from cholera alone between 1848 - 49
   3.Chadwicks report in the “Sanitary Conditions of the Labouring Population”

Question 23

What was the impact of the 1848 Public Health Act?

Answer 23

LIMITED
1. terms of the Act were not compolsary - many local government did not do what the act had suggested
2. terms for the temporary - General board of Health was only set up for five years
3.attitudes were slow to change - no proof that disease was linked to hygiene and people did not want increase in taxes to help the poor

Question 24

What did the General Board of Health do?

Answer 24

Responsible for advising on public health matters such as epidemics and disease prevention

Question 25

How did Dr John Snow recognise that cholera was waterborne?

Answer 25

1. after a soho london outbreak he drew a map showing deaths
2. noticed deaths were centred around a pump in Broad Street
3. Broad Street Pump handle was removed - no water could be collected
4. deaths from cholera stopped in that area

Question 26

In what year did Dr John Snow suggest that cholera was spread via polluted water?

Answer 26

1849

Question 27

What was the impact of discovering that cholera was waterborne?

Answer 27

little was done to improve public health (until 1858) although…

1. put pressure on water companies, local authorities and parliment to improve the water supply
2. demonstrated the link between cholera and infected water but not how other diseases was spread as the link between microbes and disease was not understood

Question 28

What was the cause of the Metropolitan Sewers Act?

Answer 28

The sumer of 1848 was hot, the rivers dried up and all of the rubbish and excretement which had been dumped in the Thames from the sewers was exposed.

This caused, “The Great Stink” all over London

Parliament recognising the urgency, made a new act to provide money for a new sewer system designed by Joseph Bazalgette

Question 29

When and why was Florence NIghtingale sent to Scutari to manage a military hospital

Answer 29

1854 - Florence Nightingale was sent to Scutari hospital during the Crimean War because death rates were so high.

Question 30

What were the conditions of the hospital when Nightingale and her team of 38 nurses arrived?

Answer 30

1. overcrowded - patients shared beds or slept on the floor
2. unsanitary - clothes were infested with lice and fleas, common typhoid fever, cholera, wards infested with rats and mice, built on a cesspool collecting human waste
3. limited funding - poor and limited food, limited medical supplies,

Question 31

What impact did Florence Nightingale make at the Scutari?

Answer 31

Death rates dropped from 42% to just 2%

1. improved sanitation levels - scrubbed everywhere clean, washed sheets, towels, bandages equipment
2. Air quality - believed in miasma so opened windows for ventilation, created separate wards for different illnesses
3. Funding - from times newspaper, improved food and bough 200 tiowels, clean shirts soap, plates and citlery
4. Cleanliness - ensured hand washing

Question 32

When, how and who discovered that microorganisms make beer sour?

Answer 32

1854 - Louis Pasteur discovered microorganisms turned beer sour after finding that heating (and killing microorganisms) meant that the beer did not go sour

Question 33

What were the causes to the discovery that microorganisms caused disease?

Answer 33

Technology - microscopes had advanced enough to be able to see microorganisms

Individuals - Pasteur was not convinced by the theory of disease at the time of spontaneous generation

Question 34

What did Pasteur experiment on to prove that liquids were being contaminated by microorganisms in the air?

Answer 34

Pasteur carried out experiments on milk, wine and vinegar

Question 35

What were Pasteurs findings and what did they prove?

Answer 35

1. a mixture left to open air went bad
2. mixture closed from air -> not bad
3. a mixture under a microscope showed microorganisms
4. heated mixture -> not bad
5. mixture -> bad

Proving, microorganisms were not created by the mixture as it decayed, instead, the microorganisms were carried in the air and they caused decay = GERM THEORY

Question 36

What is the significance of Germ Theory?

Answer 36

Proved Spontaneous Generation wrong. First time that it is proven that decay only develops if the mixture is left open to the air and thus exposed to microrgansims.

Question 37

Why was there opposition to germ theory?

Answer 37

Didn’t understand how some microorganisms caused disease and others didn’t

Hundreds of microorganisms could be seen in the blood of healthy people

Although many doctors resisted and ridiculed his work at first, as more checked his finding his theories were slowly accpeted

Question 38

What did Pasteur’s later experiment find?

Answer 38

After collecting samples of air from various places, Pasteur discovered that some air was ‘cleaner’ than other

E.g. air had the most microorganisms in cities and was cleanest in mountains

Question 39

What was the impact of Germ Theory on Medicine?

Answer 39

Surgery - led to an understanding on why infection often developed after an operation and led to Joseph Lister’s antiseptic techniques

Public Health - explained the link between hygiene and health, led to the identification of each disease causing microorganism, 30 years later vaccinations could be produced to prevent the spread of some diseases

Question 40

How and when did Pasteur make the link between microorganisms and disease?

Answer 40

1865 - Pasteur investigated disease killing silkworms, found that disease was caused by microorganisms

1878 - published “Germ theory and it’s Applications to Medicine”
A lot was unknown how the knowledge that microorganisms caused disease could help cure disease

Question 41

How did Joseph Lister discover carbolic acid as an antiseptic?

Answer 41

• 1861 - worked as a surgeon at Glasgow Royal Infirmary
• He read Pasteurs work
• Realised that carbolic acid killed microorganisms responsible for decay and smell since it was used for sewage treatment
• realised that infected wounds smelled like sewage
• wondered if carbolic acid could be sued to fight infection

Question 42

What was the first use of carbolic acid as an antiseptic?

Answer 42

boy with a broken leg which would have been otherwise amputated because the bone out of the skin would have caused infection. Instead, Lister set the bone and covered the wound in bandages soaked in carbolic acid. The wound healed without infection.

Question 43

How was carbolic acid used in surgery?

Answer 43

The first anti (fighting) septic (sepsis or infection)

1. clean wounds, equipment, bandages in all operations
2. carbolic spray to ensure no microorganisms were on the surgeons hands or equipment that could enter an open wound

Question 44

What were the causes to the discovery of carbolic acid?

Answer 44

1. John Snow discovering cholera was waterborne - linked disease to microorganisms
2. Nightingale military in Scutari - emphasised the importance of hygiene
3. Louis Pasteur’s Germ Theory - linking microorganisms to causing disease

Question 45

What was the opposition to using carbolic acid as an antiseptic?

Answer 45

1. made surgical instruments slippery, difficultto griop which may have slowed down operations which was dangerous when blood loss was still a major problem
2. cracked and make skin sore
3. some did not accept germ theory and saw no reason for an antiseptic
4. did not use carbolic spray effectively and saw no results
5. nurse di dnot like the extra tim either took to dress the wounds
6. saw no reaosn as soap and water had ‘good’ results
7. Lister frequently experimented with his techniques which others saw as him being unconfident

Question 46

Describe two features of the new Joseph Balzalgette Sewer System which was made after the 1858 Metropolitans Sewers Act

Answer 46

1. Finished in 1875
2. Cost £6.5 million
3. sewers were large oval shape
4. system planned to bring the waste to lower down the Thames where it is tidal so that the waste is washed into sea

Question 47

What were the laissez - faire attitudes in Britain and what is an example of this

Answer 47

Government should only take action in emergency (e.g. the cholera epidemic - Public Health Act) but shoudl not interfere with people’s daily lives & buisinesses

Even when a law was passed it was not mandatory which meant it was not usually obeyed

E.g. 1852 a law was passed that made it cumpolsosary for children to be vaccined against smallpox but this was often ignroed and was only enforced in 1871 with a new Act.

People did not want government action if it meant a raise in taxes

Question 48

Why did laissez - faire attitudes change?

Answer 48

1. people accepted disease was carried by microorganisms because of Pasteurs germ Theory
2. acknowledges that access to clean water, removal of sewage/rubbish and improved hygiene would improve public health
3. some local authorities tried to take action but they needed the parliament to pass laws to create a national system of improvements
4. as more people gained the right to vote, there was added pressure on the government from the working class to take action to improve public health

Question 49

When and what was the Sanitary Act

Answer 49

caused by the word of Chadwick and John Snow which proved the importance of clean water and the removal of sewage

all towns were forced to employ medical inspectors to check water supplies and drainage

Question 50

1875 Public Health Act

Answer 50

made local authroities responsible for:
1. supplying clean water
2. removal and organisation of sewage to prevent water being used for cooking and washing being polluted
3. building public toilets
4. ensuring new housing is built to good standards to avoid damp and overcrowding
5. inspecting conditions in lodging houses
6. employ health and sanitary inspectors to ensure regulations are being obeyed
7. street lights to prevent accidents
8. checking the quality of food for sale

Question 51

Significance of the 1875 Public Health Act

Answer 51

1. showed how the national government had to rely on local governments to implement parliament orders - local authorities had to collect money from rate payers to fund work
2. showed how laissez - faire attitudes were changing - parliament was now passing laws to enforce a national standard of health, increased governmental role in public health, changing attitudes towards governments responsibility

Question 52

Florence Nightingales impact on hospitals

Answer 52

1856 - returned to Britain as an expert in nursing and hospitals
1859 - published a book “Notes on Hospitals” with recommendations for hospitals on space, ventilation, cleanliness
1859 - published book “Notes on Nursing” with advice on the importance of ventilation, light, bedding, cleanliness and food

her books were published into 11 languages showing the international influence she had

she wrote over 200 books on hospitals and nursing inspiring other to copy her ideas and high standards

made it acceptable for women to train as nurses but not to become a doctor or carry out dissections

Question 53

What were the attitudes towards women

Answer 53

• women were resposible for the daily care of the home
• thought of as less intelligent than men - did not recieve the smae education
• expected to play music, sew, apint and make a home for their husband
• not expected to go to university, have higher education including medical training

Question 54

How did Elizabeth Garrett become a lisenced doctor

Answer 54

comes from a wealthy family, horrified that she wanted to be a doctor

1. a nurse and attended lectures meant for male doctors
2. applied to study medicine at several medical schools all refused to accept a female student
3. paid for private lessons, dissecting in her own bedroom
4. completed her medical training but could not be licences as none for the three medical societies would accept her
5. father threatened to sue society if they did not accept her as they had no regulations against women
6. 1865 - became officialy qualified to practice medicine
7. society immediately changed its rules os that no other women could qualify as a doctor in this way

Question 55

When were medical school forced to accept women by and act of parliment

Answer 55

1876

Question 56

Who was Robert Koch

Answer 56

A german doctor interested by Pasteurs ideas who wanted to prove that anthrax (disease affecting farm animals) was spread via infected blood.

Discovered the anthrax disease cycle and the bacteria responsible for tuberculosis and cholera

Question 57

What did Koch develop?

Answer 57

Methods of staining and photographing microorganisms

Question 58

When did Koch publish his finding on anthrax

Answer 58

1876

Question 59

When did Koch publish his, “Bacterial Infections for Wounds”

Answer 59

1878

Question 60

What was the significance of Kochs work with photographing and staining microorganisms

Answer 60

discovered new techniques to investigate disease which lead to new ways of preventing disease e.g. vaccines

Question 61

when did Koch discover the microorganisms responsible for tuberculosis and cholera

Answer 61

1882 and 1883

Question 62

What was the impact of Kochs work

Answer 62

He made a new branch of science called bacteriology and became known as the ‘Father of Bacteriology’

His methods and discoveries led to more e.g. the microorganisms for tetanus, pneumonia and meningitis were discovered in the 1880s and 1890s

Question 63

When was Pasteur’s theory that microorganisms cause decay generally accpeted

Answer 63

1875

Question 64

When did Pasteur publish his, “Germ Theory of Infection” which linked disease to microorganisms

Answer 64

1878

Question 65

How did Pasteur discover the first vaccine?

Answer 65

He was studying chicken cholera by injecting them with cultures of bacteria
- he injected a chicken with a batch which was weeks old, the delay had weakened the bacteria and stimulated natural defense when the chicken was injected with fresh cultures

this led to further research into developing vaccines

Question 66

When and what did Pasteur do to prove than an anthrax vaccine vaccine could protect farm animals

Answer 66

1881 - Pasteur combined his own andn Kochs work
- vaccined 1/2 fo the animals,
- all animals were innoculated iwth anthrax bacilli
- 2 days later only the animals with the vaccine had survived

Question 67

How did Pasteur work on a vaccine for humans?

Answer 67

To start with he couldn’t investigate vaccines for a human disease because he couldn’t experiment on people

worked on a vaccine against rabies
1885 - he vaccined a boy which had been bitten by a rabid dog and would have otherwise died - saved his life as the rabies hadn’t’t yet developed as the microorganisms had not yet reached his brain

Question 68

What accelerated advancements for both Louis Pasteur and Robert Koch?

Answer 68

Pasteur and Koch were rivals since their countries were fighting each other in a WAR between 1870-71. This increased the rivalry between them to make the next scientific break through.

Both the French and Germany governments heavily funded each scientist and there was said to be a war in the labs as well as at the frontline

Question 69

Impact of Listers surgery techniques

Answer 69

Boundaries to acceptance : slow change of attitudes, carbolic spray made surgery more difficult, but people were slowly convinced when Koch discovered the microorganism causing blood poisoning in 1878

Question 70

When did Lister discover the steam steriliser

Answer 70

1878 - combined Pasteurs discovery that heat killed microorganisms and Listers discovery that heat could sterilise equipment

Question 71

Impact of Aseptic Surgery

Answer 71

before: operations may have taken place at homes, dirty conditions, with surgeons wearing ordinary clothes which the more blood it had on it the better

surgeons prevented microorganisms reaching anywhere near wounds as they knew this would lead to infection

operations were always carried out in operating theatres without spectators

surgeons wore clean clothes, masks and rubber gloves

Question 72

cauterisation

Answer 72

any arteries which were cut in the operation were sealed using a hot iron rod against the vessel (very painful)

Question 73

ligatures

Answer 73

tying the ends of blood vessels but this prevented the wound from healing and led to infection as carbolic acid ligatures were not 100% effective

Question 74

WHo discovered cat gut ligatures and why were they effective

Answer 74

1881 - Lister discovered that cat gut ligatures were more effective, they dissolved in the body after 2-3 weeks and did not cause infection nor prevent healing

Question 75

Cocaine as a pain relief, when, imapct

Answer 75

Although chloroform was better than ether it did still cause random sudden deaths - searched for a better anaesthetic

1884 - cocaine was discovered as a local anaesthetic for numbing instead of a general anaesthetic (highly addictive)

1905 - a safer version called novocaine is developed

• improved conditions and techniques
• made surgery safer
• surgeons could carry out more complicated surgeries

Question 76

How was the 1875 public Health Act funded

Answer 76

local authorities charged more tax to rate payers

Question 77

Impact of the 1875 public health act

Answer 77

1. ensured sewage was properly treated and did not contaminate the water supply -> reduced the chance of disease
2. providing clean water -> less chance of catching water borne disease e.g. cholera
3. keeping the streets cleaned reduced the amount of mice and rats, reducing the chance of them spreading disease
4. lighting the streets -> people could avoid rubbish and dirt
5. local authroities had to employ a medical officer in charge of health
6. inspecting new houses ensured there was sufficient light and ventilation for health
7. inspecting quality for food dropped the number of people becoming ill from poor quality and infected food
8. made it illegal for factories to dump waste into the rivers
9. first time that the parliament clearly stepped in to improve quality for living showed their willingness to implement latest discoveries to improve the health of the nation

Question 78

When and what was the Artisans’ Dwelling Act

Answer 78

1875 - gave power to local authorities to buy and demolish slum housing

Question 79

When and what was The Food and Drugs act

Answer 79

1875 - to improve the standard of food being sold because dangerous practices were common e.g. painting meat red to make it appear more fresh, mix sand with flour to make it weigh more

Question 80

When and what was the River Pollution Prevention Act

Answer 80

1876 - made it illegal for factories to dump waste (including chemicals) in rivers

Question 81

When and what was the infectious Disease Act

Answer 81

1889 - ordered householders and doctors in London to report any cases of infectious diseases to the local medical health officer

1899 - extended to the whole country

Question 82

When and what was the Park Hospital

Answer 82

1 of 5 hospitals in London to cope with cases of infectious disease e.g. scarlet fever had 48 wards and 368 patients

also had isolation wards with large distances between beds

Question 83

What were the factors influencing public health

Answer 83

1. science and technology - microscopes oculd now see microorganims, sewage pipes and water systems,
2. understanding about microorganisms and how disease spreads - showed teh importance of increased hygiene, proved it was neccessary to isolate patients with infectious disease and highlighted the importance of authorities to coordinate action
3. government - passed a number of acts which improved hygiene and living standards, laissez - faire was lost and local authorities became responsible for implementing laws, more people gained the vote so the government had to listen to the needs of the working class
4. Individuals - Edward Chadwick, Dr John Baker, Florence Nightingale, Pasteur, Lister

Question 84

When and who discovered the different blood types

Answer 84

1901 - Karl Landsteiner discovers blood type A, B, O
1902 - discovered blood type AB

Question 85

What were the boundaries to advancements using knowledge about blood types?

Answer 85

Knew that the donor and receiver had to be of the same blood type.
- blood donor could not always be present and it wasn’t always to find a donor of the right blood group type
- blood clots in the tubes as it leaves the body, tubes were needed for the transfusion and couldn’t become blocked

needed to develop scientific knowledge on how to store blood and prevent clotting

Question 86

What did Paul Ehrlich discover

Answer 86

1806 - became leader for his own team after working with Koch to stain microorganisms wanted to research possible treatments to disease
could a chemical kill a specific disease causing microorganism and do no other harm?
1905 - began experimenting to find a syphillis magic bullet trying various compounds of different strengths for arsenic posion
1909 - the 606 arsenic compound = magic bullet = the first chemical to cure disease

Question 87

What caused Paul Ehrlich’s doscovery of the first magic bullet

Answer 87

CHANCE
in 1909 Dr Hata joined the team to double check their previous experiments, he discovered that the 606 arsenic compound had been wrongly rported as ineffective in 1907
the team had continued experimenting for the magic bullet without realising they had already found it

Question 88

Who and when did he discover x rays?

Answer 88

1895 - Wilhelm Roentgen published his findings on x rays
1896 - most hospitals had an x ray maschine

Question 89

Significance of x ray maschines

Answer 89

• show the exact position for a piece of shrapnel or bullet which meant that the surgeon spent less time searching for it in the open wound reducing the risk of infection and damaging the blood vessels